Ovarian cysts are balloon-like structures filled with fluid, blood or gelatinous material originating from the ovaries of patients.
The majority of ovarian cysts are physiological, that is, hormonal cysts that develop with the growth of the ovulation sac during the woman's ovulation cycle. These are also called ovulation cysts. These are the cysts that cause ovulation pain in the middle of the month. They are cysts that reach 20 or 30 mm in size.
They can be easily seen on ultrasound during ovulation. Sometimes these cysts do not ovulate and grow. They can reach sizes of 4 or 5 cm and cause discomfort such as groin pain or severe abdominal pain by bleeding into the cyst.
Cyst evaluation is first done with ultrasonography. In this evaluation, the structure of the cyst content should be evaluated to determine whether the cyst is a physiological cyst, a benign tumoral cyst, a chocolate cyst or a malignant cyst.
Ovarian cyst symptoms may vary depending on the type of cyst. Simple physiological cysts may not cause any pain or symptoms, may cause mild groin pain, and if they do not rupture and grow, they may cause severe groin pain.
The cyst may bleed and require urgent hospital follow-up of the patient. If the bleeding does not stop, emergency laparoscopic surgery may be required. Congenital cysts called dermoid cysts may contain teeth, hair and fat tissue, cause torsion or twisting of the ovary, leading to severe groin pain and loss of nutrition of the ovary.
Chocolate cysts can cause menstrual pain and pain during intercourse, leading to progressive loss of the ovarian egg reserve and infertility. Malignant tumoral cysts can cause fluid accumulation in the abdominal cavity and digestive system complaints.
Ovarian cyst surgery is a surgery in which the cyst in the ovary is removed, the ovary is preserved and the cyst is sent for pathological diagnosis. The gold standard is to perform it with laparoscopic, i.e. closed surgery. Today, the first thing that should be recommended to patients is closed surgery.
In open surgery, the abdominal layers are cut and opened, which carries the risks of a long recovery process, infection risk, hernia risk, intestinal obstruction and intra-abdominal adhesion. The advantages of intervening in the patient using laparoscopy in recurrent cysts are great.
The surgery begins with the intra-abdominal cavity being inflated with carbon dioxide from the navel and the optical camera being placed in a way that will visualize the intra-abdominal cavity and the groin cavity.
The ovaries, uterus and all intra-abdominal organs are evaluated on the camera. Then, side trocars are placed and laparoscopic surgical instruments are placed, the cyst in the ovary is separated from the ovary and removed from the abdomen in a laparoscopy bag.
Today, the first approach to ovarian cyst surgeries is laparoscopic intervention. Closed surgery is the gold standard for ovarian cysts. Prof. Dr. Önder Koç has been performing ovarian cyst surgery in Ankara for years. You can reach us from the contact menu for an appointment.
Ovarian cyst surgery begins with inflating the abdominal cavity with carbon dioxide from the navel and placing the optical camera in a way that will display the abdominal cavity and groin cavity. The ovaries, uterus and all intra-abdominal organs are evaluated on the camera.
Then, trocars are placed in the groin and side areas of the abdomen and laparoscopic surgery instruments are placed, the cyst in the ovary is separated from the ovary and removed from the abdomen in a laparoscopy bag.
The material is sent for pathological examination. The type of cyst is confirmed with pathological diagnosis. All diagnoses made until a pathological diagnosis is made are considered preliminary diagnosis. The definitive diagnosis is made after the pathological examination of the piece.
The team that will perform the ovarian cyst surgery must have high experience in laparoscopic approach to this type of surgery. Movements that will disrupt the nutrition of the ovary or damage the nutrient vascular structure may lead to the loss of the ovary.
The ovary is the main organ of reproduction. Although the other ovary continues to exist, the loss of the ovary means a decrease in reproductive functions and hormone secretion.
The team that will perform the laparoscopic approach to the ovarian cyst should approach the cyst by considering the principles of tumor surgery, without forgetting the possibility of a malignant tumor.
Ovarian cyst surgery is performed laparoscopically and can last between 1 and 2.5 hours depending on the characteristics of the cyst. Chocolate cyst surgeries in particular can take a long time due to the adhesions they cause.
Ovarian-sparing surgeries always take longer than surgeries where the ovary is removed because there is a more delicate surgery when it comes to organ preservation.
Laparoscopic surgerry times decrease with the increase of experience in surgical applications, the time difference between open surgery and open surgery applications has decreased to a minimum. The surgeon's experience in closed surgery applications and organ-preserving surgeries is important among the factors affecting the time.
Closed surgery depends on the quality of the equipment used as well as experience. The trouble-free operation of the devices is a factor that shortens the surgery time. The devices should be checked before starting the surgery.
Ovarian cyst surgeries are day surgeries. The patient can return home within 12 or 24 hours and to work within 1 week. Since it is closed surgery, there is no need to use any additional antibiotics other than painkillers at home.
The first 5 mm-10 mm incisions in the abdomen can be stitched or glued. These incisions are dressed once. The incisions covered with an antibacterial film layer are not dressed again and the patient can take a shower at home. The wound is left open.
The leakage of an ovarian cyst is known among the public as ovarian cyst bursting. It causes the patient to be hospitalized with extreme abdominal pain. It is often confused with appendicitis. The main cause of the pain is the contact of the cyst fluid or bleeding content with the intra-abdominal membrane.
If there is no decrease in pain within the 12-24 hour follow-up period, laparoscopic intervention is indicated. Mostly, the main reason that leads the patient to surgery is the failure of bleeding in the cyst wall while the cyst fluid is leaking. The main purpose of the surgery is to stop the bleeding laparoscopically and send the cyst capsule to pathology.
There are indications for removal depending on the type of ovarian cyst. If a simple cyst image persists for more than 2-3 months, it should be removed with suspicion of tumor. In chocolate cysts, a size of 4-5 cm, pain, and the desire to have children may be indications for removal.
In dermoid cysts, it should be cleaned laparoscopically in case of growth and torsion, i.e. the risk of ovarian nutrition being disrupted. Cysts that are suspicious for any kind of tumor and have contrast material retention in MRI should be removed laparoscopically and sent to pathology.
Simple cysts are those that go away within 2-3 menstrual cycles. Other cysts do not tend to go away on their own. Chocolate cysts can leak and shrink. Dermoid cysts can grow over the years. Tumoral cysts have thick walls and do not tend to go away on their own.
The most common symptoms of ovarian cysts are groin pain. They can cause digestive system complaints. They can grow in the abdominal cavity and not cause any complaints. Cyst complaints can be very atypical. Dermoid cysts can disrupt the nutrition of the ovary and cause degeneration pain.
