Laparoscopic Ovarian Cystectomy

What is laparoscopic ovarian cystectomy?

Laparoscopic ovarian cystectomy is a minimally-invasive surgery to remove ovarian cysts.

CONDITION

What is ovarian cysts?

Ovarian cysts are fluid-filled sacs that develop in the ovaries. They can widely range in size, affecting women at any age, predominantly during the reproductive age.

How do ovarian cysts affect you?

Most ovarian cysts are harmless and cause little or no discomfort. However, large cysts can cause pain.

Which part of the body is affected?

The ovaries are paired organs that are a part of the female reproductive system. Situated on either side of the uterus, their main function is to produce ova and release sex hormones. Each month, one ovum matures, is released and picked up by the fallopian tubes for reproduction.

The ovaries develop cyst-like structures every month called follicles. Each follicle has an egg that floats in a fluid that protects it as it develops. When the egg matures, the follicle bursts open, releasing the egg and the fluid.

What are the types of ovarian cysts?

There are two types of ovarian cysts:

  • Functional ovarian cysts are the most common. They do not cause any harm, are non-cancerous and short-lived.
  • Pathological cysts may be benign or cancerous (malignant).

What are the causes of ovarian cysts?

The causes of ovarian cysts depend on the type.

Functional ovarian cysts

These cysts are associated with the monthly menstrual cycle. They form when

  • fluid inside a follicle is not released at the time of egg release (corpus luteum cyst)
  • when the follicle doesn’t release the egg and the follicle swells up (follicular cyst)

Pathological cysts

These cysts form as a result of abnormal cell growth of either the cells that form the egg or the cells that cover the ovary. They are not related to the menstrual cycle. Pathological cysts may include:

  • Dermoid cysts develop from cells that form the egg and can contain tissue such as skin, hair or teeth. These are usually benign.
  • Cystadenomas develop from cells that cover the ovaries and are usually filled with liquid or mucous
  • Endometriomas develop when tissue lining the uterus, called endometrium, begins to grow outside the uterus and on the ovaries

Dermoid cysts and cystadenomas can grow big and shift the ovary from its normal position. This increases the chance of painful twisting of your ovary, called ovarian torsion.

What are the signs and symptoms of ovarian cysts?

Some cysts do not show any signs or symptoms. If symptoms present, the most common is pain, which may be characterised as:

  • Pelvic pain before your period starts or before it ends
  • Dull pelvic ache that radiates down your lower back and thighs
  • Painful intercourse
  • Pain with bowel movements

Other symptoms may include

  • Nausea, vomiting or tenderness in your breast similar to that experienced during pregnancy
  • Abdominal fullness or heaviness
  • Urination problems due to pressure on your bladder

The symptoms that indicate an emergency include:

  • Sudden extreme pelvic or abdominal pain
  • Fever or vomiting that accompanies pain
  • Shock
  • Rapid breathing
  • Weakness or light-headedness

How are ovarian cysts diagnosed?

Ovarian cysts are usually detected during a pelvic exam. Other tests that could help in the diagnosis of cysts include a pregnancy test (for corpus luteum cysts), blood test to detect cancer protein, ultrasound and laparoscopy.

TREATMENT

What are the consequences of not treating ovarian cysts?

Some ovarian cysts do not require treatment and they resolve with time. However, some may lead to infection and infertility if left untreated.

When should I consider watchful waiting of ovarian cysts?

In most cases, if you don’t have any symptoms, and your cysts are small and fluid-filled, you will be advised to wait and closely monitor the progression of the cysts as most will resolve on their own.

What are the treatment options for ovarian cysts?

The main treatment options for ovarian cysts are:

  • Birth control pills: reduces the risk of new cysts from forming and development of ovarian cancer
  • Two types of surgery may be performed:
    • Ovarian cystectomy: removal of only the cyst, leaving the ovary intact
    • Oophorectomy: removal of cyst along with the affected ovary
    • Total hysterectomy: removal of both ovaries, fallopian tubes as well as the uterus. This is considered if the cyst is cancerous.

Am I candidate for laparoscopic ovarian cystectomy?

Your surgeon may suggest ovarian cystectomy in the following cases:

  • Cyst is larger than 7.6 cm
  • Not a functional cyst
  • Cyst continues to grow
  • Cyst does not resolve within two to three menstrual cycles
  • Presence of pain or other symptoms
  • Exclusion of ovarian cancer
  • Cysts in both ovaries
  • Ovarian cyst is associated with:
    • Menarchal adolescents and adults
    • Post menopause
    • Those using birth control pills

How do I prepare for laparoscopic ovarian cystectomy?

Before laparoscopic cystectomy, you will be advised to stop eating or drinking anything at least 6 hours before the procedure. Discuss all the medications that you are taking on a regular basis so that your doctor can advise you on the ones that you can safely continue and those that may need to be stopped during the time of surgery.

How is laparoscopic ovarian cystectomy performed?

Ovarian cystectomy is performed under general anaesthesia. Two to 3 small incisions are made on your abdomen. Carbon dioxide gas in introduced to inflate your abdomen so that the surgical area can be viewed clearly. A laparoscope (narrow lighted tube with a camera) is inserted through one of the incisions to guide your surgeon with the help of images relayed on a large monitor. Other surgical instruments are inserted through the other incisions. The cysts are carefully excised from the ovary, ensuring the contents do not spill out. Once freed from the ovary, the cyst is opened and the contents aspirated to reduce its size. The deflated cyst is then removed through one of the abdominal incisions.

Alternatively, the intact cyst can be removed through the vagina or it can be collected and decompressed within a retrieval bag, minimising the chances of spillage of the cyst’s contents within the pelvic cavity.

The laparoscope and instruments are then removed and the incisions closed.

What can I expect after laparoscopic ovarian cystectomy?

Following ovarian cystectomy, you will be given medication to relieve pain and discomfort. Your navel and abdomen may be bruised and sore. You may experience back and shoulder pain as a result of the carbon dioxide gas used during the surgery. This will resolve with time. You may also have spotting or vaginal discharge.

What are the advantages of laparoscopic ovarian cystectomy?

The advantages of a laparoscopic hysterectomy are:

  • Small incisions
  • Reduced blood loss
  • Less scarring
  • Lower post-operative pain
  • Shorter hospital stay and recovery

Describe the stages of recovery and care plan?

You may feel weak and tired in the first week of surgery, but are advised to slowly increase your level of activity with short walks. Avoid strenuous activities for 2 to 6 weeks. You can resume sexual activity in about two weeks, when you feel comfortable.

Call your doctor immediately if you experience:

  • High fever more than 100.4° F
  • Heavy vaginal bleeding
  • Severe nausea/vomiting
  • Abdominal pain
  • Signs of infection at the incisions such as redness, discharge or swelling

What are the outcomes of laparoscopic ovarian cystectomy?

Laparoscopic ovarian cystectomy can help remove ovarian cysts while preserving fertility, but does not stop other cysts from forming.

What are the potential complications of laparoscopic ovarian cystectomy?

Although laparoscopic ovarian cystectomy is a safe procedure, as with most surgeries, it may be associated with potential complications such as:

  • Need to remove ovary
  • Bleeding
  • Infection
  • Damage to neighbouring organs such as bowel, ureters and bladder
  • Requirement for further surgery

What is the downtime of laparoscopic ovarian cystectomy?

You may be able to return to work after 5-7 days following the procedure.

What is the prognosis of laparoscopic ovarian cystectomy?

Since there are chances of recurrence, regular monitoring of the ovaries is advised after laparoscopic ovarian cystectomy.

What is the cost of laparoscopic ovarian cystectomy?

Any costs involved will be discussed with you prior to your surgery.

What is the likelihood of ovarian cyst recurrence? How can it be managed?

There is a 6 to 10% risk of recurrence, requiring the removal of additional tissue.

What are the current research regarding laparoscopic ovarian cystectomy?

Extensive research is being done to find better treatment outcomes for laparoscopic ovarian cystectomy. Some of the recent studies are listed below:

  • Clark M, Zigras T, Bayat L, Kashani S. Minimally Invasive Non-Laparoscopic Ovarian Cystectomy: A Unique Way to Approach Large Ovarian Cysts. J Minim Invasive Gynecol. 2015 Nov-Dec;22(6S):S150.
  • Mehdizadeh Kashi A, Chaichian S, Ariana S, et al. The impact of laparoscopic cystectomy on ovarian reserve in patients with unilateral and bilateral endometrioma. Int J Gynaecol Obstet. 2017 Feb;136(2):200-204.