Ovarian cystectomy refers to the removal of an ovarian cyst or tumor while preserving the ovary. Every effort is made to preserve the ovary for patients who desire fertility. Considerations for ovarian cystectomy include:
Post-menopausal patients: Removal of the entire ovary is preferred over ovarian cystectomy, especially if the cyst appears complex on the ultrasound. Preserving the ovary in a post-menopausal patient is of little benefit and the possibility of malignancy is greater than in younger patients.
Malignancy is suspected: Removal of the ovary is recommended to avoid the rupture and spill of the cancerous cells into the pelvis. The ovary should be sent for analysis during the surgery, and a staging procedure should be performed if cancer is confirmed.
The ovarian cyst or mass is very large: As the cyst or mass grows, it replaces the normal ovarian tissue. In cases of very large cysts, there is no normal ovarian tissue remaining.
Ovary is torsed (twisted): If the ovarian mass or cyst caused the ovary to twist, this will cause the ovary to die because the blood supply to the ovary is cut off. In most cases, it is not possible to revive the ovary and the entire ovary has to be removed.
Masses of all sizes can be removed laparoscopically. Typically, one or two tiny (1/4 inch) incisions and one slightly larger (3/4 inch) incision are necessary for a cystectomy. The smaller incisions are located at the belly button and on the far right or left side in the bikini line. The larger incision is located just above the pubic bone. The larger incision is used to remove the cyst. There is a risk of rupture of an ovarian cyst when performing cystectomy. In benign, or non-malignant cases, this is of no concern. Cysts or ovarian masses that are suspected to be cancerous may require complete removal of the ovary to avoid rupture. While not of immediate danger, if cancerous masses rupture, patients will require chemotherapy due to the spill of cancerous cells into the pelvis.
In order to remove the cyst from the body, the cyst is placed in a special bag. This allows for easy removal and prevents fluid from the mass from spilling into the pelvic cavity. Any masses suspicious for malignancy are sent for frozen section analysis. In frozen section, the mass is sent to the pathologist, while the patient is still asleep on the operating room table. The pathologist carefully reviews the sections of the mass to rule out cancer.
Since the vast majority of ovarian cysts and masses in pre-menopausal patients are benign, laparoscopy is a great option for many patients. Minimally invasive procedures allow patients to avoid large, open incisions for the removal of their cysts, thereby decreasing hospital stays, recovery times, and pain. Post-menopausal patients with masses are also usually benign, with cancer rates ranging from five to 20 percent of all masses, depending on the study cited. Laparoscopy is of significant benefit for these patients as well, since it will prevent an open surgery, and recovery from open surgery can be increasingly difficult for older women.
Women who have laparoscopic cystectomy are discharged from the hospital the same day, with excellent pain control and rapid recovery. Most patients are back to work within seven days.
Rupture of an ovarian mass is possible with either laparoscopic or open surgical procedures. According to the medical literature, rupture rates are higher in laparoscopy than open procedures. For the reasons stated above, and that rupture poses no risk of harm in benign cases, laparoscopy should always be considered unless ovarian cancer is confirmed prior to surgery by imaging studies such as CT scan or ultrasound with elevated CA-125 (hormone marker for ovarian cancer) and a confirmed pelvic exam. In some cases, malignancy can be treated laparoscopically as well, but requires a complete assessment by a gynecologic oncologist.
Please note that ovarian cancer is a very rare disease, with the risk being only one in 70, or 1.4 percent in the general population.
In properly selected patients, the treatment of ovarian masses with laparoscopy saves thousands of women every year the difficult recovery and increased complications associated with open surgery.
Ovarian cysts are a relatively common condition, but that does not mean that you should get treatment from just anyone. If a relatively painless recovery and low risk are your priorities, it is important to find a specialist, not a generalist.
That is the main reason why your OB/GYN should not perform your cystectomy. Many patients consider allowing their OB/GYNs to perform their gynecological procedures, but the truth of the matter is that these doctors are generalists, not specialists. Their focus is on Obstetrics, and GYN surgery is only a minimal portion of their practice. Therefore, they do not have the extensive training and experience that CIGC surgeons have.
At CIGC, our specialists have made a commitment to surgery. We see more cases, treat a wider range of case types, and undergo more training than an OB/GYN. Our surgeons have learned advanced techniques and procedures and can perform even the most complex surgeries with the lowest rates of complications. We use our experience to decide whether you are a good candidate for ovarian cystectomy. Some patients are better suited to ovary removal, and our doctors have the insight to make that decision so that you get the best possible outcome.
Have the least invasive cystectomy possible. While many clinics still perform open procedures, which result in severe pain, higher complication rates, and a longer recovery period, we are focused on laparoscopic procedures that are less expensive, less painful, and less risky. We prioritize your recovery, and laparoscopic cystectomies facilitate a relatively easy one.
Be informed. When you visit CIGC, we will ensure that you are aware of all of your treatment options, as well as the potential risks and side effects of each. We have performed all types of GYN surgeries, so no one knows it like we do.
As a patient and consumer, you should be discriminating and analytical when choosing a surgeon. Know that CIGC surgeons are true surgical specialists: they are board-certified, fellowship-trained, and concentrate completely on GYN surgery. We have offices in Bethesda and Annapolis, Maryland, as well as in Reston, Virginia for your convenience. Give us a call at (888) 787-4379.