Laparoscopic Ovarian Cyst Surgery

What Is Laparoscopic Ovarian Cyst Surgery (Laparoscopy)?

Laparoscopy is a minimally invasive surgical method used to visualize and operate on the organs inside the abdomen. It is also known as “closed surgery.” In this technique, generally under general anesthesia:

1. A small incision (approximately 1 cm) is made at or just below the navel.
2. The abdominal cavity is inflated with carbon dioxide (CO2) gas to widen the field of view and allow the organs to be seen more clearly.
3. A thin, lighted camera called a laparoscope is inserted into the abdomen through the incision. The camera magnifies the images from inside the abdomen and projects them onto a video monitor.
4. The surgeon performs the operation by watching the image on this monitor. To use the necessary surgical instruments (scissors, graspers, cautery, suction device, etc.), usually 1 to 3 additional smaller incisions (0.5 cm) are made in the lower abdomen.
5. In ovarian cyst surgery, laparoscopy allows the surgeon to examine the ovary, the cyst, and the surrounding tissues in detail, to precisely remove the cyst (cystectomy), or, when necessary, to remove the ovary (oophorectomy).

Why Is the Closed Method (Laparoscopy) Preferred Over Open Surgery? Main Advantages

There are many reasons why laparoscopy is preferred over open surgery (laparotomy) for ovarian cyst surgery in suitable patients:

• Smaller Surgical Scars: Instead of a large incision on the abdomen, only a few small puncture marks remain, which is a major cosmetic advantage.
• Less Postoperative Pain: Because there is less tissue trauma, postoperative pain is significantly reduced, and generally fewer painkillers are needed.
• Shorter Hospital Stay: After laparoscopy, patients can generally be discharged the same day or the next day, whereas with open surgery this period can extend to several days.
• Faster Recovery and Return to Normal Life: Patients can return to their daily activities and work much sooner (usually within 1-2 weeks). With open surgery, this period can extend to 4-6 weeks.
• Less Blood Loss: The amount of bleeding during surgery is generally lower.
• Lower Infection Risk: The risk of wound infection is lower.
• Fewer Intra-Abdominal Adhesions: The risk of adhesions forming between abdominal organs after surgery is lower than with open surgery. This is especially important for patients planning a future pregnancy or who may need further surgery.
• Better Visualization: The laparoscopic camera magnifies the surgical area, giving the surgeon a more detailed view, which allows for more precise surgery.

For these reasons, laparoscopy is the first-choice method for almost all benign ovarian cyst surgeries that are technically feasible and suitable for the patient.

In Which Cases Is Laparoscopic Ovarian Cyst Surgery Performed?

Laparoscopic surgery is frequently used for the treatment of ovarian cysts in the following situations:

• Functional Cysts That Persist or Grow on Follow-up: Cysts that were expected to resolve on their own but do not resolve or continue to grow.
• Symptomatic Cysts: Cysts that cause complaints such as severe pain or a feeling of pressure, regardless of size.
• Large Cysts: Benign-appearing cysts that are generally larger than 5-7 cm but still of a size that can be removed laparoscopically (sometimes up to 10-15 cm).
• Endometriomas (Chocolate Cysts): Particularly in cases where surgical treatment is planned due to pain or infertility.
• Dermoid Cysts (Mature Cystic Teratoma): These cysts are usually removed surgically regardless of their size or symptoms, due to the risk of torsion (twisting) or rupture, and, very rarely, the potential for malignant transformation.
• Cystadenomas and Other Benign Tumors: Benign cysts that do not resolve on their own and have the potential to grow.
• Ovarian Torsion (Twisting of the Ovary): If the ovary twists on itself, emergency laparoscopy may be needed to correct the twisting (detorsion) and/or remove the cyst. If the ovary has not lost its viability, it can be preserved.
• Suspicious but Most Likely Benign Cysts: To remove and pathologically examine cysts that show mildly suspicious findings on ultrasound or blood tests but are assessed to carry a very low risk of cancer.

Situations Where Laparoscopy May Not Be Suitable: Laparoscopy may not always be possible. In situations such as extremely large cysts (>15-20 cm or more), cases with a very high suspicion of cancer, a general health condition unsuitable for laparoscopy (severe heart-lung disease), or extensive intra-abdominal adhesions, open surgery (laparotomy) may be preferred, or the procedure may start laparoscopically and be converted to open surgery.

How Is Laparoscopic Ovarian Cyst Surgery Performed? (Steps of Laparoscopic Cystectomy / Oophorectomy)

Laparoscopic ovarian cyst surgery generally involves the following steps:

1. Anesthesia: The patient is put under general anesthesia.
2. Preparation: The surgical area is sterilized, and a catheter may be placed to empty the bladder.
3. Incision and Gas Insufflation: A small incision is made at the navel, and the abdominal cavity is inflated with CO2 gas.
4. Camera and Instrument Ports: The camera (laparoscope) is inserted through the incision at the navel, and surgical instruments are inserted through 1-3 small incisions in the lower abdomen.
5. Assessment: Using the camera image, the surgeon examines the entire abdominal cavity in detail, especially the uterus, fallopian tubes, and both ovaries. The appearance and size of the cyst and the presence of any adhesions are assessed.
6. Surgical Procedure (Cystectomy or Oophorectomy):
   
   • Laparoscopic Cystectomy (Removal of the Cyst While Preserving the Ovary): If the cyst appears benign and the ovarian tissue is healthy, the goal is to remove only the cyst. Using fine instruments, the surgeon carefully separates the cyst wall from the healthy ovarian tissue (the “stripping” technique). The aim of this procedure is to cause minimal damage to the healthy ovarian tissue. The cyst wall is removed in its entirety. Small bleeding vessels are controlled with cautery or other energy-based methods.
   • Laparoscopic Oophorectomy (Removal of the Ovary Together With the Cyst): If the cyst appears suspicious, the ovarian tissue has been completely destroyed by the cyst, the patient is postmenopausal, or there are other medical reasons, the ovary may be removed entirely along with the cyst. The ligaments and blood vessels connecting the ovary to the uterus and pelvic wall are cut and sealed to free the ovary.
7. Tissue Removal: The removed cyst or ovarian tissue is placed in a special bag (endobag) to prevent it from spreading inside the abdomen. This bag is then removed through one of the abdominal incisions (usually slightly enlarged) or, sometimes, through the vagina. Large tissue specimens may be broken into smaller pieces inside the bag before removal.
8. Final Check and Closure: The abdominal cavity is irrigated, and a final check for bleeding is performed. The gas is released from the abdomen. The instruments are removed, and the small incisions are closed with cosmetic sutures or special tapes.
9. Pathology: All removed tissue is always sent for pathological examination for a definitive diagnosis.

What Are the Risks of Laparoscopic Ovarian Cyst Surgery?

Laparoscopic ovarian cyst surgeries are generally safe procedures, but they do carry potential risks:

• General Surgical and Anesthesia Risks: Bleeding, infection, clot formation (DVT/PE), and anesthesia-related complications.
• Organ Injury: Although very rare, injury to the bladder, ureter (urinary tract), bowel, or major blood vessels can occur during surgery. This risk may be somewhat higher in patients with adhesions from previous surgeries or difficult anatomy. Experienced surgeons minimize this risk.
• Conversion to Open Surgery: If unexpected situations arise during laparoscopy, such as technical difficulties, uncontrollable bleeding, or organ injury, the procedure may be converted to open surgery for the patient’s safety.
• Decrease in Ovarian Reserve: Especially during cystectomy, some damage may occur to the healthy ovarian tissue. This can affect the ovarian reserve (egg count). This risk depends on the size and type of the cyst, as well as the surgeon’s experience and technique.
• Loss of the Ovary: Even if cystectomy is planned, if the ovarian tissue is found to be too damaged during surgery or an unexpected complication occurs, complete removal of the ovary (oophorectomy) may become necessary.
• Cyst Recurrence: Especially endometriomas (chocolate cysts) or certain functional cysts may recur after surgery. Dermoid cysts or cystadenomas generally do not recur once completely removed.
• Adhesions: Adhesions may form inside the abdomen after surgery.

Recovery Process After Laparoscopic Ovarian Cyst Surgery

One of the biggest advantages of laparoscopic surgery is its rapid recovery process:

• Hospital Stay: Generally, staying in the hospital the same day or for one night after surgery is sufficient.
• Pain: Postoperative pain is generally mild and can be easily controlled with oral painkillers. Shoulder pain may occur for a few days due to residual gas in the abdomen.
• Activity: Patients can generally get up and walk the day after surgery. Light housework and short walks can be started within a few days. Return to normal daily activities and non-strenuous work is generally possible within 1-2 weeks. Avoiding heavy lifting (over 5 kg) and strenuous exercise for approximately 2-4 weeks is recommended.
• Wound Care: The small incisions generally close on their own or are closed with cosmetic sutures. It is sufficient to keep them clean and dry. Whether dressing changes or suture removal are needed depends on the doctor’s preference.
• Follow-up: A follow-up examination is generally performed 1-2 weeks after surgery. The pathology result is shared with the patient at this visit or earlier. Whether additional follow-up or treatment is needed is determined based on the cyst type and pathology result.

Laparoscopic Ovarian Cyst Surgery in Ankara: A Safe and Protective Approach With Prof. Dr. Nuray Bozkurt

In the surgical treatment of ovarian cysts, Prof. Dr. Nuray Bozkurt offers her patients the most up-to-date and comfortable treatment options in Ankara, using modern laparoscopic (closed) surgical techniques:

• Expert Evaluation: Before surgery, she evaluates the patient in detail, determines the characteristics of the cyst through ultrasound and other tests, and carefully establishes whether surgery is necessary.
• Focus on Minimally Invasive Surgery: As long as it is suitable for the patient, she prefers the laparoscopic method over open surgery, ensuring faster recovery and less pain for the patient.
• Ovary-Preserving Surgical Principle: Especially in women of reproductive age, she takes great care to preserve as much healthy ovarian tissue as possible during surgery (laparoscopic cystectomy). Her goal is both to treat the cyst and to preserve the patient’s fertility potential.
• Experienced Surgical Practice: She performs laparoscopic cystectomy and oophorectomy surgeries in advanced-technology, safe hospital settings in Ankara, taking all necessary precautions.
• Patient Information and Support: She informs her patients in detail about the pre- and postoperative process, explains the risks and benefits, answers their questions, and provides support throughout the entire process.
• Easy Communication: She ensures her patients can easily reach her during the postoperative follow-up process or if any problem arises (0538 983 18 78)(0312 284 00 12).

If surgery has been recommended for your ovarian cyst, or if you would like more information about the laparoscopic (closed) surgery option, you can consult Prof. Dr. Nuray Bozkurt at our clinic in Ankara. To determine the safest approach best suited to your specific situation, and an ovary-preserving surgical approach whenever possible, please call 0538 983 18 78 to schedule an appointment. We are here to help you regain your health with modern surgical methods.