Before you read this page, please refer to the information page on laparoscopy to answer your general questions that are common to all laparoscopic procedures. Questions such as “what to expect after surgery?”, “what happens on the day?” and many other questions.
In this page, we will deal with what is unique to laparoscopic removal of ovarian cysts or “laparoscopic ovarian cystectomy” and explain how the procedure is usually done.
Is an operation necessary?
Mr. Khazali will have discussed the alternatives to surgery with you. Often, a small cyst that has no worrying features on ultrasound scan can be managed without surgery but sometimes surgery is necessary, particularly if there are symptoms or when the cyst is large, of there are features on ultrasound that are not entirely reassuring.
Mr Khazali has been a member of the writing group for the national guidelines of the Royal College of Obstetricians and Gynaecologist (RCOG) to help gynaecologists decide how to manage ovarian cysts in women before the age of menopause.
Laparoscopy or open surgery?
Ovarian cystectomy can almost always be done through keyhole surgery, that means laparoscopically. The exceptions are when cancer is suspected, in which case it is often advised to perform open surgery.
Will my ovaries be removed?
The cyst can be removed without removing the ovary. There are, however, certain circumstances in which ovaries may be removed. For example, if you have gone through menopause or if the ovary or the ovarian cyst looks suspicious.
How is laparoscopic ovarian cystectomy done?
After inserting the camera into your abdomen (Click here for details of how this is done) and filling the abdominal cavity with CO2, Mr. Khazali will make two or three small incisions (5-10 mm) to pass fine laparoscopic instruments through the abdominal wall. He then carefully examines all pelvic organs to make sure no there is no other abnormality.
A small incision on the ovary is then made and the cyst is “shelled out” and separated from the rest of the ovary. A bit like peeling an orange. Mr Khazali is very careful in making sure that he minimised any injury to the healthy ovarian tissue. This is even more important in younger women as damaging healthy ovarian tissue can bring about menopause earlier or affect fertility.
Mr. Khazali believes that ovarian tissue should be treated with even more “respect” than other tissues in the pelvis. For this reason, he uses diathermy on the ovary very sparingly and uses other techniques instead.
Is the cyst drained or excised?
Draining an ovarian cyst is a pointless exercise because the cyst will just recur within a couple of months. Mr. Khazali almost always excises ovarian cysts, rather than drain or “puncture” them, to ensure the risk of recurrence is minimised. There are one or two exception to this rule where excision is not appropriate or possible.
What if the cyst is an endometriotic cyst?
If the cyst is endometriotic (endometrioma), often there will be other areas of the pelvis that are affected. These may need to be treated at the same time. You can read more here about surgical excision of endometriosis.
How is the cyst taken out of the body?
This depends on the size of the cyst, whether or not it has solid contents and the nature of the cyst. There are various techniques to “retrieve” the cyst wall. Usually, one of the incisions is used to do that, after removing the contents of the cyst and making it small. If the incisions are too small for removal of the ovarian cyst, Mr. Khazali may need to cut the tissue into smaller pieces or rarely, make one of the incisions slightly bigger. Usually the specimen is put inside a special plastic bag to make sure the contents of the cyst are not spilled inside the pelvis.
What happens to the cyst after removal?
It is always sent to pathology lab to be examined under the microscope to confirm the nature of the cyst. In women under the age of menopause, ovarian cysts are almost always benign.
You can watch a video Mr. Khazali has done for the Royal College of Obstetricians and Gynaecologists (RCOG) here, in which he explains how to recover well from a laparoscopy. You can also visit the Royal College’s website at rcog.org.uk, then click on Patients on the top right hand side and under recovering well, you can download an information leaflet or watch the video.