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| Laparoscopic Ovarian Cystectomy |
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 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 |
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| What
are ovarian cysts? |
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| 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.
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| 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. |
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| 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. |
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| What
are the causes? |
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| 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. |
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| The following are possible risk factors
for developing ovarian cysts: |
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- 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
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| What
are the symptoms? |
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| Many women have ovarian cysts without
having any symptoms. But some may complain of: |
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- 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
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| How
Ovarian Cysts are diagnosed? |
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| 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. |
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| 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. |
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| 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.
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| 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. |
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| 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. |
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| What
are the treatment options? |
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| 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: |
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| Watchful Waiting |
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| 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. |
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| 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. |
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| Medications |
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| 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. |
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| Pain relievers: Anti-inflammatories
may help reduce pelvic pain. Narcotic pain medications
by prescription may relieve severe pain caused by ovarian
cysts. |
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| Surgery |
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| 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. |
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| There are two main surgical procedures: |
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- Laparoscopy-if the cyst is small and looks
benign on the ultrasound, your doctor may perform
a laparoscopy. This procedure is done under general
anaesthesia. 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 anaesthesia, 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.
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| Whether performing a laparoscopy or
Laparotomy, the goals are as follows: |
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- 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
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| Benefits
and drawbacks |
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| 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: |
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- Less postoperative pain
- May shorten hospital stay
- May result in a quicker return to bowel function
- Quicker return to normal activity
- Better cosmetic results
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| 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: |
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LAPAROSCOPIC
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OPEN
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Small Incisions (less than ½ an inch)
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Large Incision
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Hospital stay is 1 to 3 days
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Hospital stay of about 5 days
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Patients usually return to work in 5 to 10 days
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Return to work in about 4 weeks
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Lesser risk of Infection
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Greater risk of infection
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Less pain
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More painful
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Less chance of hernias
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More chance of hernias
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