Laparoscopic Ovarian Cystectomy

The ovaries are located on both sides of the uterus, in the lower abdomen. Women have two ovaries that are responsible for the production of eggs as well as progesterone and estrogen. Sometimes, cysts develop in the ovaries or on their surface. These ovarian cysts are fluid-filled pockets or sacs. A lot of women have at least one cyst during their lifetime and in most cases, they are painless and cause no symptoms.

Types and causes of ovarian cysts

There are various types of ovarian cysts. The most common type of cysts is a functional cyst, which can be further divided into follicle cysts and corpus luteum cysts.

• Follicle cyst – Follicles are sacs in the ovaries in which an egg grows during a woman’s menstrual cycle. Normally, the follicle breaks open and the egg is released when ovulation occurs. When this doesn’t happen, the fluid inside the follicle leads to a cyst on the ovary.
• Corpus luteum cyst – Generally, once the egg is released, follicle sacs dissolve. In case the follicle doesn’t dissolve and its opening is sealed, this can lead to the development of additional fluid inside the sac. Due to the accumulation of this fluid, a corpus luteum cyst is formed. 

Other ovarian cysts include –

• Cystadenomas – These are noncancerous growths that generally develop on the outer surface of the ovaries.
• Endometriomas – When tissues that normally grow inside the uterus, develop outside of it and attach to the ovaries, endometriomas occur.
• Dermoid cyst – A dermoid cyst is a sac-like growth on the ovaries that might contain fat, hair, or other tissue.

Sometimes a lot of small cysts develop in the ovary, due to a condition called polycystic ovary syndrome.

Symptoms

Most of the time, ovarian cysts don’t cause any symptoms. However, as it grows, some symptoms might appear, including –

• Painful bowel movements
• Painful intercourse
• Breast tenderness
• Abdominal swelling or bloating
• Pelvic pain during or before the menstrual cycle
• Pain in thighs or lower back
• Vomiting and nausea

Severe symptoms of ovarian cysts include –

• Fever
• Rapid breathing
• Sharp or severe pelvic pain
• Dizziness 

These symptoms are generally an indication of ovarian torsion or ruptured cyst and immediate medical attention is required as these are both complications with serious consequences.

READ: Laparoscopic Ovarian Cystectomy

Diagnosis

Ovarian cysts can be diagnosed by physical examination of the pelvic area. There might be swelling on one of the ovaries. To confirm the presence of a cyst, imaging tests such as CT scan, MRI and ultrasound can be performed. With these tests, the size, shape, location, and composition of an ovarian cyst can be determined.

Since a majority of cysts disappear on their own within a few weeks or months, your doctor might suggest getting a repeat ultrasound test after a few weeks or months instead of immediately starting treatment.

If the cyst doesn’t disappear or increases in size, additional tests might be conducted to find out other causes of your symptoms. These tests include a pregnancy test, a CA-125 blood test for ovarian cancer screening, and a hormone level test to check for hormone-related problems.

Treatment

Treatment for ovarian cysts is recommended when a cyst grows larger or doesn’t go away on its own. There are various treatment options for it, including –

• Birth control pills – Your doctor might prescribe oral contraceptives if you have recurrent ovarian cysts. These prevent new cysts from developing as ovulation is stopped. Oral contraceptives also reduce the risk of ovarian cancer, which can cause cysts.
• Surgery – Ovarian cyst surgery can include different types of procedures –
  • Laparoscopic ovarian cystectomy – Ovarian cystectomy can be done laparoscopically. Ovarian cystectomy procedure steps include –
    • Patients are put under general anesthesia.
    • Then, the surgeon makes small cuts in the patient’s tummy.
    • Through these cuts, gas is blown into the pelvis. This allows the surgeon to access the ovaries.
    • Then, a laparoscope is inserted through one of the cuts into the abdomen. This allows the surgeon to see the internal organs. Through these cuts, the surgeon removes the cyst.
    • Once the cyst is removed, the cuts are closed using dissolvable stitches.

Laparoscopy for ovarian cystectomy is preferred because it is a minimally invasive and less painful method. Most patients can go home on the same or next day of this surgery.

• Laparotomy – A laparotomy, also known as open ovarian cystectomy is recommended when the cyst is cancerous or very large. In this procedure, instead of small cuts, a single cut larger in size is made in the abdomen and the cyst is removed. To close the incision, staples or stitches are used. Most patients are required to stay in the hospital for a few days after this surgery. The cyst may be sent to a laboratory for further examination if it is suspected to be cancerous. 

After the surgery

After a laparoscopic ovarian cystectomy, patients experience some pain in their tummy for which pain medication is given. Most patients generally recover within 6 to 8 weeks. It is recommended to avoid all strenuous activities for at least two weeks after the surgery. If you observe any of the following symptoms after leaving the hospital, you should immediately contact your doctor as there might be an infection –

• Fever
• Heavy bleeding
• Vaginal discharge that is dark or smelly
• Severe swelling or pain in the abdomen 

Risks

There are some risks associated with ovarian cystectomy, including –

• Bleeding during surgery
• Damage to surrounding organs including ureters, bladder or bowel
• Need for removal of the affected ovary
• Infection of the bladder or surgical site
• Requirement of further surgery 

Prevention

It is not possible to prevent ovarian cysts. However, they can be detected early with routine gynecologic examinations. Hence, look out for these symptoms –

• Loss of appetite
• Abdominal fullness
• Menstrual cycle changes
• Unexplained weight loss
• Persistent pelvic pain 

These symptoms could indicate the presence of cysts, so you should visit your doctor to get a correct diagnosis. If left untreated, cysts can affect a woman’s fertility.