A procedure (cystectomy) in which ovarian cysts that require surgery rather than observation are removed while preserving as much ovarian tissue as possible. Preferably performed laparoscopically.
Indication
- Persistent ovarian cyst requiring surgery rather than monitoring due to size, appearance, or structure
- Lesions with high probability of malignancy based on suspicious ultrasound/MRI findings and risk calculations (RMI, IOTA-ADNEX)
- Endometriotic cyst (chocolate cyst, endometrioma) — due to pain, fertility concerns, or growth
- Lesions with high torsion risk such as dermoid cysts (mature cystic teratoma) and mucinous cystadenoma
- Emergency surgery for suspected ovarian torsion
- Tubal or ovarian abscess and complex cysts with unclear contents
- Increased pain or pressure-related symptoms during conservative follow-up
Preparation
- Risk assessment with pelvic ultrasound (Doppler/MRI if needed) and tumor markers such as CA-125 and HE4
- Fasting 6-8 hours before the procedure; routine blood tests, ECG, and anesthesia consultation if needed
- Adjustment of blood thinners with physician approval
- Information about reproductive plans (desire for pregnancy) and shared decision-making regarding fertility-preserving surgery
- Availability of blood and bowel preparation if needed (in cases of suspected endometriosis)
How it's performed
- Under general anesthesia, the laparoscopic method is most often used through a few 0.5-1 cm incisions in the umbilicus and lower abdomen
- The abdominal cavity is inflated with carbon dioxide gas; the pelvis and abdomen are evaluated with a camera
- The cyst is separated from the ovarian tissue along with its intact capsule; healthy ovarian tissue is preserved as much as possible
- If suspicious appearance is present, an endobag is used to prevent cyst content from spilling into the abdomen; frozen section (rapid pathology) is requested when needed
- Removed tissue is taken out with a specimen bag, bleeding is controlled, and the ovarian tissue is sutured
- Open surgery (laparotomy) may be preferred for large masses, adhesions, or suspected malignancy
Post-procedure
- Same-day or 1-2 day hospital stay (usually 1 day for laparoscopy)
- Avoiding heavy lifting, sexual intercourse, and pools/bathtubs for the first week
- Follow-up within 1-2 weeks after the procedure and review of pathology results
- Follow-up of ovarian reserve (AMH) and pregnancy plans after endometrioma surgery
- Additional treatment planning with oncology council if pathology shows malignancy
Risks
- Infection, bleeding, hematoma, and wound problems
- Injury to neighboring organs (bladder, bowel, ureter) — rare
- Anesthesia reactions and risk of thromboembolism
- Reduction in ovarian reserve due to ovarian tissue loss (especially in endometrioma)
- Detection of unexpected malignancy on pathology and need for additional surgery/treatment
FAQ
Does every ovarian cyst require surgery?
No. A significant portion of small, simple-appearing cysts may resolve on their own and follow-up may be sufficient. The decision to operate is based on size, appearance, symptoms, and risk calculation.
Will my chance of pregnancy decrease after surgery?
The aim of cystectomy is to preserve healthy ovarian tissue as much as possible. However, especially endometrioma surgery may reduce ovarian reserve; fertility-preserving approaches are planned for those who want to conceive.
Could the removed cyst turn out to be cancer?
Most ovarian cysts are benign. The likelihood of malignancy is estimated before surgery with ultrasound, blood tests, and risk scoring; the definitive result is provided by the post-surgical pathology report.
When can I return to work?
Return to daily life is generally possible within 1-2 weeks after laparoscopic cystectomy and within 4-6 weeks for non-strenuous work after open surgery. The exact duration varies by individual and occupation.
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