What is ovarian cystectomy?

It is a surgical procedure that is done to remove an ovarian cyst or tumor by preserving the ovary and fertility.
Ovarian cysts are fluid-filled sacs that are formed in the ovaries and surrounded by a very thin layer. Any ovarian follicle that is larger than 3 centimeters is considered an ovarian cyst.

There are two types of ovarian cysts formed in the body:

• Functional ovarian cysts: These are harmless and the most common type of cysts in females. The functional cysts are sac-like structures formed on the surface of the woman’s ovary during or after the ovulation cycle.
• Pathological cysts: These cysts are formed in the ovary but are not a part of the ovulation cycle. The pathological cysts may be benign or malignant.

Ovarian cystectomy is performed based on the patient’s age, size of the cyst, and any chance of malignancy.

Why is it performed?

Your healthcare expert will recommend ovarian cystectomy if you have any of these signs & symptoms:

• If the ovarian cysts are size is larger than 6-7 cm.
• If any ovarian masses are present in both ovaries
• Ovarian cancer
• If the ultrasound recommends that the cyst formed is not a simple functional cyst.
• If any complications like rupture appear.

How is it diagnosed?

The doctor may recommend different diagnostic tests before ovarian cystectomy:

• Ultrasound test: Done to detect the ovarian cysts.
• CA-125 blood test: Though not specific, high levels can be suggestive of a malignancy.
• A pregnancy test is conducted to rule out pregnancy.
• Other imaging tests like MRI scan, CT scan and Doppler flow studies are conducted, if required.

How is ovarian cystectomy performed?

Ovarian cystectomy can be done in two ways:

• Open surgery
• Laparoscopic surgery

Laparoscopic Surgery 

Laparoscopic surgery, also referred to as keyhole surgery, is a minimally invasive technique. In the laparoscopic method, only the ovarian cyst is removed by preserving the ovarian tissue or ovaries. The laparoscopic method is also helpful in the confirmation of the presence of ovarian cysts.

• The patient will be subjected to general anesthesia or local anesthesia intravenously for sedation.
• The surgeon will make three or four small incisions in the abdomen to insert a laparoscope and other surgical instruments to remove the cysts.
• A laparoscope with a video camera at its end is inserted in to one of the incision to view the internal organs on a monitor in the operating room. The images displayed on the monitor helps the surgeon to guide the surgical instruments to the exact location of the ovarian cyst.
• The cyst is separated from the healthy ovarian tissue and removed. If the cyst involves the whole ovary, it may not be possible to separate the cyst alone, necessitating the removal of the ovary. Sometimes, if a cyst cannot be removed completely, then either partial removal or aspiration is done.
• After the completion of the procedure, the incisions are sewn with dissolvable stitches. 

Open Surgery 

If the laparoscopic removal is not possible due to adhesions or other problems encountered during the surgery like - if the cyst is very large or if there is a suspicion of cancer, an open surgery will have to be performed.

Precautions:

• Resume your normal daily routine activities
• Refrain from performing strenuous activities such as heavy lifting in the gym or sports 
• Do not lift anything that weighs more than 5 kg. for 2- 4 weeks post-surgery
• Consult the doctor if you have symptoms like abdominal pain, sudden chest pain, or breathing trouble.
• Take medication as directed by the physician.

Advantages of laparoscopic ovarian cystectomy:

• Shorter stay in the hospital
• Recovery is very fast
• Pain and discomfort after the surgery is very less
• Less risk of infections
• Fewer side effects.