Laparoscopic ovarian cystectomy

A laparoscopic ovarian cystectomy is a type of keyhole surgery used to treat ovarian cysts.

What is an ovarian cyst?

An ovarian cyst is a sac that is formed in a woman’s ovary. Ovarian cysts are very common in women of reproductive age as most of the cysts identified are physiological due to the normal process of the menstrual cycle.

However, ovarian cysts are also common in menopausal women.

There are different types of cysts:

  • Physiological cysts – formed by the process of ovulation. When the egg is released from the ovary, a small cyst called corpus luteum persists. If the egg is not fertilised, this cyst starts breaking down after 14 days
  • Pathological cysts – due to overgrowth of cells of the ovary. The majority of these cysts are non-cancerous. Only a very small proportion of ovarian cysts can be cancerous and this is the case usually in women who have gone into the menopause. Ovarian cysts can be caused by endometriosis. These are non-cancerous cysts called endometriotic cysts or ‘chocolate cysts’ as their content is old blood that looks like melted chocolate. Another common non-cancerous cyst is a dermoid cyst that may contain hair, skin, fatty fluid or even teeth

Symptoms of ovarian cysts

Commonly ovarian cysts don’t cause any symptoms especially when they are small. When the cyst increases in size it can cause:

  • Pressure symptoms
  • Pelvic pain
  • Pain during intercourse
  • Frequency in passing urine
  • Difficulty in opening the bowels

Occasionally, there can be bleeding inside the cyst or the cyst can burst and this can cause:

  • Severe pelvic pain
  • Shoulder tip pain

Finally, a cyst or the whole ovary can twist and this can cause:

  • Sudden twisting pain
  • Vomiting

How do we diagnose ovarian cysts?

The best way to diagnose an ovarian cyst is by doing an ultrasound scan. This can be done either over your tummy or by an internal scan using a probe placed into the vagina.

Management of ovarian cysts

The management of ovarian cysts depends on a number of factors:

  • Your symptoms
  • Your fertility wishes
  • Your age
  • The type of cyst

If the cyst that you have is not causing any symptoms, if it is physiological and if it does not have any concerning signs, your gynaecologist may suggest to conservatively manage the cyst that is to keep an eye on the cyst by having a scan every few months to ensure that the cyst is not getting bigger.

However, if your cyst causes symptoms like pelvic pain, then your gynaecologist may suggest having the cyst treated with surgery. The majority of the times, ovarian cysts are treated laparoscopically through key-hole surgery. Very rarely, if the cyst is too big or if there are worrying signs on the cyst, an open operation may be recommended to you.

Surgery to remove ovarian cysts

You will have a keyhole surgery where the ovary with the cyst will be identified. A small cut on the surface of the ovary is performed in order to expose the cyst wall. Then the cyst is gradually dissected from the ovary and removed. During the dissection the cyst may rupture but this is not a problem as the cyst content can be removed with suction.

The ovary is left open but it heals back to its normal shape. If the cyst removed is too big and the defect on the ovary is big some surgeons may choose to suture the ovary closed. During the excision of the cyst there may be some bleeding from the ovary that can be controlled by applying thermal energy to the ovary. This can rarely damage some of the egg reserve of the ovary therefore some surgeons prefer again to suture the ovary to stop the bleeding rather than using thermal energy.

If you have gone through the change (menopause), if your family is complete and you are near the age of menopause, or if there are any worrying signs on the ovarian cyst, your gynaecologist may suggest removing the whole of the ovary rather than just the cyst itself. This can also be done through keyhole surgery but sometimes an open procedure may be recommended. This is called laparoscopic or open oophorectomy.

Risks associated with laparoscopic ovarian cystectomy

The specific risks for ovarian cystectomy are:

  • Damage of egg reserve
  • The cyst may come back
  • If there is excessive bleeding from the ovary, the surgeon may have to remove the whole of the ovary to stop you bleeding
Content for this treatment has been provided by Mr Ilias Nikolopolous at BMI The Park Hospital

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