Open surgeries, with larger incisions, are the best treatment option for removal of all ovarian cysts
The vast majority of ovarian cysts and masses in pre-menopausal women are benign (noncancerous), making minimally invasive laparoscopic procedures a great option for many patientS
What is an ovarian cystectomy?
Ovarian cystectomy is a minimally invasive surgical procedure that uses laparoscopy to remove an ovarian cyst while still preserving the ovary so women can remain fertile.
However, not all women are candidates for ovarian cystectomy, especially if the cyst is very large, the ovary is twisted due to the cyst, or malignancy is suspected. In post-menopausal women, removal of the ovary (oophorectomy) is preferred as the risk of malignancy is greater.
You are likely not a good candidate for a cystectomy if:
- You are post-menopausal
- Cancer is suspected
- Ovarian cyst is very large
- Ovary is twisted
What are the benefits & risks associated with a laparoscopic ovarian cystectomy?
Like any surgical procedure, ovarian cystectomy is associated with certain risks such as excessive blood loss and an infection requiring antibiotic treatment. Additionally, women should consult their surgeon regarding:
- Laparoscopic Risks – The rupture of an ovarian cyst is possible with either laparoscopic or open surgical procedures, but studies indicate that rupture rates are higher in laparoscopy. In benign, or non-malignant (non-cancerous) cases, this is of no concern. If a cancerous mass does rupture, patients will require chemotherapy due to the spill of cancerous cells into the pelvis.
- Laparoscopic Advantages – In properly selected patients, using laparoscopy to remove cysts saves thousands of women every year the difficult recovery and increased complications associated with open surgery. Women are discharged from the hospital the same day, with excellent pain control and rapid recovery.
- DualPortGYN for ovarian cystectomy is a pioneering new GYN surgical tehcnique developed at The Center for Innovative GYN Care that uses only two, 5 millimeter incisions. One incision is placed at the belly button and the other is at the bikini line. With these incisions, most GYN procedures can be performed safely in an outpatient setting in less than one hour.
How does DualPortGYN work?
- Clearer view and fewer complications – DualPortGYN uses a technique known as retroperitoneal dissection (RPD), originally developed to remove cancerous tissue. By going behind (retro) the lining (peritoneal), the surgeon completely visualizes all of the anatomy of the pelvis, and avoids complications such as excessive bleeding, bladder injury, injury to the ureter and bladder. RPD allows surgeons to map the organs and arteries in the pelvis, much like a GPS system, reducing the time of the procedure and avoiding injury to the pelvic structures.
- More convenient – In many situations, the surgery is performed on an outpatient basis allowing patients to go home the same day and return to most normal activity in approximately one week.
What happens during the procedure?
Typically, one or two tiny (1/4 inch) incisions are made at the belly button and on the far right or left side in the bikini line. One slightly larger (3/4 inch) incision is also made just above the pubic bone. The larger incision is used to remove the cyst.
During the surgery, the cyst is placed in a special bag to remove it from the body. This allows for easy removal and prevents fluid from the mass from spilling into the pelvic cavity. Any masses that many be cancerous are sent for analysis.
How long is recovery?
Women who have a laparoscopic cystectomy are discharged from the hospital the same day, and experience a rapid recovery. Most patients are back to work within seven days.
What should I ask my doctor or OB-GYN if he/she recommends an ovarian cystectomy?
Before undergoing surgery, you will likely have many questions for your doctor or OB-GYN. Below are some recommended questions to ask – and background information to help you weigh the answers. You can also download a printable version of these questions.
Are there additional steps to be undertaken to determine whether or not these cysts are cancerous?
Your doctor might recommend any of the following procedures to diagnose your ovarian cysts:
Ultrasound: Examining an ovarian cyst via ultrasound will help determine proper diagnosis and management. Essentially, he/she will look at the shape (regular or irregular), the size, and the composition of the cyst – is it filled with fluid, is it solid or is it a mix of the two?
- Fluid-filled cysts (commonly called simple cysts) are not likely to be cancerous and most often require observation and close follow-up unless they are too large or causing disturbing symptoms.
- Those cysts that are solid or mixed (fluid-filled and solid) may require further evaluation to determine if cancer is present and most often require surgical treatment. These cysts are commonly called complex cysts.
MRI: Your doctor may recommend that you get an MRI to further evaluate solid tumors.
Blood tests: You might need to get a pregnancy test, tests to check your hormone levels and a CA-125 – a blood test that can be performed to rule out ovarian cancer – may be necessary, depending on the characteristic of the cyst on the ultrasound.
How do you perform an ovarian cystectomy?
Masses of all sizes can be removed laparoscopically. This includes cystectomy, removal of the cyst only, or oophorectomy, removal of the entire ovary and cyst. The fallopian tube is usually also removed during the procedure since it is connected to the ovary and may cause complications if left. Typically, one or two tiny (1/4 inch) incisions and one slightly larger (3/4 inch) incision are necessary for a cystectomy or oophorectomy. The smaller incisions are located at the belly button and on the far right and left side in the bikini line. The larger incision is located just above the pubic bone. The two procedures do not differ surgically in terms of surgical time, incisions, recovery, or any other measure. The only difference is whether ovarian tissue is left in place.
In order to remove the cyst or ovary from the body, a special bag is used to surround the ovary. This allows for easy removal and prevents fluid from spilling into the pelvic cavity. Any masses that are suspected as cancerous are sent for analysis. Often, 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.
Do you recommend open surgery?
Open ovarian cystectomies are still the mostly commonly performed surgery to remove ovarian cysts, but the major disadvantages with this type of approach are that it requires a much larger incision than new, minimally invasive techniques, resulting in longer hospital stays, more pain during recovery and longer recovery times – patients often need six to eight weeks to recover.
A recent advancement in minimally invasive GYN surgery, DualPortGYN is a new way to perform an ovarian cystectomy and has been used in thousands of women.
How many times have you performed this procedure?
When it comes to any form of surgery, training, skill and practice matter, which is why GYN surgeons who specialize in minimally invasive surgery are the most qualified. The reality is that OB-GYNs are highly skilled obstetric practitioners, but very few perform GYN surgeries often enough to be surgical specialists. This is borne out by studies, which find that GYN surgery is commonly a secondary component of what an OB-GYN does.
What have your other patients experienced after this procedure?
Robotic, open and conventional laparoscopic GYN surgeries can lead to longer recovery times, increased blood loss and larger scars than newer procedures. Make sure your surgeon is trained in the latest minimally invasive techniques, such as The Center for Innovative GYN Care’s DualPortGYN, that prevent injury to the pelvic structures and minimize blood loss – resulting in reduced complication rates and improved recovery times.
Have you had fellowship training in minimally invasive GYN surgery?
While most OB-GYNs are highly trusted generalists, they spend most of their time focusing on obstetrics and basic GYN care and therefore, perform specialized GYN surgeries rarely. Be sure to choose a surgeon who has received comprehensive training and performs many minimally invasive surgeries each year.
Will you use robotics to assist with the surgery?
Although the American Medical Association and other leading medical societies have issued statements discouraging robotic techniques due to much higher costs to patients without any medical advantages, robotics continue to be used in GYN surgeries. This is because robotic procedures “enable” an OB-GYN not well trained in laparoscopic GYN surgical techniques to complete a procedure through a “minimally invasive” approach. This is why women need to ask if robotics will be used during a GYN surgery and to seek a specially trained surgeon able to perform the latest minimally invasive surgical techniques, such as DualPortGYN and retroperitoneal dissection that do not use robotics.
What is my anticipated recovery time?
New minimally invasive techniques require, on average, only a week to recover. Other procedures such as open abdominal surgery can take up to 8 weeks.
What are my other surgical options?
If your physician recommends an open or robotic procedure, ask why he or she would not recommend laparoscopic surgery or a newer technique like DualPortGYN.
Women need to be their own best advocate, which is why getting a second opinion is always good practice. Since there are different surgical options for treating ovarian cysts, getting a second opinion is a way you can ask questions about how the surgery will be performed, the recovery time, and possible complications.