Gynaecology

Ovarian Cystectomy

at Cadogan Clinic, Leaders in Women’s Health and Wellness.

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What is an Ovarian Cystectomy?

An ovarian cystectomy is a surgical procedure to remove large or persistent cysts from the ovaries.

There are two different types of surgical procedure used in an ovarian cystectomy, namely a laparoscopy and laparotomy. Most cysts will be removed via laparoscopy. More commonly known as keyhole surgery, a laparoscopic ovarian cystectomy is a minimally-invasive surgical procedure which allows the surgeon to see inside the abdomen and pelvis without having to make large cuts through the skin. Instead only a small incision is needed, just big enough to allow a small tube with a light and camera into the body. However if the cyst is particularly large, or if there are concerns that the cyst may be cancerous, then a laparotomy will be carried out instead. This procedure involves a larger cut to the abdomen to give the surgeon a better view of the ovary and the cyst. It is a more major surgery, meaning the ovarian cystectomy recovery time is longer than a laparoscopy. Both operations are carried out under a general anaesthetic.

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When is an Ovarian Cystectomy necessary?

Often ovarian cysts are harmless and go on their own over the course of a few months without the need for medical intervention. Sometimes doctors may adopt a ‘watchful waiting’ approach, using ultrasound scans and blood tests to monitor cyst development. A doctor will decide on the appropriate treatment depending on the size and appearance of the cyst, whether it is causing any symptoms and whether the patient has been through menopause. This is because postmenopausal women are at a slightly higher risk of ovarian cancer.

But there are some cases where an ovarian cystectomy is necessary. If an ovarian cyst ruptures, is very large (bigger than seven centimetres) or blocks the blood supply to the ovaries, then this can cause pain, urinary problems and digestive problems. Large ovarian cysts may lead to a condition called ovarian torsion, a rare complication which sees the ovary twist on the tissues that support it. It can cause sudden, intense pain and vomiting. If not treated promptly, it can cause the ovary to die. Ovarian torsion is a medical emergency.

An ovarian cystectomy is necessary if the cyst is thought to be cancerous or could turn cancerous.


What does the procedure involve?

Laparoscopy: The surgeon will begin by making a small incision measuring around 1-1.5cm in the abdomen, usually close to the belly button. A tube will be inserted into this opening and carbon dioxide gas is pumped into the abdomen, lifting the wall of the abdomen to give the surgeon a clear view of the ovary and the cyst. The laparoscope, which has a light source and a camera, is then inserted through this tube. The pictures from the camera are displayed on a monitor so the surgeon can have a good view of what is going on inside the body.

Small surgical instruments are inserted through the incisions and the surgeon removes the cyst through the small cuts in the skin.

Once the procedure is over, the carbon dioxide will be let out of the abdomen and the incisions closed using dissolvable stitches.

A laparoscopic ovarian cystectomy is carried out as a day case and because it is minimally invasive, it has a quicker recovery time.

Laparotomy: If the cyst is particularly large, or if there are concerns that it may be cancerous, then a laparotomy will be carried out instead. A single larger cut is made in the abdomen to give the surgeon better access to the cyst and the ovary. The whole cyst and sometimes the ovary may be removed and sent off for further tests. Stitches or staples will be used to close the incision. The ovarian cystectomy recovery time is longer for a laparotomy.


What can I do to enhance my fertility?

The goal of ovarian cystectomy is to preserve as much of your fertility as possible. If the surgeon has no choice but to remove one of your ovaries along with your cyst, then the remaining ovary should still release eggs and hormones as normal and you should still be able to get pregnant. If both ovaries are removed, then this puts the body into menopause and you will be unable to get pregnant.

If your ovarian cysts are caused by an underlying health condition, such as endometriosis or polycystic ovary syndrome (PCOS) then treating these conditions can help to reduce the likelihood of harmful cysts from developing and help to increase your chances of getting pregnant.

Laparoscopy can be used to treat endometriosis and a minor surgical procedure called laparoscopic ovarian drilling, which involves using heat or a laser to destroy part of the ovary, can help with PCOS if ovulation medicine has not worked.

It is also important to practice safe sex with new partners and seek treatment for sexually transmitted infections (STIs). This is because chlamydia and gonorrhoea, two common STIs, can lead to complications such as pelvic inflammatory disease (PID) and infertility in women if left untreated. A lot of people do not display any symptoms of chlamydia and gonorrhoea, so it is important to get tested.

Other things you can do to enhance your fertility include maintaining a healthy weight, particularly as obesity raises the risk of PCOS, quitting smoking, cutting alcohol consumption, stopping using illegal drugs, keeping stress levels in check and eating a healthy diet.


What causes ovarian cysts?

Most cysts form as a natural part of the menstrual cycle and are very common.

As part of a woman’s monthly cycle, the ovaries release an egg to be released during ovulation. The egg grows inside the ovary in a follicle, which contains fluid that protects the egg as it grows. Once the egg is released, the follicle bursts and shrinks.

However sometimes the follicle does not release an egg or it does not burst and shrink as it is supposed to. If this happens, the follicle becomes swollen and turns into a cyst.

This type of cyst is very common, noncancerous and usually harmless.

Cysts which form due to abnormal cell growth are not linked to the menstrual cycle and can also affect women who have been through menopause. This abnormal  growth can occur in cells that are used to create eggs or cells that are found on the outer part of the ovary. Cysts caused by abnormal cell growth can grow to a large size or rupture and sometimes they can even block the blood supply to the ovaries. In rare cases, they may be cancerous. Cysts caused by abnormal cell growth may be surgically removed via an ovarian cystectomy.

Endometriosis is a medical condition where tissue similar to that found in the lining of the uterus is found growing outside of this space, such as on or in the fallopian tubes, ovaries, vagina, bowel or intestine.

It is a long-term medical condition and although some women are fortunate enough not to experience any endometriosis symptoms, for others the condition can have a devastating impact on their quality of life. Endometriosis pain can be debilitating and the condition sometimes causes infertility. Other complications may include the development of blood-filled ovarian cysts.

Polycystic Ovary Syndrome, commonly known by its initials PCOS, is a condition that affects the functions of a woman’s ovaries. This includes irregular ovulation and the development of harmless fluid-filled sacs, causing the enlargement of the ovaries. PCSO may be caused by the presence of high levels of male hormones, insulin resistance, genetics or low-grade inflammation.

Pelvic inflammatory disease (PID) is a bacterial infection that affects the female reproductive system. It can be successfully treated with antibiotics if caught early, but as it progresses it can damage the uterus and fallopian tubes, causing collections of infected fluid to develop in the fallopian tubes and ovaries.


How long does it take to recover from an Ovarian Cystectomy?

The ovarian cystectomy recovery time depends on the type of surgery performed. A laparoscopic ovarian cystectomy generally has a faster recovery time.

In the days after your ovarian cystectomy, you may experience bruising, pain or discomfort in your lower abdomen. You may feel more tired than normal and there may be a small amount of vaginal bleeding for a couple of days. If you have had a laparoscopic ovarian cystectomy, you may also find you have some pain in your shoulders. This is because of the presence of carbon dioxide gas used to lift the wall of the abdomen. This is normal and the gas will naturally disperse.

You may feel able to return to work after two or three weeks, depending on the nature of your job and the type of surgery carried out. If you have a job that involves heavy lifting or strenuous physical activity, you should consult your doctor before returning. Heavy lifting, or pushing and pulling heavy objects, should be avoided during the recovery period. Most women can expect a full recovery by six weeks.

You should avoid smoking as this can delay the recovery process. Make sure you follow all the aftercare instructions issued by your surgeon.



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Frequently Asked Questions

Early warning signs of an ovarian cyst include pelvic pain, which can range from a dull ache to a very sudden, sharp and severe pain. A woman with an ovarian cyst may experience a frequent need to urinate, difficulty emptying her bowels, bloating, feel full despite not eating much food, and period changes (heavier, lighter or irregular bleeding). Pain during sex is also an early warning sign that an ovarian cyst may be present.

No, there is no conclusive proof that stress causes ovarian cysts. Cysts are linked to the menstrual cycle or underlying medical conditions, such as endometriosis and polycystic ovarian syndrome (PCOS). Sometimes it is not clear what causes ovarian cysts to form.

There are two main types of ovarian cysts. Functional ovarian cysts develop as part of the menstrual cycle. These are common, short-lived and usually harmless. Pathological ovarian cysts are much less common and are the result of abnormal cell growth.

Other types of cysts include dermoid cysts (rarely cancerous but can contain tissue such as skin, hair or teeth), cystadenoma (filled with watery or mucous material and grow on the surface of the ovary) and endometrioma (caused by endometriosis).

The ovarian cystectomy itself is not painful, as a keyhole and open surgery are carried out under a general anaesthetic. You may experience pain or discomfort in your lower abdomen in the days after surgery. This can be controlled with over-the-counter painkillers.

Possible ovarian cystectomy complications include blood clots, damage to surrounding organs or the development of a hernia.

If you experience any heavy bleeding, fever, severe pain or swelling in the abdomen or a dark, smelly vaginal discharge then you should contact the doctor straight away as this may indicate an infection.


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