An ovarian cystectomy is a surgical procedure focused on removing a cyst from one or both ovaries while preserving healthy ovarian tissue and function. This approach is fundamentally different from an oophorectomy, which involves the removal of the entire ovary. This targeted surgery aims to resolve the issues caused by the cyst while maintaining the patient’s reproductive potential and hormonal production.
Defining Ovarian Cystectomy
The primary objective of an ovarian cystectomy is the removal of a fluid-filled sac from the ovary. Surgeons attempt to peel the cyst wall away from the normal ovarian tissue, which helps to conserve the organ’s ability to produce eggs and hormones. This preservation is particularly important for patients of reproductive age.
Most ovarian cysts are benign and resolve without intervention. Surgery becomes necessary when a cyst is causing persistent and severe symptoms, such as chronic pelvic pain or bloating. Cysts that are large (often exceeding 5 to 10 centimeters) or those that appear complex on imaging, such as having solid components or internal septations, may also require removal.
Urgent indications for surgery include complications like ovarian torsion, where the ovary twists on its supporting ligaments, or cyst rupture, both of which cause sudden, severe pain. A strong suspicion of malignancy, based on imaging characteristics or elevated tumor markers like CA-125, necessitates surgical removal and pathological examination of the cyst tissue. Cystectomy is the preferred approach for benign masses in premenopausal patients to maintain fertility.
Different Surgical Techniques
Ovarian cystectomy is performed using one of two primary surgical methods, with the choice depending on factors like cyst size, suspicion of cancer, and the patient’s medical history.
Laparoscopic Cystectomy
Laparoscopic cystectomy, often referred to as “keyhole surgery,” is the minimally invasive approach. This involves making a few small incisions, typically three, in the abdomen. Through one incision, a laparoscope—equipped with a camera and light—is inserted to visualize the pelvic organs. Specialized surgical tools are then inserted through the other ports to carefully separate the cyst from the ovarian tissue. The cyst is then removed, sometimes placed in a retrieval bag before extraction to prevent spillage, and the remaining ovarian tissue is repaired. Laparoscopy is favored because it is less invasive, results in smaller scars, and is associated with reduced post-operative pain.
Laparotomy
The second approach is a laparotomy, or open abdominal surgery, which requires a single, larger incision in the lower abdomen. This method is reserved for cases where the cyst is extremely large, if there is a high suspicion of cancer, or if the presence of extensive scar tissue from prior surgeries makes the laparoscopic approach unsafe. Although more invasive, laparotomy provides the surgeon with direct access to the reproductive organs, which is necessary for complex or potentially malignant masses.
Recovery and Post-Operative Care
The recovery period following an ovarian cystectomy varies significantly based on the surgical technique used.
Laparoscopic Recovery
Patients undergoing a laparoscopic cystectomy often experience a quicker recovery, sometimes being discharged from the hospital the same day or after a short overnight stay. Recovery typically spans one to three weeks before a return to normal daily activities. During the first 24 to 48 hours after laparoscopy, patients may experience abdominal discomfort and referred pain in the shoulder or neck, a temporary side effect caused by the residual carbon dioxide gas used to inflate the abdomen during the procedure. Pain management is typically achieved with prescribed or over-the-counter medication. Patients are encouraged to engage in light activity, such as short walks, soon after surgery to aid circulation and prevent blood clots, but they must avoid heavy lifting or strenuous exercise for at least two weeks.
Laparotomy Recovery
Recovery following an open cystectomy (laparotomy) is considerably longer due to the larger incision and greater tissue manipulation. Patients generally require a hospital stay of one to three days. Full recovery can take six to eight weeks, during which time patients must strictly avoid putting strain on the abdomen, including heavy lifting, pushing, or pulling. Returning to work or driving may be delayed for several weeks, and the surgeon will provide specific, detailed instructions for incision care and activity restrictions.
Long-Term Ovarian Function
A primary benefit of the ovarian cystectomy is the preservation of the ovary, which maintains long-term ovarian function, including hormonal production and fertility potential. While there may be a temporary decline in ovarian reserve, measurable through a decrease in Anti-Müllerian Hormone (AMH) levels, this often recovers within three to six months after surgery. The impact on ovarian reserve is influenced by factors such as the cyst type, particularly endometriomas, and the surgical technique used for hemostasis.
Surgeons employ careful techniques to reduce trauma to the healthy ovarian tissue and preserve the follicular pool. Despite the preservation of the ovary, there is a risk of cyst recurrence, especially with certain types of cysts like endometriomas. This necessitates ongoing follow-up care and monitoring with the gynecologist, especially for women planning future pregnancies. For women with significant fertility concerns, a discussion about potential impacts and options like egg or embryo freezing before surgery may be warranted.