some fluid-filled cysts are not likely to be cancerous & cysts that are solid or mixed (fluid-filled & Solid) May Require Further evaluation to determine if cancer is present.

 What are ovarian cysts?

An ovarian cyst is an accumulation of fluid within an ovary that is surrounded by a thin “shell” and can be as small as a pea or become so large that a woman looks pregnant. 

Occurring most frequently during a woman’s reproductive years, ovarian cysts can cause pain and bleeding and may be an early form of ovarian cancer. In situations where the cyst is large, causes pain or bleeding, or may be cancerous, physicians may recommend surgical removal

 Who gets ovarian cysts?

About 8% of premenopausal women develop large cysts that need treatment.  There are several types of ovarian cysts that fall into this category. Learn more about these cysts. 

 What are the symptoms?

Most of the time, ovarian cysts are small, harmless and cause no symptoms. In some cases, cysts may cause problems if they get larger, if they twist (ovarian torsion), or if they burst and cause internal bleeding. Immediate attention and treatment is then needed. 

If you have an ovarian cyst, you might experience any of the following symptoms:

  • Menstrual irregularities or abnormal bleeding
  • Dull ache in your lower back or thighs
  • Pelvic pain shortly before or after the beginning of your menstrual cycle
  • Pelvic pain with intercourse 
  • Fullness or heaviness in your abdomen
  • Nausea, vomiting or bloating
  • Pressure on your bowel or pain during bowel movements
  • Difficulty emptying your bladder completely

 How are ovarian cysts treated?

In many cases, observation may be all that is necessary, especially for small cysts that don’t produce any symptoms. However, women who experience bothersome symptoms due to ovarian cysts may require an ovarian cystectomy.

Ovarian cystectomy is a minimally invasive surgical procedure that uses laparoscopy to remove the 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 and cyst (oophorectomy) is preferred as the risk of malignancy is greater

 When is surgery necessary to treat ovarian cysts?

Ovarian cysts that are not part of a menstrual cycle are known as ovarian tumors. Some tumors can be cystic (or filled with fluid), some can be solid, and some can have both cystic and solid components. Ovarian tumors usually do not resolve and require surgical removal.

 What advances are there in surgery to treat ovarian cysts and what are the benefits over other procedures?

Laparoscopic surgery is very effective for removing masses, such as ovarian cysts. Benign (non-cancerous) cysts can usually be removed, while preserving the ovary. 

Developed at The Center for Innovative GYN Care, DualPortGYN is a recent advancement in minimally invasive GYN surgery that uses two cosmetically appealing five millimeter incisions in the abdomen, and a technique known as retroperitoneal dissection (RPD) to perform ovarian cystectomies. 

RPD allows surgeons to map the organs and arteries in the pelvis, much like a GPS system in a car. It reduces the time of the procedure and helps to avoid injury to vital pelvic structures. The surgeon can see the entire pelvic region to ensure the procedure is performed safely and efficiently. 

Extremely large masses may require removal of the entire ovary and fallopian tube. Patients seeking cancer prevention due to increased genetic risk factors will also require complete removal of the ovaries and fallopian tubes.

Although ovarian cysts are fairly common and some even resolve themselves, they can be cancerous or burst, causing internal bleeding. It is important to put your health in the hands of a trusted surgeon when seeking ovarian cyst or pelvic mass treatment.

Board-certified gynecological surgeons can help patients with ovarian cysts avoid larger incisions, and longer recovery time. These specialists have made a commitment to surgery.

 How long is recovery?

Women who have laparoscopic cystectomy or oophorectomy are almost always discharged the same day, with excellent pain control and rapid recovery. Most patients are back to work within seven days. 

 Are there alternatives to surgery?

If a woman’s symptoms are not bothersome and it is not suspected that the cysts could be cancerous, a doctor may recommend watchful waiting, as the cysts may not need to be removed.

 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 physician or surgeon. View our recommended questions to ask - and background information to help you weight the answers - below or download a printable version

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.