Ovarian cysts are fluid-filled sacs that develop on or within the ovaries and are commonly encountered in women of reproductive age. While many cysts are small and asymptomatic, larger cysts or those causing symptoms such as pelvic pain, bloating, or menstrual irregularities may require surgical intervention. Among minimally invasive surgical options, laparoscopic ovarian cystectomy has become the preferred technique due to its advantages, including faster recovery, minimal postoperative pain, and superior cosmetic outcomes. In certain cases, cyst aspiration using a transparent needle during laparoscopy can facilitate the removal of large cysts, reducing the risk of rupture and enabling careful preservation of ovarian tissue.

Indications for Laparoscopic Cystectomy with Needle Aspiration

Aspiration with a transparent needle is particularly useful in cases of large cysts or cysts containing fluid that can be safely decompressed, such as serous or functional cysts. Indications include:

Symptomatic ovarian cysts causing pain, pressure, or menstrual disturbances.

Large cysts that are difficult to remove intact through conventional laparoscopic ports.

Benign-appearing cysts on imaging, where malignancy is unlikely.

Desire to preserve ovarian tissue for fertility purposes.

Preoperative assessment is crucial to ensure that the cyst is suitable for aspiration. Ultrasound imaging helps determine the cyst’s size, content, and morphology, while tumor markers may be evaluated if malignancy is suspected. Patients are counseled regarding the procedure, potential complications, and the need for follow-up.

Surgical Technique

The procedure is performed under general anesthesia. The patient is positioned in a lithotomy or supine position with a slight Trendelenburg tilt to enhance pelvic visualization. Pneumoperitoneum is established using carbon dioxide, and laparoscopic ports are inserted—typically a 10-mm umbilical port for the laparoscope and two 5-mm accessory ports for instruments.

Once the ovary and cyst are identified, careful inspection of the cyst wall and surrounding pelvic structures is performed. To minimize spillage of cyst contents into the peritoneal cavity—which could lead to chemical peritonitis or adhesions—a transparent aspiration needle is used. This needle allows the surgeon to aspirate cyst fluid while directly visualizing the contents, ensuring controlled decompression.

A small incision is made on the cyst surface, and the transparent needle is inserted. The cyst fluid is gradually aspirated, reducing the cyst’s volume and making it easier to manipulate and extract. In cases of dermoid or complex cysts, aspiration may be limited to avoid spillage of solid contents. Once decompressed, the cyst wall is carefully dissected from the ovarian stroma using laparoscopic scissors or energy devices. Meticulous care is taken to preserve healthy ovarian tissue and achieve hemostasis using bipolar cautery or fine sutures. The cyst wall and any residual tissue are removed using an endoscopic retrieval bag to prevent contamination of the peritoneal cavity.

Intraoperative Considerations

Using a transparent needle offers several advantages during laparoscopic cystectomy:

Visualization: The transparent design allows the surgeon to observe fluid aspiration, ensuring complete decompression.

Safety: Minimizes the risk of spillage and chemical peritonitis.

Efficiency: Facilitates removal of large cysts through small laparoscopic ports.

Surgeons must exercise caution to avoid injuring surrounding structures such as the bowel, bladder, and major vessels. For large or complex cysts, decompression may be combined with cystectomy techniques to ensure safe removal. Conversion to open surgery is rare but may be necessary if adhesions, malignancy suspicion, or uncontrolled bleeding occurs.

Postoperative Care

Recovery after laparoscopic ovarian cystectomy with needle aspiration is generally rapid. Most patients are discharged within 24–48 hours. Postoperative pain is minimal and can be managed with oral analgesics. Early ambulation is encouraged to reduce thromboembolic risk, and patients are advised to avoid strenuous activity for a few weeks. Follow-up includes ultrasound assessment to monitor ovarian healing and ensure there is no recurrence.

Complications

While the procedure is safe, potential complications include bleeding, infection, adhesion formation, and inadvertent injury to surrounding structures. Chemical peritonitis is rare but possible if cyst contents spill during aspiration. Recurrence of ovarian cysts can occur, particularly in functional cysts, making routine follow-up important. Preservation of healthy ovarian tissue ensures continued hormonal function and fertility potential.

Advantages of Needle Aspiration Technique

Minimally invasive: Small incisions and reduced tissue trauma.

Fertility preservation: Healthy ovarian tissue is conserved.

Controlled decompression: Transparent needle allows safe aspiration of fluid.

Short recovery: Faster postoperative recovery and shorter hospital stay compared to laparotomy.

Better visualization: Enhances surgical precision during cyst removal.

Conclusion

Laparoscopic ovarian cystectomy with transparent needle aspiration is a safe, effective, and fertility-preserving technique for managing ovarian cysts, especially large or fluid-filled lesions. This method combines the benefits of minimally invasive surgery with controlled cyst decompression, allowing for meticulous removal while minimizing risks. With careful patient selection, meticulous surgical technique, and diligent postoperative care, outcomes are excellent, and patients can expect rapid recovery with preservation of ovarian function.