Laparoscopic Ovarian Cystectomy

OVERVIEW

The goal of a laparoscopic ovarian cystectomy is to ONLY remove the ovarian cyst (including the cyst wall) and save the ovary. The surgeon CANNOT just drain the cyst fluid only, otherwise the hole in the cyst wall will reseal and the ovarian cyst will fill back up with fluid again. The objective of this surgery is to completely remove the ENTIRE cyst wall, peeling the cyst wall off the ovary, and preserving the remaining ovarian tissue. If the ovarian cyst is BENIGN, then the surgery can be performed laparoscopically.

ovarian cystectomy

TWO CHARACTERISTICS in the management of ovarian cysts.

1st. SIZE of the ovarian cyst.

a. If the ovarian cyst is LESS THAN 6 cm, then the cyst can be watched conservatively, with serial pelvic US every 6-12 months.
b. If the ovarian cyst is GREATER THAN 6 cm, then the next step would be to consider surgical intervention. Large ovarian cysts have a higher risk of ovarian TORSION in the future.

2nd. TYPE of cyst: SIMPLE cyst versus COMPLEX cyst.

a. If a SIMPLE cyst, then conservative management is a good option
b. If a COMPLEX cyst, then there is a HIGHER SUSPICION for malignancy, so the ovarian cyst or possibly the entire ovary many need to be removed.

simple vs comples cyst

Many DIFFERENT types of ovarian cysts.

cyst

Simple Ovarian cyst. This is a simple cyst filled with either clear or serous fluid. Always benign

normal cyst

Dermoid cyst (aka Mature Teratoma). This cyst originates from possibly 3 germ cell layers, so this cyst can possibly contain a mixture of hair, teeth, bone, sebaceous fluid, and others.

dermoid

Endometrioma (aka Chocolate cyst): This is a cyst filled with endometriosis fluid. This cyst is associated with endometriosis in the pelvis and associated with an increased risk of pelvic adhesions.

chocolate

Ovarian torsion. This ovary cyst is typically greater than 6 cm, leading the ovary cyst to twist off its blood supply. This causes the ovary to turn black and blue, causing increased pelvic pain and discomfort).

torsion

Post op recovery.

a. The surgery should take approx. 30 min to 1.5 hours, depending up the size of the ovarian cyst, the number of ovarian cysts, and the amount of pelvic adhesions.
b. For the LAPAROSCOPIC cystectomy, the patient should be able to go home the same day. Full recovery in approximately 2 weeks.
c. The post op limitations from the surgery are:

  • NO heavy lifting for 6-8 weeks.
  • Showers only x 6-8 weeks. No baths. No pools, no Jacuzzi for 6-8 weeks.