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Ovarian cyst surgery
Laparoscopic, classic and minimally invasive solutions
Ovarian cysts can be operated laparoscopically (laparoscopy) or by the classical method (laparotomy). The advantage of laparoscopy is faster recovery and shorter hospital stay.
Depending on the appearance of the cyst, age and desire for pregnancy, a decision is made whether to remove only the cyst or the entire ovary and whether laparoscopy or laparotomy will be performed.
Cystectomy is the surgical removal of a cyst and can be performed laparoscopically (minimally invasive) or by the classic method.
The principle of the surgery is to make an incision on the ovary sheath and then separate the outer part of the ovary (which contains the egg cells) from the capsule of the cyst. Then the cyst with the capsule is removed and sent for histopathological analysis.
It is very important not to damage the surrounding healthy tissue in which the egg cells are located.
The first choice is laparoscopy, and if the cyst is large and there is a suspicion of malignant changes, laparotomy is performed.
Ovariectomy or oophorectomy is the removal of the entire ovary containing the cyst. Usually, the fallopian tube is also removed and this surgery is called salpingo-oophorectomy.
Ovarian surgery at Gyn-Fertility Clinic Milenković
In the Gyn. Fertility Clinic Milenković, laparoscopy, laparotomy and cyst puncture are performed, with a special emphasis on preserving a woman's fertility .
The cyst is operated on in women who have symptoms: pain, pressure in the small pelvis, bleeding from the cyst, frequent urination, bleeding disorders, as well as in cases of suspected malignant cyst. The decision on cyst surgery is made after a gynecological, ultrasound, and possibly radiological examination and laboratory analyses.
The intervention is performed in the period outside of menstrual bleeding, but in acute situations it is also performed during menstruation, while in menopausal women it can be performed at any time.
The surgery is performed in a hospital.
- Before the surgery, the patient fills out a detailed questionnaire about her health condition.
- Cyst surgery can be performed laparoscopically and by the classical method with an open incision (laparotomy).
- It is done under general anesthesia.
- Before the surgery, a doctor's examination by an anesthesia specialist is performed and blood tests are performed.
- If there is a disease or risk factor, it is necessary to perform additional analyses and an examination by a doctor of another specialization, most often an internist.
- The patient receives an antiseptic shampoo in the Clinic, which will be used for showering in the evening and morning before the surgery.
- The patient is admitted to the hospital on the same day, possibly the day before the surgery. 6-8 hours before the surgery, the patient stops taking food and liquids.
The cyst surgery procedure is the same as for other surgeries where laparoscopy and laparotomy are applied.
- The procedure itself when removing the cyst consists of separating the outer covering of the ovary, that is, the ovarian cortex from the cyst capsule. Egg cells, i.e. ovarian reserve, are located in the ovarian cortex and the essence of the surgery is to separate the cyst capsule from the ovary with as little damage and bleeding as possible.
- The first choice is laparoscopy, but if the cyst is large, laparotomy is performed.
- Removal of the cyst, that is cystectomy, can be done regardless of the size of the cyst.
- When the patient is in menopause or does not plan to become pregnant, the entire affected ovary is removed, usually with the fallopian tube. The surgery lasts from 45 minutes to 2 hours, depending on the type of cyst, previous surgeries, the method used, and body weight and height.
Recovery is the same as for other surgeries when laparoscopy and laparotomy are used.
Types of interventions
| Types of interventions | What does it mean? | When is it applied? |
|---|---|---|
| Ovarian cystectomy | Removal of the cyst with its wall, while preserving the ovary | With benign cysts, when it is important to preserve fertility. Even large cysts can be operated on to save the ovary |
| Oophorectomy | Removal of the entire ovary | Suspected malignancy, menopausal cysts |
| Salpingo-oophorectomy | Removal of ovaries and fallopian tubes | Suspected malignancy, menopausal cysts |
| Aspiration (puncture) | Fluid withdrawal with a needle | Benign cysts with the aim of delaying or avoiding surgery, pain, during IVF |
Cyst aspiration - when surgery is not required
Cyst puncture or aspiration is a simple and effective method where fluid is drawn from the cyst using a thin needle. This procedure is applied when the cyst is benign, confirmed by ultrasound and analysis. Cyst puncture is not performed when there is minimal suspicion of a malignant cyst.
Preoperative diagnostics
To diagnose an ovarian cyst, the following is done:
- gynecological examination;
- ultrasound;
- computerized tomography-scanner (CT);
- magnetic resonance imaging (MRI);
It is necessary to perform additional blood tests, depending on the appearance of the cyst: Ca 125, HE4, beta hCG, alpha-fetoprotein, estradiol, Anti-Müllerian hormone (AMH), inhibin.
Expert advice: frequently asked questions
Answers by: Milan Milenković, MD, PhD.
How long does ovarian cyst surgery take?
Ovarian cyst surgery lasts from 45-120 minutes depending on the type of cyst, the method used, previous surgeries or infections in the small pelvis, as well as body weight and height.
What is the difference between laparoscopic and classic cyst surgery?
The principle of the surgery is the same, to separate the capsule of the cyst from the healthy tissue of the ovary (cystectomy), or to remove the entire ovary with the cyst. In laparoscopic surgery, a camera is inserted into the abdominal cavity, and then instruments are inserted through skin incisions of 5-12 mm, while in classic surgery, an incision is made in the front abdominal wall of 8-10 cm or more, depending on the size of the cyst. Recovery is significantly shorter after laparoscopic surgery.
Does surgery always remove the entire ovary?
The ovary is not always removed during ovarian cyst surgery. When a woman is in menopause or approaching menopause, when there is a suspicion of malignancy and when the cyst has already been operated on, the entire ovary is removed. The assessment is individual.
What does the recovery look like after classic ovarian cyst surgery?
The patient is usually discharged from the hospital 1-3 days after the surgery. It is recommended to refrain from work and heavy physical activities for 3-4 weeks. Recovery is similar to other laparotomy surgeries and depends on the size of the incision on the anterior abdominal wall.
What is an ovarian cystectomy?
Cystectomy is the removal of only the ovarian cyst while preserving the ovary.
Does cyst surgery affect fertility?
Cyst surgery can reduce fertility, that is, ovarian reserve, since during the removal of the cyst, part of the outer layer of the ovary, where the egg cells are located, is also removed. It is important that the operation is performed with as little trauma as possible to the surrounding healthy tissue.
When can I have intercourse after ovarian cyst surgery?
If the cyst was operated on laparoscopically, you can have intercourse 10-14 days after the operation, while after laparotomy (open incision) that period is 4-5 weeks.
Can a cystectomy be performed for large cysts on the ovary?
Cystectomy can also be done for large cysts. When ovarian cysts are larger than 10-15 cm, surgery is performed through an open incision on the front abdominal wall (laparotomy).
