In some cases, observation may be all that is necessary, especially for small, functional cysts causing no symptoms. Sometimes, monitoring with ultrasound and further blood testing may be required during the observation period, especially for post-menopausal women. For women who require removal of ovarian cysts or removal of the ovaries, including women seeking prophylactic oophorectomy to reduce future cancer risk, Advanced Laparoscopic Surgery offers fast solutions and nearly painless recovery.
Surgical Treatment Options
Laparoscopy is very effective for masses involving the ovaries or fallopian tubes. Benign (non cancerous) cysts of the ovary can usually be removed while preserving the ovary. Extremely large masses or endometriomas 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.
A decision to remove an ovary is based on patient age, the likelihood of cancer, and the safety of the procedure. Every effort is made to preserve ovaries for patients who desire fertility. However, patients with suspected cancers, with family or personal history of breast or ovarian cancer, or with prior histories of ovarian pain or scarring may need complete removal of the ovary at the time of surgery.
The size and type of cyst present determine if the ovary will need to be removed. At the Women’s Surgery Center, our aim is to minimize your surgical experience. A woman’s ovaries are only removed after a full discussion of this possibility before surgery, or if there is no way to remove a mass without significant blood loss or compromising safety during the procedure.
How does the Women's Surgery Center treat Ovarian Cysts or Masses?
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 tube is usually also removed during the procedure since it is adherent to the ovary and may cause further complications if left in place. Typically, two or three 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.
Cysts are surgically removed from the ovary using a unique type of surgical equipment, the Harmonic Scalpel. This device uses sound waves to cut tissue and seal vessels at the same time. 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 massed 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 in the pelvis.
In order to remove the cyst or ovary from the body, a special bag is used to encapsulate the ovary. 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.
What are the advantages of laparoscopic treatment with the Women's Surgery Center?
Since the vast majority of ovarian cysts and masses in premenopausal 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. Postmenopausal patients with masses are also usually benign, with cancer rates ranging from 5 – 20% of all masses, depending on the study cited. Laparoscopy is of significant benefit for these patients as well, since it will avoid an open surgery and recovery from open surgery can be increasingly difficult for older women.
Women who have laparoscopic cystectomy or oopherectomy are almost always discharged from the hospital the same day with excellent pain control and rapid recovery. Most patients are back to work within 7 to 10 days.
What if my ovarian mass is cancerous?
If cancer is identified, a staging operation is performed at the same surgery. Staging means evaluating other areas such as lymph nodes to rule out metastasis, or spread of disease, that may require chemotherapy. Frozen section and staging with identification of cancer is helpful to both the surgeon and the patient. By having the section immediately reviewed and staging in the same surgery, the patient avoids having to undergo a second surgical procedure at a later date. Not only is laparoscopic surgery easier to recover from for all patients, but we find that our oncology patients feel better and stronger if chemotherapy is required if they are not recovering from extensive open surgery, as well.
Occasionally, a patient with more extensive malignancy will require open surgery for complete removal of malignant masses, as indicated. Conversion from laparoscopy to open if required is simple and does not increase complications for Women's Surgery Center patients, and has only a slight increase in surgical time.
What are the risks of laparoscopic surgery for ovarian cysts?
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 an 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 confirmed pelvic exam. In some cases, malignancy can be treated laparoscopically, as well, but requires a complete assessment by a gynecologic oncolgist.
Please note that ovarian cancer is a very rare disease, with the risk being only 1 in 70, or 1.4%, 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.
Laparoscopic Management of Ovarian/Tubal Cysts
| Indications | All patients without confirmed evidence of ovarian cancer |
| Discharge Home | Same day, 24 hours or less |
| Recovery Time | 5 to 7 days |
| Incision Size | 2 – 3 1/4 inch incisions with one 3/4 inch incision |
| Pain Tolerance | Very good to excellent |
| Procedure Time | Less than one hour, range 15 to 60 minutes |
| CA-125 | A hormone marker for ovarian cancer. Can be falsely elevated in premenopausal patients. More accurate in postmenopausal patients. |
| Frozen Section | Performed at the time of surgery to rule out cancer for suspicious masses only. If cancer is identified, staging is accomplished at the same surgical procedure, avoiding a second surgery at a later date. |
| Conversion to Open | Rare, usually indicated with frozen section confirmation of ovarian cancer |
For more information about the types of ovarian cysts, please refer to the Learning Center.