Laparoscopic Ovarian Cystectomy
Ovarian cysts can be found in women of any age group. It arises from the ovaries which are two small organs located on either side of a woman’s uterus. These are the organs that produce eggs in the reproductive period in women’s life.
They are basically of three types- Functional, Benign or Cancerous. The first type usually does not require surgical intervention. The benign cyst are persistent or large they need laparoscopic surgical excision which can be just removal of cyst (cystectomy) in young or removal of ovary (oophorectomy) in older.
OVARIAN CYSTS CAN BE OF FOLLOWING TYPES
- FUNCTIONAL- these are due to hormonal changes, usually less than 5 cms.
- BENIGN CYSTS- These are tumours of the ovary and often need surgical treatment as medicines do not help. They also grow large and can undergo torsion or rupture requiring intermediate surgical intervention. The common types of benign cysts are Dermoid, serous cyst adenoma or mucinous cyst adenoma. There is a 10-12 % chance of occurrence of these cysts in both the ovaries.
- ENDOMETRIOMA- can be seen in upto 60% of women with endometriosis. Often associated with severe dysmenorrhoea and infertility. Laparoscopic Cystectomy is the best treatment for improving symptoms as well as fertility.
- MALIGNANT OR CANCEROUS CYSTS- Ovarian cancer is often diagnosed late due to its silent nature. Requires a combined treatment of surgery and chemotherapy. It runs in the family.
Most cysts are benign (not cancerous). Benign cysts require surgical treatment if they are big (>5cms), growing rapidly or are symptomatic. These types of cysts can be dermoid cysts, endometrioma (chocolate cysts) or cystademonas. Rarely, a few cysts may turn out to be malignant (cancerous). Cysts like dermoid are common in girls and young woman. Reproductive age is likely to be associated with functional cysts or cystadenoma. Malignant are more common in woman above 40 years.
Symptoms
Most ovarian cysts are small and asymptomatic. Some cysts may cause a dull or sharp ache in the abdomen and pain during certain activities. Larger cysts may cause torsion (twisting) of the ovary that causes acute severe pain. Cysts that bleed or rupture (burst) may lead to serious problems requiring prompt treatment.
Diagnosis
Usually diagnosed by Ultrasound examination. MRI and tumour markers (CA125, CEA, Inhibin, LDH) is needed for further evaluation.
Treatment
Choosing an option primarily depends on Size and type of cyst; the woman’s age, severity of symptoms, desire for future childbearing.
Watchful Waiting
Asymptomatic cysts can be monitored it for 3-6 months. Most functional cysts disappear.
Surgery
laparoscopy is the gold standard approach irrespective of the size. Laparoscopy surgery is associated with quick recovery with minimal postoperative pain or discomfort. Even cysts that are 15-20 cms in size can be removed laparoscopically with us.
Laparoscopy for Ovarian cyst Emergencies
- Torsion- Pedicle of the cysts typically of 7-8 cms twists on its own axis thus cutting off the blood supply. Immediate surgical intervention (laparoscopy) is done to save the ovary from necrosis.
- Rupture- Causes bleeding inside the abdomen. Immediate surgical intervention (laparoscopy) to remove the cyst as well as the blood that has collected.