Laparoscopic Ovarian Cystectomy

Medically reviewed by Dr Manan Boob, MS ObGyn (Gold Medalist), DNB — Consultant Gynaecologist & Laparoscopic Surgeon

What it is

A laparoscopic ovarian cystectomy is an operation to remove a cyst from the ovary through three or four small openings in the abdomen, while leaving the ovary itself in place and working.

That last part is the whole point. The alternative operation — oophorectomy — takes the entire ovary out with the cyst inside it. A cystectomy is more painstaking: the shell of the cyst is separated from the normal ovarian tissue wrapped around it, lifted out whole wherever possible, and the ovary is then reshaped so it heals into something close to its old self. It takes longer and it demands a steadier hand, and for a woman who has not completed her family — or who simply has no reason to lose an organ — it is worth every extra minute.

The cyst is placed in a retrieval bag before it comes out, so that its contents never spill into the abdomen. With a dermoid cyst full of sebaceous material, or a cyst where the pathology is not yet certain, that bag matters a great deal.

Who needs it

Not every cyst on a scan report needs an operation, and a good deal of my clinic time goes on reassuring women of exactly that. The cysts that do need surgery tend to be:

• Cysts that persist beyond two or three menstrual cycles instead of resolving, or that keep growing on serial scans.
• Cysts larger than about 5 centimetres that are unlikely to disappear on their own and carry a real risk of twisting.
• Endometriotic cysts (chocolate cysts) causing pain or interfering with fertility.
• Dermoid cysts, which never resolve spontaneously and slowly enlarge.
• Complex cysts on ultrasound — solid areas, thick septae, unusual blood flow — where we need tissue to know what we are dealing with.
• Ovarian torsion, where the ovary has twisted on its stalk. This is an emergency and the operation happens the same day.
• A cyst that has ruptured and is causing significant bleeding or pain.
• Cysts found during a fertility work-up that are getting in the way of treatment.

“My cyst is 4 cm and I have no symptoms at all. Why are you asking me to just wait?” Because in a woman who is still having periods, that is very often a follicle that grew a little too enthusiastically this month. Waiting six to eight weeks and repeating the scan costs you nothing and spares a lot of women an unnecessary operation. If it is still there at the next scan, we will talk about taking it out — but let us find out first.

How it is done

You come to theatre fasting, and the anaesthetist puts you to sleep.

A small opening is made near the navel, the abdomen is filled gently with carbon dioxide gas to create working space, and the telescope goes in. Two or three more slim ports are placed low down, in positions that are easy to hide.

The first thing we do is look — at both ovaries, the tubes, the uterus, the appendix, the lining of the pelvis. It is remarkably common to find something useful that the scan did not show, endometriosis in particular. Any free fluid is collected and sent for examination.

The ovary is then held steady and the covering over the cyst is opened at the point where the normal tissue is thinnest. This is the step that decides how good the result will be. The plane between the cyst wall and the ovary is found and the cyst is stripped out by gentle traction on both sides, working around it like peeling the skin off a grape without bruising the fruit. Where possible it comes out intact; endometriotic cysts, whose walls are stuck to the ovary, sometimes have to come out in pieces.

The raw surface inside the ovary is checked for bleeding and controlled with minimal, carefully targeted energy — over-enthusiastic cautery on an ovary destroys eggs, so we are miserly with it and use sutures instead where they will do the job. The ovary is left to close over itself or is stitched, depending on the size of the defect.

The cyst goes into a retrieval bag and out through one of the port sites. The pelvis is washed out, the gas is released and the small cuts are closed. The specimen is sent for histopathology in every case.

Anaesthesia, duration and hospital stay

The operation is done under general anaesthesia — you are fully asleep throughout.

A straightforward cystectomy takes 45 to 90 minutes. A large endometriotic cyst stuck to the bowel or pelvic wall, or a cyst in a pelvis scarred by previous surgery, can take two hours or more, and in that situation taking the time is exactly what protects the ovary.

Most women are admitted on the morning of surgery and go home after one night. You will be sipping water within a few hours, eating a light meal the same evening, and walking to the bathroom before you sleep. Painkillers are usually needed for the first two or three days and then only occasionally.

Recovery

Day 1. Sore at the small cuts and a bit bloated. A dull ache under one shoulder blade is common and comes from the gas, not from anything going wrong — walking clears it faster than lying still. Normal food, short walks, home the next morning in most cases.

The first week. Tiredness is the main complaint. Light bleeding or spotting per vaginum can occur and is not a problem. Showers from day three, dressings kept dry. Most women are off regular painkillers by day four.

Weeks 2 to 4. Desk work, driving, cooking, walking — all fine, guided by how you feel rather than by the calendar. Avoid lifting anything heavy, and hold off on the gym, swimming and vigorous exercise.

By six weeks. Everything back to normal, including exercise and intercourse. Your next period may be early, late or heavier than usual — the ovary has been handled and it takes a cycle or two to settle. Call us sooner if you develop fever, spreading redness at a port site, worsening pain, or vomiting.

The histopathology report usually comes back within a week to ten days, and we go through it with you in person.

Why keyhole rather than open surgery

For ovarian cysts, laparoscopy is the default approach in nearly every case, and for good reasons.

Magnification is the first one. Seeing the plane between cyst and ovary at four or five times life size means less normal ovarian tissue is sacrificed, which matters directly for your egg reserve. Beyond that: less bleeding, far less pain, one night in hospital rather than four or five, a much lower rate of wound infection and hernia, fewer adhesions afterwards — which is important if you are trying to conceive — and a return to work in one to two weeks instead of six.

Open surgery still has its place. A very large cyst, or one where the ultrasound and blood tests raise a genuine suspicion of malignancy, may need a different operation altogether with a different kind of preparation. Occasionally a laparoscopic case is converted to open midway. That is a judgement made in your interest, not a setback.

Risks and complications

This is a safe operation, but you are entitled to the honest list.

• Bleeding from the ovarian bed, occasionally needing further stitching or, rarely, a transfusion.
• Loss of ovarian reserve. Some healthy tissue inevitably goes with the cyst, and heat used to stop bleeding costs eggs. The risk is highest with large or recurrent endometriotic cysts.
• Removal of the whole ovary if the cyst has replaced the ovary entirely or bleeding cannot be controlled. Uncommon, but we discuss and consent for this possibility beforehand.
• Spillage of cyst contents, which is why we use a bag. Spilled dermoid material can cause chemical irritation.
• Injury to bowel, bladder or blood vessels — rare, more likely in a pelvis with dense adhesions.
• Infection of a port site or within the pelvis.
• Adhesion formation, which can affect fertility.
• Recurrence of the cyst, particularly endometriotic ones.
• An unexpected histopathology result that changes the plan and needs a second, more extensive operation.
• Conversion to open surgery.
• Anaesthetic risks, which the anaesthetist will discuss with you separately.

Alternatives

Watchful waiting. For simple cysts under about 5 centimetres in a woman who is still menstruating, a repeat scan after six to eight weeks is often the entire treatment. Our blog on ovarian cysts — when to worry and when to wait walks through how that decision is made.

Hormonal treatment. Combined pills do not shrink a cyst that already exists, but they suppress ovulation and so prevent new functional cysts from forming. For endometriosis, hormonal treatment controls pain and slows recurrence — useful before surgery, and often continued after it.

Pain management and follow-up alone, where the cyst is not dangerous and the symptoms are manageable.

Cyst aspiration, drawing the fluid out with a needle. We rarely recommend it: recurrence rates are high and, more importantly, you lose the cyst wall that the pathologist needs to look at.

Oophorectomy — removing the whole ovary — which becomes the sensible choice around or after menopause, when the ovary is no longer doing hormonal work, or when the cyst has left no usable ovarian tissue behind.

“If you find endometriosis in there, will you treat it in the same sitting?” Yes, and that is one of the arguments for having the operation done by a team that does this work regularly. Chocolate cysts almost never travel alone. Removing the cyst and leaving the deposits behind means the pain often comes back. See our advanced laparoscopy and hysteroscopy page for how we approach that.

What it costs

Laparoscopic ovarian cystectomy at Shubham Hi-Tech Hospital: ₹40,000 – ₹66,000. This is an all-inclusive figure — surgeon’s fee, operation theatre, anaesthesia, room rent for a typical stay, medicines and routine investigations.

Please note: The figures above are indicative estimates for a typical case. The final cost depends on your individual condition, the complexity of the surgery, the room category you choose, how long you stay, and any complications that arise. Deluxe and super-deluxe rooms are charged higher. Emergency admissions and night or holiday surgery attract additional charges. These charges are subject to change without prior intimation. Please call us on +91-8668954915 for a written estimate for your own case before you decide anything.

Preparing for your surgery

• Bring every scan you have, including the older ones. Two scans six weeks apart tell us more than one scan today.
• Bring blood reports, tumour marker results if they were done, and notes from any previous abdominal or pelvic operation.
• List all your medicines, especially blood thinners, aspirin and diabetes tablets. Some need stopping in advance — never stop them on your own.
• Tell us clearly if you are trying to conceive or planning to. It changes how we operate, not just what we advise afterwards.
• Nothing to eat for six hours and nothing to drink for two hours before surgery, unless told otherwise.
• Leave jewellery, nail polish and contact lenses at home.
• Arrange one attendant for the night and someone to drive you home.
• Keep two clear weeks free of heavy lifting and hard physical work.

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An ovarian cyst is one of those findings that sounds far more frightening on a scan report than it usually turns out to be — and the right answer is often patience rather than an operation. If a cyst has been found and you are not sure what to do next, bring your reports to the gynaecology and laparoscopy team at Shubham Hi-Tech Hospital, Amravati, and we will tell you plainly whether it needs removing or watching. Call +91-8668954915, get in touch here, or see all the procedures we perform.

Disclaimer: This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor for guidance specific to your situation.