Ovarian cysts
Ovarian cysts are sacs that develop in the ovary and are filled with fluid or other tissue. The most common are functional cysts, which form as part of ovulation; they often disappear on their own within a few menstrual cycles. Types of cyst that may require surgery include:
- Endometrioma (chocolate cyst): develops in connection with endometriosis.
- Dermoid cyst: a usually benign cyst that may contain different tissues such as fat and hair.
- Cystadenoma: a benign cyst that develops from the surface tissue of the ovary. Some similar-looking masses can be borderline or malignant; the definite distinction is made by pathological examination.
The small follicles seen in polycystic ovary syndrome are not cysts that require surgery.
Monitoring or surgery?
The decision takes into account the cyst’s appearance and size on ultrasound, age, menopausal status, complaints and, if necessary, blood tests. Simple-looking cysts that cause no complaints are mostly monitored with ultrasound. Surgery is considered if the cyst is growing, does not go away, causes complaints or looks suspicious. For masses that may be malignant, planning is different and an assessment by gynecologic oncology may be needed.
Laparoscopic approach
Cystectomy is usually performed laparoscopically (keyhole surgery): a camera and special instruments are introduced through small incisions in the abdomen. Open surgery may be needed because of the size or appearance of the cyst or adhesions from previous surgery. The removed tissue is sent for pathological examination.
Preserving ovarian tissue
The aim of the operation is to remove the cyst while preserving as much healthy ovarian tissue as possible. Ovarian tissue maintains the egg reserve and hormone production. Even so, surgery may reduce the ovarian reserve to some extent; this effect can be more marked in endometrioma surgery. For this reason, ovarian reserve tests such as AMH may be requested before surgery in people planning a pregnancy. After menopause, or when ovarian tissue cannot be preserved, removal of the whole ovary may be discussed.
Recovery and possible risks
After laparoscopic cystectomy, most people can return to daily activities within a short time; gas-related pain in the abdomen and shoulders may last a few days. Possible risks include bleeding, infection, blood clots, injury to the bowel or bladder, problems related to anesthesia, a reduction in ovarian reserve and recurrence of the cyst. If ovarian tissue cannot be preserved during the operation, removal of the ovary may rarely be necessary; this possibility is discussed before surgery.