Ovarian Cystectomy in Delhi, India

Ovarian cystectomy is a surgical procedure designed to remove ovarian cysts, which are fluid-filled sacs that develop on the ovaries. The surgery is typically performed when a cyst causes significant symptoms, such as pain or discomfort, or when it poses potential health risks. During the procedure, the surgeon makes an incision in the abdomen to access the ovaries and carefully excises the cyst while preserving as much of the healthy ovarian tissue as possible. The operation can be done through various approaches including minimally invasive laparoscopy, open surgery, and robotic-assisted surgery. The primary goal of ovarian cystectomy is to alleviate symptoms and address any concerns related to the cyst’s impact on the patient’s health.

There are two main ways in which an ovarian cystectomy can be done:

Laparoscopic ovarian cystectomy

This minimally invasive technique involves making a few small incisions in the abdomen. A laparoscope—a thin, flexible tube with a camera—is inserted through one incision, allowing the surgeon to view the cyst and surrounding structures on a monitor. Specialised surgical instruments are inserted through the other incisions to remove the cyst. Laparoscopic ovarian cystectomy generally results in less postoperative pain, quicker recovery, and smaller scars compared to traditional open surgery.

Robotic-Assisted Ovarian Cystectomy

This advanced technique uses a robotic surgical system that assists the surgeon in removing the cyst. Controlled by the surgeon, the robotic instruments provide enhanced precision, flexibility, and a three-dimensional view of the surgical site. This method is particularly useful for intricate procedures, offering benefits similar to laparoscopy, including shorter recovery times and reduced scarring.

Open ovarian cystectomy

In cases where the cyst is large, complex, or complications are anticipated, an open ovarian cystectomy may be necessary. This approach involves making a larger incision in the abdomen to directly access and remove the cyst without causing any spillage of contents. Although this method provides a clear view and allows for the removal of larger cysts, it typically involves a longer recovery period, more postoperative pain, and larger scars compared to laparoscopic surgery.

Ovarian cystectomy offers several benefits, especially when other treatments have not been effective or the cyst poses significant health concerns. Here are some key advantages:

• Symptom Relief: The procedure effectively alleviates symptoms caused by ovarian cysts, such as pelvic pain, bloating, and discomfort, improving the patient’s quality of life.
• Prevention of Complications: Removing the cyst can prevent potential complications, such as rupture or torsion (twisting of the ovary), which can lead to more severe pain, extra abdominal bleeding and health issues.
• Preservation of Ovarian Function: Especially with laparoscopic cystectomy, efforts are made to preserve as much healthy ovarian tissue as possible, which helps maintain normal ovarian function and hormonal balance as well as preserve fertility. 
• Improved Diagnostic Accuracy: During the procedure, the cyst and surrounding tissue can be examined more closely, allowing for a more accurate diagnosis and better management of any underlying conditions.
• Minimally Invasive Option: For suitable cases, laparoscopic cystectomy offers a less invasive approach with quicker recovery times, less postoperative pain, and minimal scarring compared to traditional open surgery and early resumption of daily activities. 
• Enhanced Fertility Preservation: The procedure helps maintain fertility for women who wish to conceive in the future by removing the cyst while preserving healthy ovarian tissue.

Before The Procedure

Before undergoing an ovarian cystectomy, patients will go through several preparatory steps to ensure that the procedure is as safe and effective as possible:

• Preoperative Assessment: Patients will undergo a comprehensive evaluation, which includes a detailed review of their medical history, current health status, and any previous surgeries or conditions. Imaging tests, such as pelvic ultrasound or CT scans, will be performed to determine the size, location, and type of cyst, as well as to assess the overall health of the ovaries and surrounding structures.
• Preoperative Instructions: Specific instructions, including dietary guidelines, will be provided. Patients are typically advised to fast for several hours before the surgery, especially if general anaesthesia is used. This fasting period usually begins the night before the surgery. Clear instructions on what is allowed and what should be avoided will be given.
• Medications: The healthcare provider will review the patient’s current medications and may recommend stopping or adjusting certain drugs, particularly those that could affect blood clotting or interact with anaesthesia. Patients should follow these instructions closely and discuss any concerns with their doctor. If necessary, alternative medications may be prescribed.
• Anaesthesia Consultation: An anaesthesiologist will meet with the patient to discuss the anaesthesia options, including the type of anaesthesia to be used and any associated risks. They will review the patient’s health history to ensure a safe anaesthesia plan and answer any questions the patient may have.
• Preparation for the Procedure Day: Patients should plan for someone to drive them to and from the hospital, as they will be under the effects of anaesthesia and will not be able to drive themselves. It’s also a good idea to arrange for support at home during the initial recovery period.

During The Procedure

During an ovarian cystectomy, patients can expect the following steps:

• Anaesthesia: The procedure is performed under general anaesthesia, meaning the patient will be asleep and pain-free throughout the surgery.
• Incisions: Depending on the surgical method, the surgeon will either make small incisions for laparoscopic surgery or a larger incision for open surgery. In laparoscopic surgery, a camera (laparoscope) is inserted to guide the removal of the cyst.
• Cyst Removal: The surgeon will carefully remove the cyst while preserving as much healthy ovarian tissue as possible. If multiple cysts are present, they may all be removed during the same procedure.
• Frozen Section Analysis: In some cases, especially when the cyst appears unusual during surgery, a portion of the removed tissue is sent for a frozen section analysis. This quick biopsy helps determine whether the cyst is benign or malignant, providing immediate information that may guide further surgical steps.
• Examination: The cyst may be sent to a lab for detailed pathological analysis to confirm its nature and rule out malignancy.
• Closure: Once the cyst is removed, the incisions are closed with stitches or surgical glue. In the case of open surgery, the larger incision is sutured closed.

This process typically takes a couple of hours, depending on the complexity of the surgery and the size of the cyst.

After The Procedure

After an ovarian cystectomy, patients can expect the following:

• Recovery Room: Immediately after the surgery, patients will be taken to a recovery room, where medical staff will monitor vital signs as they wake up from anaesthesia.
• Postoperative Pain and Discomfort: Some pain or discomfort, particularly at the incision sites, is normal. Pain medication will be provided to manage this.
• Hospital Stay: For laparoscopic surgery, most patients can go home the same day. In cases of open surgery, a short hospital stay (1-2 days) may be required for monitoring and recovery.
• Activity Restrictions: Patients will need to avoid strenuous activities, heavy lifting, and exercise for a few weeks, particularly after open surgery. Gentle walking is encouraged to aid recovery.
• Follow-up Appointments: A follow-up visit with the surgeon will be scheduled to monitor healing and review lab results of the cyst. Any signs of infection or complications, such as fever or increased pain, should be reported.
• Resuming Daily Activities: Most patients can gradually return to normal activities within 1–2 weeks for laparoscopic surgery, while recovery from open surgery may take longer, typically 4–6 weeks.

Patients can expect improvement in symptoms once healed and a gradual return to their usual routines.

Ovarian cystectomy carries some risks and potential complications, which should be discussed with the doctor prior to surgery. These include:

• Infection: As with any surgical procedure, there is a risk of infection, either at the incision sites or internally. Signs include redness, swelling, fever, or discharge. Infections are typically treated with antibiotics but may require further intervention if severe.
• Bleeding: While controlled during surgery, excessive bleeding can occur, either during the operation or postoperatively. In rare cases, significant blood loss may require a blood transfusion or additional surgery.
• Damage to Surrounding Organs: Since the ovaries are located near structures like the bladder, ureter, intestines, and blood vessels, there is a small risk of unintentional injury during surgery. This is more likely in complicated or larger cyst cases. If damage occurs, additional surgical repair may be needed.
• Ovarian Damage or Loss: The goal is to preserve the ovary, but in some cases, removing the cyst may cause damage to healthy ovarian tissue. If the ovary is severely affected or if the cyst is too large, the entire ovary might need to be removed, which could affect hormone levels and fertility.
• Formation of Scar Tissue (Adhesions): After surgery, adhesions or scar tissue may form inside the pelvis, which could lead to chronic pelvic pain, difficulty with future surgeries, or even fertility issues if they affect the fallopian tubes or reproductive organs, typically more in open surgery. 
• Recurrence of Cysts: While the removed cyst will not return, the development of new cysts on the ovaries in the future is possible, particularly in individuals with a history of recurrent ovarian cysts.
• Anaesthesia-related Risks: Complications from general anaesthesia include allergic reactions, breathing difficulties, or heart issues, especially in patients with pre-existing conditions. Nausea and vomiting post-surgery are common anaesthesia side effects, but typically resolve quickly.
• Blood Clots (Deep Vein Thrombosis): There is a small risk of developing blood clots in the legs during recovery, especially if mobility is limited after surgery. These clots can be dangerous if they travel to the lungs (pulmonary embolism), making early movement and preventive measures important.
• Changes in Menstrual Cycle: Some women may experience temporary changes in their menstrual cycle after surgery, such as irregular periods, due to the impact on the ovaries.
• Fertility Concerns: Although efforts are made to preserve fertility, repeated surgeries or damage to the ovaries could affect a woman’s ability to conceive. It's essential to discuss fertility preservation options with the surgeon before the procedure if future pregnancy is a concern.

While these complications are relatively rare, understanding them allows patients to make informed decisions and prepare for the recovery process.

How long does the ovarian cystectomy procedure take?

The duration of an ovarian cystectomy typically ranges from 1 to 2 hours, depending on the size and complexity of the cyst and the surgical method used (laparoscopic vs. open surgery). However, recovery time in the hospital or outpatient centre may extend the overall time spent there.

Will ovarian cystectomy affect my hormonal balance?

 In most cases, ovarian cystectomy does not significantly affect hormonal balance, especially if only the cyst is removed, leaving the ovaries intact. However, if one or both ovaries are removed, it could impact hormone production, which may lead to hormonal changes such as irregular periods or menopause symptoms if both ovaries are removed.

What types of ovarian cysts typically require surgery?

Ovarian cysts that typically require surgery include large cysts (over 5 cm), cysts that cause significant pain or discomfort, cysts that appear suspicious for cancer, or those that persist or grow despite conservative ovarian cyst treatments. Dermoid cysts, endometriomas, and cystadenomas are some types that might require surgical removal.

Are there non-surgical alternatives to ovarian cystectomy?

Yes, non-surgical options may include watchful waiting, where the cyst is monitored with periodic ultrasounds to see if it resolves on its own, and hormonal birth control pills, which may prevent new cysts from forming. Pain management strategies can also help manage symptoms, but these alternatives are only applicable in cases of benign or small, asymptomatic cysts.

Will I need hormone therapy if one or both ovaries are removed?

If only one ovary is removed, the remaining ovary usually continues to produce enough hormones to prevent the need for hormone replacement therapy (HRT). However, if both ovaries are removed, hormone therapy may be recommended to help manage symptoms of menopause, such as hot flashes, mood changes, and bone loss.

How often should I have follow-up exams after an ovarian cystectomy?

Follow-up exams are typically scheduled within a few weeks after surgery to assess healing and review any pathology results from the cyst. If the surgery was for benign cysts, annual pelvic exams may be recommended. However, for patients with a history of cyst recurrence or other risk factors, more frequent monitoring might be advised.

Is ovarian cystectomy a permanent solution, or can cysts return?

Ovarian cystectomy removes the existing cysts, but it does not prevent new cysts from forming. Some women, especially those with certain conditions like polycystic ovary syndrome (PCOS) or endometriosis, may experience recurrent cysts even after surgery. Regular monitoring can help detect any new cysts early.

Reviewed by Dr. Ankita Chandna, Director - Obstetrics & Gynaecology, Robotic & Laparoscopic Gynaecology Surgery on 16 Dec 2024.