Laparoscopic Ovarian Cystectomy: A Concise Review
Abstract
Laparoscopic ovarian cystectomy is a minimally invasive surgical procedure performed to remove ovarian cysts while preserving healthy ovarian tissue. It has become the preferred approach for managing benign ovarian cysts due to its advantages of reduced postoperative pain, faster recovery, and improved cosmetic outcomes. This article outlines the indications, surgical technique, advantages, and potential complications of laparoscopic ovarian cystectomy.
Introduction
Ovarian cysts are a common gynecological condition encountered in women of all age groups. While many cysts are functional and resolve spontaneously, persistent, symptomatic, or suspicious cysts require surgical management. Laparoscopic ovarian cystectomy allows precise excision of cysts with preservation of ovarian function, making it particularly important in women of reproductive age.
Indications
Laparoscopic ovarian cystectomy is indicated in the following situations:
- Persistent ovarian cysts larger than 5–6 cm
- Symptomatic cysts causing pain or pressure symptoms
- Suspected benign neoplasms (e.g., dermoid cyst, cystadenoma)
- Endometriotic cysts (endometriomas)
- Cysts not resolving after observation
- Complications such as torsion (selected cases)
Proper preoperative evaluation is essential to rule out malignancy.
Contraindications
Although widely used, the procedure may not be suitable in certain cases:
- Strong suspicion of ovarian malignancy
- Large complex masses with solid components
- Extensive pelvic adhesions
- Hemodynamically unstable patients (in emergency situations)
In such cases, laparotomy or oncological management may be preferred.
Preoperative Preparation
Evaluation includes detailed history, pelvic examination, and imaging—primarily ultrasound. Tumor markers such as CA-125 may be used in selected patients. Routine investigations include complete blood count and biochemical tests. Patients should be counseled about the procedure, risks, and the possibility of conversion to laparotomy if required.
Surgical Technique
1. Patient Positioning and Port Placement
The patient is placed in the dorsal lithotomy position with Trendelenburg tilt. A primary umbilical port is inserted for the laparoscope, along with 2–3 accessory ports.
2. Inspection and Cyst Assessment
The pelvis is inspected to assess cyst size, location, and relation to surrounding structures.
3. Ovarian Incision
A small incision is made over the ovarian cortex using monopolar or scissors.
4. Cyst Enucleation
The cyst wall is carefully separated from the ovarian tissue using traction and counter-traction. This step requires precision to preserve healthy ovarian tissue.
5. Hemostasis
Bleeding is controlled using bipolar cautery or sutures, minimizing thermal damage to ovarian reserve.
6. Specimen Retrieval
The cyst is removed using an endobag to prevent spillage, especially in dermoid cysts.
7. Ovarian Reconstruction
The ovarian tissue may be sutured or left to heal depending on the defect.
Advantages
- Minimally invasive approach
- Preservation of ovarian function
- Reduced postoperative pain
- Short hospital stay and faster recovery
- Better cosmetic results
- Lower risk of adhesions compared to open surgery
Complications
Intraoperative:
- Bleeding
- Injury to surrounding structures (bowel, bladder, ureter)
- Cyst rupture and spillage
Postoperative:
- Infection
- Adhesion formation (though less common)
- Recurrence of cyst
- Reduced ovarian reserve (if excessive cautery used)
Conclusion
Laparoscopic ovarian cystectomy is a safe and effective procedure for the management of benign ovarian cysts. It offers significant advantages over open surgery, particularly in preserving fertility and ensuring rapid recovery. Careful patient selection, meticulous surgical technique, and adherence to minimally invasive principles are key to achieving optimal outcomes.