Cystectomy

Ovarian cystectomy is usually performed under general anaesthesia and typically involves a minimally invasive laparoscopic approach. This technique allows the surgeon to remove the cyst through small incisions while preserving the healthy ovarian tissue. The goal is to relieve symptoms and prevent complications while maintaining fertility and hormonal function.

• Accessing the pelvic cavity — small incisions are made in the lower abdomen, through which a laparoscope (a thin camera) and specialised instruments are inserted to visualise the reproductive organs.
• Identifying the cyst — the surgeon carefully examines the ovaries to locate the cyst and assess its size, position, and appearance.
• Separating the cyst — the cyst wall is gently dissected away from the ovarian tissue, taking care to preserve as much of the ovary as possible.
• Removing the cyst — the cyst is placed in a retrieval pouch and removed through one of the incisions to minimise the risk of rupture or spillage.
• Controlling bleeding and closing incisions — any bleeding is stopped using cautery or sutures, and the small incisions are closed with absorbable stitches or surgical glue.

In cases where the cyst is very large, deeply embedded, or shows signs suspicious for malignancy, the surgeon may recommend an open procedure (laparotomy) for better access and safety.

Most ovarian cysts are asymptomatic and resolve without intervention. However, certain cysts can lead to complications such as rupture, bleeding, or ovarian torsion, conditions that require prompt surgical treatment. Ovarian cystectomy is performed to remove these abnormal growths while preserving the ovary. It is commonly used to treat:

• Follicular cysts — these are functional cysts that develop when an ovarian follicle fails to release an egg during ovulation. They may continue to enlarge due to hormonal stimulation and fill with fluid.
• Corpus luteal cysts — after ovulation, the follicle becomes the corpus luteum. If it fails to regress and fills with blood, it forms a corpus luteal cyst, which may cause pain or internal bleeding.
• Theca lutein cysts — these cysts result from overstimulation by high levels of human chorionic gonadotropin (hCG), often seen in pregnancy, particularly in conditions like molar pregnancy or multiple gestation.
• Polycystic Ovary Syndrome (PCOS) — PCOS is characterised by multiple small follicles along the ovary’s periphery. While it's usually treated medically, cystectomy may be considered for unusually large or symptomatic cysts.
• Cystadenomas — benign epithelial tumours that can grow quite large. They are classified as serous or mucinous, depending on the type of fluid they contain.
• Dermoid cysts (mature teratomas) — benign germ cell tumours that may contain hair, teeth, or fat. Though usually non-cancerous, they can grow large or twist the ovary. Rarely (1–2% of cases), they may become malignant.
• Endometriomas — also known as “chocolate cysts,” these form when endometrial tissue implants on the ovary. They are associated with endometriosis (Endometriosis Excision) and often cause pelvic pain and infertility.
• Ovarian fibromas — benign stromal tumours that may become cystic if they undergo degeneration, necrosis, or contain fluid or blood.
• Ovarian cancers — malignant tumours arising from ovarian tissue or metastasising from other organs (e.g., breast, gastrointestinal tract, uterus, or lymph nodes). In such cases, ovarian cystectomy may be part of a wider surgical staging or treatment plan.

Ovarian cystectomy offers several important benefits, particularly for women who wish to preserve their fertility and ovarian function. It is a targeted surgical option that allows for the removal of problematic cysts without removing the entire ovary.

• Preservation of fertility — unlike oophorectomy, ovarian cystectomy retains healthy ovarian tissue, supporting natural hormone production and the ability to conceive.
• Relief from symptoms — it helps resolve symptoms such as pelvic pain, bloating, pressure, irregular periods, or discomfort during intercourse caused by persistent or large cysts.
• Prevention of complications — removing cysts that are at risk of rupture or torsion lowers the chance of emergency situations and damage to the ovary.
• Diagnostic clarity — the removed cyst can be sent for histopathological analysis to confirm the diagnosis and rule out malignancy.
• Minimally invasive options — when performed laparoscopically, patients benefit from faster recovery, minimal scarring, and a lower risk of postoperative pain and infection.

While ovarian cystectomy is generally considered a safe and effective procedure, like any surgery, it carries certain risks. These risks can vary depending on factors such as the surgical approach, the size and nature of the cyst, and the patient’s overall health.

• Bleeding and infection — as with most surgeries, there is a small risk of bleeding during the procedure or developing an infection at the incision sites.
• Damage to surrounding organs — the ovaries are located near the bladder, bowel, and blood vessels, and there is a slight risk of accidental injury to these structures.
• Adhesion formation — scar tissue (adhesions) may develop within the pelvis after surgery, which can occasionally lead to chronic pelvic pain or affect fertility.
• Recurrence of cysts — some types of cysts, especially functional or endometriotic cysts, may recur even after removal.
• Loss of ovarian tissue or function — although the goal is to preserve the ovary, in some cases, a portion of healthy tissue may be lost, which can affect ovarian reserve, particularly if both ovaries are involved.
• Anaesthesia-related risks — reactions to general anaesthesia, such as nausea or breathing difficulties, are rare but possible.

In experienced hands, ovarian cystectomy is typically a safe procedure with low complication rates.

Ovarian cystectomy is typically a short, well-tolerated procedure performed under general anaesthesia. Most cases are done using laparoscopy, which allows for quicker recovery and minimal scarring.

• Before the procedure — you will be asked to fast for several hours, and routine blood tests or imaging may be performed. Your gynaecologist will explain the risks and benefits, and you will be asked to sign a consent form.
• Anaesthesia and preparation — once in the operating theatre, general anaesthesia will be administered so you're completely asleep and pain-free. A urinary catheter may be inserted, and your abdomen will be cleaned with antiseptic solution.
• The surgery itself — small incisions are made in the lower abdomen, and a laparoscope (thin camera) is inserted to visualise the ovaries. The surgeon carefully removes the cyst, preserves the ovarian tissue, and ensures there is no bleeding. In some cases, the cyst is placed in a retrieval pouch to prevent fluid spillage.
• After the procedure — you will be monitored in a recovery area until you wake up fully. Most patients experience mild abdominal discomfort, bloating, or shoulder tip pain from the gas used during laparoscopy. You can usually go home the same day or within 24 hours.

Your gynaecologist will provide personalised instructions on wound care, activity restrictions, and follow-up. Most people can return to normal activities within 1–2 weeks, depending on the surgical approach.

Recovery after an ovarian cystectomy is generally smooth, especially if the procedure is performed laparoscopically. Most patients can expect a short hospital stay and a gradual return to normal activities.

• Immediate recovery — you may feel drowsy or mildly sore when you wake up from anaesthesia. It’s common to experience light vaginal bleeding, bloating, or cramping for a few days. Pain is usually mild and managed with oral pain relief.
• Hospital discharge — many patients are discharged on the same day or within 24 hours. If the surgery was done through open laparotomy, a longer hospital stay may be required.
• At-home care — you will be advised to rest, avoid heavy lifting, and keep the incision sites clean and dry. Most patients can return to work or light activity within 1–2 weeks after laparoscopic surgery, or 4–6 weeks after open surgery.
• Follow-up appointment — a post-operative review will be scheduled to check your healing, discuss pathology results, and plan further care if needed.
• Fertility and menstrual cycle — your periods may take a cycle or two to normalise. Most women resume regular menstruation and retain their fertility if ovarian function is preserved.
• When to seek medical help — contact your doctor if you develop fever, heavy bleeding, worsening pain, or signs of infection at the incision site.

Your gynaecologist will guide you through recovery and provide personalised advice based on your condition and treatment plan.