Laparoscopıc Cystectomy

Laparoscopic cystectomy is a closed surgical method performed through small incisions, especially used for the removal of ovarian cysts. In gynecology, it may be preferred both to provide diagnostic clarity and to treat cysts that need to be evaluated in terms of pain, pressure, growth tendency, or the possibility of malignancy [1][2][3].

When laparoscopic cystectomy is planned, the main goal is not only to remove the cyst. In appropriate cases, it is also important to preserve the ovary, make the recovery process more comfortable, improve the patient’s quality of life, and take fertility plans into account as much as possible if pregnancy is planned [2][4].

Not every ovarian cyst requires surgery. Some small, simple, and asymptomatic cysts can be monitored with ultrasound at certain intervals. However, if the cyst is large, persistent, painful, tends to grow, or has findings suggesting a malignant structure, surgery may become a stronger option [2][3][4].

At this point, laparoscopic cystectomy stands out in suitable patients because it can offer advantages such as smaller incisions, less pain, and faster recovery compared with open surgery [1][2][5]. With a detailed gynecological evaluation by Assoc. Prof. Dr. Nazlı Korkmaz, whether laparoscopic cystectomy is truly necessary and which surgical approach would be more appropriate can be clarified.

What Is Laparoscopic Cystectomy?

Laparoscopic cystectomy is the procedure of carefully separating and removing a cyst from ovarian tissue. The main difference here is that the focus is on clearing the cyst rather than removing the entire ovary. This distinction is especially important in patients who have fertility plans [2][4].

ACOG defines laparoscopy as a surgical method in which a camera and surgical instruments are used through small incisions [1]. Cleveland Clinic states that ovarian cystectomy is the procedure of removing ovarian cysts, and that many ovarian cysts may disappear without treatment; however, if surgery is required, the procedure can be performed laparoscopically in suitable patients [4].

In the laparoscopic method, a large incision is not made in the abdominal wall. Instead, three or four small incisions are usually made around the navel and in the lower abdominal area. A camera system is placed through one of these incisions, while thin surgical instruments are advanced through the others [1][2][5].

With the carbon dioxide gas introduced into the abdomen, the surgical field is seen more clearly and the cyst is removed in a controlled manner. This technique allows the surgeon to obtain better visibility and approach surrounding tissues more precisely [1][2].

In Which Situations Is Laparoscopic Cystectomy Necessary?

The need for laparoscopic cystectomy is not the same for every patient. In general, surgery may come to the agenda for cysts that cause pain, show growth, do not disappear spontaneously, recur, or need close evaluation in terms of imaging findings [2][3][4].

The NHS states that large or persistent ovarian cysts and cysts that cause symptoms are often surgically removed [2]. Mayo Clinic also notes that surgery may be considered for cysts that are large, growing, painful, or do not appear to be functional cysts [3].

Situations in which laparoscopic cystectomy may be evaluated include:

• Persistent or growing ovarian cysts
• Cysts causing groin pain, pressure, or bloating
• Structures that do not have the appearance of functional cysts
• Cysts such as endometriomas that are not expected to disappear spontaneously
• Large cysts that may increase the risk of ovarian torsion
• Cysts requiring close evaluation on ultrasound or MRI
• Cystic structures that may affect fertility or cause pain

The important point here is that the information “there is a cyst” alone is not sufficient for a surgical decision. The patient’s age, menopausal status, internal structure of the cyst, whether it is unilateral or bilateral, tumor markers, ultrasound appearance, and overall risk assessment should be interpreted together [2][3].

How Is the Evaluation Performed Before Laparoscopic Cystectomy?

The first step before surgery is a detailed patient history. Menstrual pattern, duration and severity of groin pain, pain during intercourse, sudden pain attacks, previous cyst history, past surgeries, and pregnancy plans must be questioned.

After this, the size, location, and internal structure of the cyst are evaluated with gynecological examination and transvaginal ultrasound. ACOG states that imaging methods such as ultrasound may be used in the evaluation of ovarian cysts [1]. Mayo Clinic also emphasizes that the shape, content, and size of the cyst are important in the treatment decision [3].

If surgery is planned, anesthesia evaluation, necessary blood tests, and the surgical preparation process are initiated. Medications used, blood thinners, allergies, previous surgeries, and existing diseases must be shared before the procedure [2][5].

This preparation process is important for increasing surgical safety and reducing unexpected risks on the day of the operation. In planning performed by Assoc. Prof. Dr. Nazlı Korkmaz, it is necessary to evaluate not only the cyst itself but also how suitable the patient is for surgery.

How Is Laparoscopic Cystectomy Performed?

Laparoscopic cystectomy is usually performed under general anesthesia; in other words, the patient sleeps during the procedure and does not feel pain [2][5]. At the beginning of the operation, a small incision is made around the navel, the camera system is inserted through this incision, and the surgical field is expanded by introducing gas into the abdomen [1][2].

Afterwards, additional small incisions are made in the lower abdominal area, and the cyst is carefully separated from the ovary using surgical instruments. The removed material is sent for pathological examination when necessary. At the end of the procedure, the gas is released and the small incisions are closed [2][5].

The general stages of laparoscopic cystectomy are as follows:

1. Anesthesia: The patient is put to sleep with general anesthesia.
2. Making a small incision: Camera entry is usually made around the navel.
3. Introducing gas into the abdomen: The surgical field is made easier to see [1][2].
4. Creating additional entries: Thin surgical instruments are placed through the lower abdominal area.
5. Separating the cyst: The cyst is carefully removed from the ovarian tissue.
6. Bleeding control: The ovarian tissue and surrounding areas are checked.
7. Pathology: The removed cyst is sent to the laboratory when necessary.
8. Closure: The gas is released and the small incisions are closed.

One of the most critical goals in this surgery is to preserve healthy ovarian tissue as much as possible while clearing the cyst. Especially in young patients and in people who plan pregnancy in the future, it is particularly important for the surgical technique to be tissue-preserving [2][4].

What Are the Advantages of Laparoscopic Cystectomy?

The most important advantage of laparoscopic cystectomy is that it is less invasive than classic open surgery. The NHS states that laparoscopy is performed through small incisions and that most ovarian cysts can be removed using this method [2]. ACOG also notes that laparoscopy may provide advantages in the recovery process because it is performed through smaller incisions [1].

Possible advantages of laparoscopic cystectomy include:

• It is performed through small incisions.
• Postoperative pain may be less compared with open surgery [1][2].
• The hospital stay may be shorter [2][5].
• Return to daily life may be faster.
• The scar may be smaller.
• Ovarian tissue may be preserved in suitable patients [2][4].
• Pathological evaluation of the cyst can be performed.
• Diagnosis and treatment can be provided in the same session.

Thanks to small incisions, trauma to the abdominal wall is more limited. This may generally mean a shorter hospital stay, earlier return to daily life, and easier movement during the postoperative period [2][5].

Risks and Possible Complications of Laparoscopic Cystectomy

As with every surgery, laparoscopic cystectomy also has certain risks. These include bleeding, infection, injury to surrounding organs, need for additional surgery, and rarely failure to preserve the ovary [2][4][5].

In the Royal Berkshire NHS patient information form, risks of laparoscopic ovarian cystectomy include serious but rare complications such as damage to the bowel, bladder, ureter, uterus, or major blood vessels; hernia at the incision site; blood clot formation in the leg veins; and a clot traveling to the lungs [5].

Possible risks of laparoscopic cystectomy include:

• Bleeding
• Infection
• Bruising, redness, or wound opening at the incision site
• Injury to the bladder, bowel, ureter, or blood vessels [5]
• Ovarian tissue being affected more than expected
• The cyst not being completely removed or recurring
• Need to switch to open surgery
• Complications related to anesthesia
• Blood clot in the leg veins or a clot traveling to the lungs [5]
• Need for additional treatment depending on the pathology result

The likelihood of complications may vary depending on the difficulty of the surgery. Previous surgeries, dense adhesions, endometriosis, large cysts, or anatomical challenges may make the operation more complex [3][5]. Therefore, these risks must be explained clearly, directly, and understandably during the informed consent process before surgery.

Recovery Process After Laparoscopic Cystectomy

In the first hours after laparoscopic cystectomy, tenderness in the abdominal area, mild gas pain, fatigue, and sometimes pain radiating to the shoulder tip may be seen. This shoulder pain may occur due to the gas introduced into the abdomen and usually decreases within a short time [1][5].

Resting in the first days is important; however, remaining completely immobile is generally not recommended. Short walks support circulation and may facilitate recovery. Royal Berkshire NHS states that many patients may be discharged on the day of surgery or the next day, while the time to return to work may vary depending on the type of work and recovery [5].

Things to consider during the recovery period include:

• Painkillers recommended by the doctor should be used.
• Incision sites should be kept clean and dry.
• Circulation should be supported with short walks.
• Heavy lifting and intense exercise should be postponed until doctor approval.
• The period recommended by the doctor should be awaited for sexual intercourse, tampon use, or swimming.
• Pathology results and follow-up appointments should not be neglected.

In cases of severe abdominal pain, high fever, foul-smelling discharge, marked redness at the incision site, gradually increasing swelling, heavy bleeding, shortness of breath, or pain-swelling in the leg, a doctor should be consulted without delay [2][5].

The Relationship Between Laparoscopic Cystectomy and Fertility

One of the topics patients wonder about most when laparoscopic cystectomy is mentioned is whether fertility will be affected. The NHS states that in premenopausal patients, surgeons try to preserve the reproductive system whenever possible, and in most cases only the cyst can be removed while the ovary is left in place [2].

Cleveland Clinic also states that ovarian cystectomy aims to remove the cyst; however, if the cyst is very large or there is suspicion of cancer, different surgical approaches may be required [4]. Therefore, the effect on fertility varies depending on the type and size of the cyst, its relationship with ovarian tissue, and the scope of the surgery [2][4].

Especially in young patients, those planning pregnancy, or patients with only one actively functioning ovary, the surgical plan must be made very carefully. The important point here is both to treat the disease and to avoid unnecessary tissue loss. Appropriate patient selection and a tissue-preserving surgical approach may be decisive for long-term reproductive health.

For Whom May Laparoscopic Cystectomy Not Be Suitable?

Laparoscopic cystectomy may not be the first choice for every cyst. If the cyst is very large, if the possibility of malignancy is significant, or if there is a technical difficulty that the surgeon believes cannot be managed safely, open surgery may be more appropriate [2][3][4].

Mayo Clinic states that if the cyst is large or there is concern about cancer, an open procedure with a larger incision may be required [3]. The NHS also states that laparotomy may be preferred instead of laparoscopy in cases where cancer is suspected [2]. Therefore, a definitive approach such as “closed surgery is always better” is not correct.

Situations in which laparoscopic cystectomy should be evaluated carefully include:

• Very large ovarian cysts
• Suspicion of a malignant mass
• Expected dense intra-abdominal adhesions
• Advanced endometriosis and suspicion of bowel/bladder involvement
• Having undergone many previous abdominal surgeries
• High-risk situations in terms of anesthesia
• Serious heart, lung, or coagulation problems

The aim here is not only to make a small incision, but to achieve the safest and most appropriate surgical result. Therefore, suitability for laparoscopic cystectomy should be determined through a detailed clinical evaluation before surgery.

Practical Information Before and After Laparoscopic Cystectomy

This table summarizes the basic framework regarding laparoscopic cystectomy. Nevertheless, the surgical path of every patient is not exactly the same. The type and location of the cyst, its degree of adhesion to ovarian tissue, and the patient’s general health condition may directly affect the form of the operation and the recovery period.

Why Is Follow-Up Important After Laparoscopic Cystectomy?

Even if the surgery is successful, the follow-up process should not be neglected. The pathology result of the removed cyst, the postoperative appearance of the ovary, whether the pain has decreased, and the risk of new cyst formation should be evaluated [2][3].

In some patients, long-term follow-up after surgery may be sufficient, while in others, additional treatment may be planned due to underlying causes such as endometriosis or hormonal imbalance. Therefore, laparoscopic cystectomy is not a treatment limited only to the day of surgery; it is a process that requires control and follow-up.

Especially in patients with a history of recurrent cysts, lifestyle, menstrual pattern, pain monitoring, and ultrasound controls become important. Even if the patient’s complaints decrease, not neglecting planned follow-up examinations is useful for detecting possible recurrences early.

A regular follow-up plan with Assoc. Prof. Dr. Nazlı Korkmaz is important not only for monitoring the outcome of the current surgery but also for protecting future gynecological health.

Frequently Asked Questions About Laparoscopic Cystectomy

References

1. American College of Obstetricians and Gynecologists (ACOG). Laparoscopy. (https://www.acog.org)
2. NHS. Ovarian cyst - Treatment. (https://www.nhs.uk)
3. Mayo Clinic. Ovarian cysts - Diagnosis and treatment. (https://www.mayoclinic.org)
4. Cleveland Clinic. Ovarian Cystectomy: Purpose, Procedure, Risks & Recovery. (https://my.clevelandclinic.org)
5. Royal Berkshire NHS Foundation Trust. Having a laparoscopic ovarian cystectomy. (https://www.royalberkshire.nhs.uk)