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Speciality

Laparoscopic Ovarian Cystectomy Treatment

 What are ovarian cysts?
 What are the causes?
 What are the symptoms?
 How Ovarian Cysts are diagnosed?
 What are the treatment options?
 Benefits and drawbacks
 
What are ovarian cysts?
  
A female has two walnut-sized ovaries. These are located on either side of the uterus, nestled under the fringed ends of the fallopian tubes. These tubes create a pathway for a released egg to reach the center of the uterus. During the menstrual cycle, one ovary will develop and mature an egg. The egg is encased in a sac called a follicle. About day 14 of the menstrual cycle, ovulation occurs and the egg is released from the ovary.
 
Ovarian Cysts Treatments in India
 
Ovarian cysts are small fluid-filled sacs that develop on a woman's ovaries. In an ultrasound image, ovarian cysts resemble bubbles. The cyst contains only fluid and is surrounded by a very thin wall. This kind of cyst is also called a functional cyst, or simple cyst. If a follicle fails to rupture and release the egg, the fluid remains and can form a cyst in the ovary.
 
Ovarian cysts are common among women of childbearing age. They are considered functional (or physiologic). Most often, cysts in women of this age group are not cancerous and many disappear on their own in a matter of weeks without treatment. But some may cause problems such as bleeding and pain and need medical intervention. Women who are past menopause (ages 50-70) with ovarian cysts have a higher risk of ovarian cancer. At any age, if you think you have a cyst, it's important to tell your doctor.
 
 
What are the causes?
  
Ovarian cysts form for numerous reasons. The most common type is a follicular cyst, which results from the growth of a follicle. A follicle is the normal fluid-filled sac that contains an egg. Follicular cysts form when the follicle grows larger than normal during the menstrual cycle and does not open to release the egg. Usually, follicular cysts resolve on their own over the course of days to months. Cysts can contain blood (hemorrhagic or endometrioid cysts) from injury or leakage of tiny blood vessels into the egg sac. Occasionally, the tissues of the ovary develop abnormally to form other body tissues such as hair or teeth. Cysts with these abnormal tissues are called dermoid cysts.
 
The following are possible risk factors for developing ovarian cysts:
 

History of previous ovarian cysts

Irregular menstrual cycles

Hypothyroidism or hormonal imbalance

Tamoxifen therapy for breast cancer

Ovarian cancer and cancer that has spread to outside the ovary

 
What are the symptoms?
 
Many women have ovarian cysts without having any symptoms. But some may complain of:
 

Pressure, fullness, or pain in the lower abdomen or pelvic region

Dull ache in the lower back and thighs

Problems passing urine completely

Pain during sexual intercourse

Weight gain

Painful menstrual periods and abnormal bleeding

Nausea or vomiting

Breast tenderness

Weakness, dizziness, or faintness, especially from standing

Persistent fever

 
How Ovarian Cysts are diagnosed?
 
Pelvic Exam- Since ovarian cysts may not cause symptoms, they are usually found during a routine pelvic exam. During this exam, your doctor is able to feel the swelling of the cyst on your ovary. If a cyst is suspected, an ultrasound is usually the next step.
 
Pelvic Ultrasound- Once a cyst is found, the doctor may perform an endovaginal ultrasound which is a painless procedure resembling a pelvic exam. A thin, covered wand or probe is placed into the vagina, and the examiner directs the probe toward the uterus and ovaries. This type of ultrasound produces a better image than a scan through the abdominal wall can because the probe can be positioned closer to the ovaries. With an ultrasound, the doctor can see how the cyst is shaped; its size and location; and whether it's fluid-filled, solid, or mixed.
 
Diagnostic Laparoscopy- Laparoscopy is a surgical procedure performed when your doctor wants to see the cyst. A thin, lighted telescope, called a laparoscope, is inserted through a small incision into the abdomen. Laparoscopy may be used for treatment as well as diagnosis.
 
Other imaging- CT scan aids in assessing the extent of the condition. Though it is considered to be inferior to ultrasonography and MRI in defining ovarian cysts and pelvic masses. MRI is used to clarify results of an ultrasound.
 
Other tests- A pregnancy test is also done. Hormone levels (such as LH, FSH, estradiol, and testosterone) may also be checked. To find out if the cyst might be cancerous, your doctor may do a blood test to measure a substance in the blood called CA-125. The amount of this protein is higher if a woman has ovarian cancer. However, some ovarian cancers do not make enough CA-125 to be detected by the test. There are also non-cancerous diseases that increase the levels of CA-125, like uterine fibroids and endometriosis. These non-cancerous causes of increased CA-125 are more common in women under 35, while ovarian cancer is very uncommon in this age group. For this reason, the CA-125 test is recommended mostly for women over age 35, who are at high risk for the disease and have a cyst that is partially solid.
  
 
What are the treatment options?
 
Functional ovarian cysts are the most common type of ovarian cyst. They usually disappear by themselves and seldom require treatment. But some cysts may require medical or surgical intervention. So after the surgeon evaluates the complete case history, he decides on the appropriate line of action. Here are the three basic mode of action:
 
Watchful Waiting
 
If you have no symptoms and ultrasound shows a small, fluid-filled cyst, your doctor may simply schedule another pelvic exam and ultrasound in six weeks. The patient waits and gets re-examined in one to three months to see if the cyst has changed in size. It also might be an option for postmenopausal women.
 
The concept behind watchful waiting is to not actively treat the cyst until does not go away as your hormones change. An unchanging or growing cystic ovary needs further investigation.
 
Medications
 
Oral contraceptives: If you have a functional cyst that is larger in size and causing some symptoms, birth control pills may be prescribed. The purpose of birth control pills is to alter your hormone levels so the cyst will shrink. Birth control pills will reduce the probability of other cysts growing.
  
Pain relievers: Anti-inflammatories may help reduce pelvic pain. Narcotic pain medications by prescription may relieve severe pain caused by ovarian cysts.
  
Surgery
 
The cyst may be surgically removed if it is large, solid or filled with debris, persistently growing, irregularly shaped, or causing pain or other symptoms. If the cyst is not cancerous, it can be surgically removed without also removing the ovary. This is called a cystectomy. In some cases, the doctor may want to remove the affected ovary, while leaving the other intact in order to maintain your ability to have a normal hormone cycle. Sometimes an ovarian cyst may twist and cause severe abdominal pain as well as nausea and vomiting. This is an emergency, and an operation is necessary to correct it.
 
There are two main surgical procedures:
 
Laparoscopy- f the cyst is small and looks benign on the ultrasound, your doctor may perform a laparoscopy. This procedure is done under general anesthesia. A very small incision is made above or below the navel, and a small instrument that acts like a telescope is inserted into the abdomen. If the cyst is small and looks benign, it can be removed.

Laparoscopy- if the cyst is large and looks suspicious, the doctor may perform a procedure called a Laparotomy. This procedure involves making bigger incisions in the stomach to remove the cyst. While you are under general anesthesia, the doctor is able to have the cyst tested to find out if the tissue is cancerous. If it is cancerous, the doctor may need to remove the ovary and other tissues that may be affected, like the uterus or lymph nodes.

Whether performing a laparoscopy or Laparotomy, the goals are as follows:
 

To confirm the diagnosis of an ovarian cyst

To assess whether the cyst appears to be malignant

To obtain fluid from peritoneal washings for cytologic assessment

To remove the entire cyst intact for pathologic analysis, including frozen section, which may mean removing the entire ovary

To assess the other ovary and other abdominal organs

 
Benefits and drawbacks
 
One advantage of laparoscopic cystectomy is that the incisions are smaller (1/2 inch) and much less uncomfortable than that of Laparotomy. So people are able to resume normal activity in about 2 weeks. So Laparoscopic cystectomy has many advantages like:
 

Less postoperative pain

May shorten hospital stay

May result in a quicker return to bowel function

Quicker return to normal activity

Better cosmetic results
However, the surgeon must be experienced in the procedure before these benefits can be seen or else complications may occur. Disadvantages include a possible longer operating time (depends on how much of the operation is performed laparoscopically), higher costs and an increased risk of damage to the urinary tract. So, if we were to compare an open surgery with a laparoscopic surgery, we can display it in a nutshell as under:
 
LAPAROSCOPIC
OPEN
  • Small Incisions (less than ½ an inch)
    		•
  • Large Incision
    		•
  • Hospital stay is 1 to 3 days
    		•
  • Hospital stay of about 5 days
    		•
  • Patients usually return to work in 5 to 10 days
    		•
  • Return to work in about 4 weeks
    		•
  • Lesser risk of Infection
    		•
  • Greater risk of infection
    		•
  • Less pain
    		•
  • More painful
    		•
  • Less chance of hernias
    		•
  • More chance of hernias
    		•