This video discusses the various levels and techniques of ultrasound in the setting of endometriosis and highlights specifics markers of endometriosis to investigate for.
What is an Ovarian Cystectomy?
Cystectomy is a surgery to remove a cyst growing in or on the ovary. Minimally invasive laparoscopy is preferred in most cases because it's less risky.
Ovarian cystectomy is commonly used to treat:
Cystadenomas
Dermoid cysts (sometimes called teratomas)
Endometriomas (sometimes called chocolate cysts)
Other stubborn follicular or corpus luteum cysts
Your surgeon will do everything they can to spare your ovary and other nearby healthy tissues. However, they may recommend removing it (this is called oophorectomy) at the same time if it's very large, complex, or shows signs of being malignant (cancerous).
What is Minimally Invasive Approach to the Large Ovarian Cyst?
A Minimally Invasive Approach to the Large Ovarian Cyst involves using laparoscopy, where small incisions and a camera are used to view and remove the cyst. The procedure includes preoperative imaging, strategic port placement, careful cyst removal, and minimal recovery time, offering benefits such as reduced pain and quicker return to normal activities.
Laparoscopy: Small incisions and a camera are used to view and remove the ovarian cyst.
Preoperative Imaging: Ultrasound or MRI to assess the cyst.
Port Placement: Strategic small incisions for optimal access.
Cystectomy: Careful removal of the cyst, potentially aspirating if too large.
Tissue Extraction: Cyst placed in a bag and extracted to prevent spillage.
Closure: Incisions closed with sutures or surgical glue.
Benefits: Reduced pain, quicker recovery, and minimal scarring.
What are the Risks of Minimally Invasive Approach to the Large Ovarian Cyst?
Risks of Minimally Invasive Approach to the Large Ovarian Cyst include:
Infection: Potential for infection at the incision sites or within the abdomen.
Bleeding: Risk of bleeding during or after the procedure.
Injury to Surrounding Organs: Possible damage to nearby organs like the bladder, bowel, or blood vessels.
Cyst Rupture: Risk of the cyst rupturing during removal, which could spread its contents and cause complications.
Incomplete Removal: Potential for residual cyst tissue, leading to recurrence.
Anesthesia Risks: Complications related to general anesthesia, such as allergic reactions or respiratory issues.
Adhesion Formation: Development of scar tissue within the abdomen, which could cause pain or other complications.What are the Risks of Laparoscopic Cystectomy?
Pre- and Post-Surgery Checklist
What to Expect
You'll meet with a practitioner from the hospital's Pre-Operative Clinic (PAC) a few days or weeks before your procedure. They'll review your current medications, arrange for any necessary testing, and answer any questions or concerns you have.
Laparoscopic cystectomy is usually performed under general anesthesia and takes about one to two hours, depending on the size and complexity of the cyst. You may be allowed to go home later the same day or admitted for monitoring instead.
What to Prepare
The surgeon will give you specific instructions ahead of time, and it's important to follow them carefully.
This may include:
• When to stop eating and drinking before your operation
• Whether to stop, continue, or adjust any of your current medications
• When you should arrive at the hospital and check in
If you have any questions about your instructions or aren't sure what to do, call the surgeon's office and ask for guidance right away.
Questions for Your Doctor
Having surgery can be stressful. Asking the right questions at your appointments can help you feel more confident, informed, and in control as you move forward.
Patients often ask questions like:
• Is laparoscopic cystectomy really the right choice for my case?
• Are there other options for treating my cyst that don't involve surgery?
• Will I need any special tests, and if so, which ones will you order?
• What are the chances that you'll need to convert to an open surgery?
• Where can I find trusted information about ovarian cysts online?
• How likely is it that my ovary can be preserved?
• Could this affect my fertility, and if so, how?
Some people find it helpful to write down a list of questions before each appointment. You can also bring a support person with you, if desired.
Post-Surgery Recovery Process
Most patients heal from laparoscopic surgery very quickly. Some are able to return to light activities or even go back to work after the first week, while others need more time. Recovery usually takes 1 to 2 weeks. Some patients may continue to feel some discomfort from surgery for 6 to 8 weeks.
In the first few days, you may:
• Feel fatigued or need to sleep more often
• Experience bloating or feel full after eating small meals
• Notice mild swelling or redness in and around your incisions
It's also normal to have some pain, especially in the first 3 to 4 days. Over-the-counter medications like naproxen and acetaminophen can help. Walking can also help by dispersing any remaining gas in your abdomen and reducing your risk for blood clots.
Surgery Process
Laparoscopic cystectomy is performed in stages, beginning with anesthesia and ending with closure of the incisions. Most procedures will closely follow the steps below, but keep in mind that your surgeon might adapt them to better suit your needs or case.
STEP 1: Anesthesia
On the day of your surgery, you'll check in at a set time, change into a gown, and have an IV placed. You'll be brought into the operating room as soon as the surgical team is ready for you.
The anesthesiologist will give you medicine through your IV to put you into a deep sleep. They'll remain present and continue to monitor your vital signs until the surgery is over.
STEP 2: Abdominal Entry
Once you're asleep, your surgeon will make a few small incisions in your abdomen and inflate it with gas. This makes it easier to see, work, and navigate around the cyst.
STEP 3: Decompression
Large cysts often need to be drained before they can be taken out through small incisions. If this is the case for you, the surgeon will make a small cut on the surface of the cyst, then use gentle suction to remove the contents.
STEP 4: Separation
Next, the cyst is carefully separated from the ovary, fallopian tubes, and/or other nearby healthy tissue. The team will place it into a protective bag that prevents any remaining contents from spilling over into your abdomen.
STEP 5: Extraction
The bag containing the cyst is carefully drawn out through one of the small incisions on your lower abdomen. The tissue is then sent to a lab for further evaluation. If necessary, the team will suction out any remaining fluids or tissue left behind.
STEP 6: Closing Up
The surgeon will take one final look around your abdomen to make sure there is no bleeding or other signs of trouble before closing you up. Your incisions may be sutured (sewn up) with stitches or closed with butterfly strips and bandages.
Ovarian Cystectomy FAQs
Should All Large Ovarian Cysts Be Removed?
Ovarian cysts affect every patient differently, so there isn't a set size where surgery becomes necessary. Instead, your care team will look at how the cyst is affecting your daily life, whether you’re having symptoms, and how it's growing or changing over time.
Depending on the type of cyst, some smaller cysts may resolve on their own. Bigger cysts are more likely to cause pain and pressure or interfere with fertility, making surgery necessary.
Is Laparoscopic Cystectomy Always An Outpatient Surgery?
Not necessarily. While some patients do get to go home the same day, your care team may decide that an overnight stay is the safer option, either in advance or after your procedure. You may also be asked to stay until you can drink fluids, pass urine, and rest comfortably.
Will My Scars Be Very Noticeable?
The incisions used in laparoscopy are so small that any related scarring is usually minimal. Cuts are also typically placed low on the abdomen, where they're less likely to be seen.
Applying a Vitamin E ointment to the area after the initial healing period may help. Ask your surgeon when it's safe to start applying it.
Will the Cyst Be Tested After It’s Removed?
Yes. Any tissue removed from your abdomen will be sent to pathology for testing, even if your doctor doesn't have any reason to suspect cancer or infection. This is the best way to identify what type of cyst it is and what developing them means for your reproductive health.
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