Ovarian Cystectomy - Laparoscopic and Open Cystectomy

What Is an Ovarian Cyst?

A cyst can be defined as an abnormal sac that is filled with liquid or semi-solid substances. Cysts are usually non-cancerous. Ovarian cysts are fluid-filled sacs that are typically simple or complex. They can develop in one or both ovaries. These cysts often develop as a result of ovulation. Ovarian cysts are extremely common, and about 20 % of women develop them in their lifetime.

They are frequently found incidentally during physical examination or imaging tests. The most common causes of ovarian cysts are:

• Polycystic ovarian disorder and other hormonal disorders.

• Ovulation.

• Endometriosis.

• Using drugs to induce ovulation.

• Pelvic inflammatory disease.

• Cancer.

Most ovarian cysts in women of reproductive age are benign and need no surgical intervention. However, certain ovarian cysts can grow large and cause several symptoms. In addition, complications from ovarian cysts can lead to gynecological emergencies such as bleeding, torsion, and rupture. Therefore, it is crucial to diagnose and treat ovarian cysts immediately.

What Is Ovarian Cystectomy?

Ovarian cystectomy is the surgical removal of ovarian cysts. Ovarian cystectomy is done to remove one or more cysts from both ovaries. Although most ovarian cysts do not require surgical intervention, some can become large, complicated, or cancerous, requiring surgical removal. Ovarian cystectomy depends on certain factors:

• Cyst size.

• If the cyst is causing pain.

• If the patient is planning pregnancy.

• If the cyst is cancerous or has a chance of becoming cancerous.

• Medical and surgical history of the patient.

What Are the Types of Ovarian Cystectomy?

Ovarian cystectomy is in the following ways:

• Laparoscopic Ovarian Cystectomy: Small incisions and specialized instruments are used during the laparoscopic procedure. A small abdominal incision introduces the laparoscope, a small camera with a light on top. A laparoscope can help the doctor view the patient's reproductive and pelvic organs. The doctor makes two more minor incisions and inserts the surgical instruments. The ovarian cyst is then removed through those incisions. Surgeons prefer laparoscopic ovarian cystectomy due to its less invasive nature and ease of patient recovery.

• Open Surgery: In open surgery, the cyst and surrounding tissue are visible through a big abdominal incision. In the case of a large cyst or numerous cysts, several difficulties may arise during a laparoscopic operation. Therefore, in such cases, an open cystectomy may be done. An open procedure can be the only choice if the doctor detects cancer or if the cyst is too large to be removed laparoscopically.

Why Is an Ovarian Cystectomy Done?

Most ovarian cysts are benign (non-cancerous), and they resolve on their own. However, in some cases, cystectomy becomes a necessity. Although there are various treatment options, the management ultimately depends on the patient's age, whether they are experiencing pain, the cyst's size, and whether it exhibits any signs of malignancy. An ovarian cystectomy is done in the following cases:

• In the case of a large ovarian cyst more than 2.5 to 3 inches in diameter.

• Acute pain in the affected ovary.

• Suspected ovarian torsion.

• A persistent cyst that does not resolve after several menstrual cycles.

• Suspected malignancy (cancerous cyst).

How Is Open Surgery Done for Cystectomy?

Open surgery is done in the following ways:

• The patient is given general anesthesia. An intravenous catheter will be inserted into the vein by the anaesthesiologist. The intravenous catheter provides the patient with drugs and fluids during surgery. The surgeon starts the procedure once the patient is sedated and prepared for surgery.

• The surgeon makes an abdominal incision. Next, the abdomen is opened by separating the abdominal muscles. The cyst is located and removed. Along with the cyst, a sample tissue is also taken and sent to the laboratory for testing (for cancer). The abdominal muscles will next be stitched up. the incision is closed with stitches or staples. The region will be covered with a bandage.

• The surgery typically takes one to two hours, and most patients are discharged from the hospital after two to three days.

How Is Laparoscopic Surgery Done for Cystectomy?

• The patient is given general anesthesia. An intravenous catheter will be inserted into the vein by the anaesthesiologist. The intravenous catheter will provide the patient with drugs and fluids during surgery. The surgeon will start the procedure once the patient is sedated and prepared for surgery.

• The surgeon makes an incision just below the navel, and a laparoscope is inserted through it.

• The surgeon uses carbon dioxide to expand and inflate the abdominal wall (like a balloon). The pelvic organs can best be seen by doing this.

• The cyst is located using the laparoscope. Additional one or two incisions are made once the cyst has been located. Through these incisions, small instruments are inserted to remove the cyst.

• A tissue sample is also removed along with the cyst and sent to the laboratory for testing. This testing is done to confirm malignancy.

• Next, the instruments are removed, and the incisions are sutured.

What Happens After an Ovarian Cystectomy?

The patient is sent to the recovery room after the surgery. The patient may feel pain and discomfort post-surgery. This pain could primarily be due to the incisions and the effects of carbon dioxide inflation. While recovering, healthcare professionals closely monitor the patient's vital signs. Following the procedure, the surgeon will provide the patient with detailed instructions:

• When the patient can take a shower.

• Taking care of the incision.

• Changes in routine activity are to be made while recovering.

• Follow-ups.

• How much bleeding from the vaginal area or other symptoms can the patient experience while recovering.

• Pain medications.

• When the patient can resume sexual activities and work.

What Are the Complications of Ovarian Cystectomy?

Although ovarian cystectomy is a safe procedure, certain complications are associated with the surgery. The possible complications of ovarian cystectomy are as follows:

• Post-surgical infection.

• Irritation and discomfort at the incision site.

• Damage to the surrounding tissues and structures (ovary and fallopian tube).

• Excessive bleeding.

• Allergic reaction to drugs and anesthetic agents.

• Recurrence of the cyst after surgery.

• Removal of one or both ovaries.

Does Ovarian Cystectomy Reduce the Chances of Getting Pregnant?

No, the chances of falling pregnant are not affected after getting a cystectomy. However, the underlying illness resulting from an ovarian cyst may make it more challenging to conceive. For instance, endometriosis and polycystic ovarian syndrome (PCOS) can both result in ovarian cysts and impact fertility. Moreover, surgical damage can occur to the ovaries or fallopian tubes, reducing the chances of getting pregnant. However, this is very rare.

Conclusion:

Ovarian cysts are prevalent among women of reproducing age, but these cysts usually resolve independently without any intervention. However, some patients may require surgical intervention to get ovarian cysts removed. If the patient has a large ovarian cyst or does not go away on its own, the doctor may advise an ovarian cystectomy. In addition, ovarian cysts can occasionally be malignant. Ovarian cystectomy can be done through laparoscopy or open surgery.