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Excerpt
I use the sutures in the angles of the ellipse because I have encountered some problems using skin hooks or dissecting forceps for handling the cyst, as these tools often accidentally puncture the cyst or release the cyst during manipulation. I also use stay sutures for traction of the cyst, as the authors mention in their letter when they use the end of the suture they use to close the ruptured cyst wall.
I have found loupes to be helpful in identifying the cyst wall during dissection, and thus helpful in avoiding cyst rupture.
With regard to dealing with rupture of the cyst during manipulation, I think the best way to prevent this is to be careful and patient and to have continuous visualization of the cyst wall during dissection, using loupes and continuous suction. However, if the cyst does rupture, I use the same method described by the authors.
