Ovarian cysts are fluid-filled or solid masses that develop on the ovaries and are common in women of reproductive age. While many cysts are small and asymptomatic, larger cysts or those causing pain, menstrual irregularities, or infertility may require surgical intervention. Laparoscopic ovarian cystectomy has emerged as the gold standard for treating benign ovarian cysts due to its minimally invasive nature, safety, and ability to preserve ovarian function. This technique offers improved visualization, reduced postoperative pain, faster recovery, and excellent cosmetic outcomes compared to traditional open surgery.

Indications for Laparoscopic Ovarian Cystectomy

Laparoscopic cystectomy is indicated in the following scenarios:

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

Large ovarian cysts typically greater than 4–5 cm in diameter.

Cysts that show progressive growth on serial imaging.

Suspicious cysts where malignancy cannot be ruled out with imaging or tumor markers.

Endometriomas or dermoid cysts in women desiring fertility preservation.

Recurrent functional cysts not responding to medical therapy.

Preoperative evaluation includes a thorough medical history, physical examination, pelvic ultrasonography, and, if necessary, MRI to assess cyst characteristics. Tumor markers such as CA-125 may be measured to rule out malignancy in select cases. Counseling about the procedure, potential risks, and expected outcomes is crucial for informed consent.

Surgical Technique

Laparoscopic ovarian cystectomy is performed under general anesthesia. The patient is positioned in a supine or lithotomy position with a slight Trendelenburg tilt to allow optimal visualization of the pelvic organs. Pneumoperitoneum is established using carbon dioxide, and trocars are inserted—typically a 10-mm umbilical port for the laparoscope and two or three 5-mm accessory ports for instruments.

Once the ovary and cyst are identified, a careful inspection of the pelvic cavity is conducted to assess the cyst, ovarian tissue, and any adhesions or associated pathology. Adhesiolysis is performed if necessary to mobilize the ovary. A small incision is made on the ovarian cortex overlying the cyst using cold scissors, harmonic scalpel, or monopolar diathermy. The cyst is gently dissected from the surrounding ovarian stroma using traction and counter-traction.

For cysts containing fluid, controlled aspiration may be performed using a needle or suction device to reduce the cyst size and facilitate manipulation. Care is taken to prevent spillage of cyst contents into the peritoneal cavity, particularly in dermoid cysts or endometriomas, as this can lead to chemical peritonitis or adhesion formation. Once excised, the cyst wall and contents are removed using an endoscopic retrieval bag. Hemostasis is achieved using bipolar cautery, fine sutures, or hemostatic agents, while ensuring preservation of healthy ovarian tissue.

Intraoperative Considerations

Successful laparoscopic ovarian cystectomy requires meticulous technique and careful handling of ovarian tissue. Surgeons must avoid excessive cauterization of ovarian stroma to maintain ovarian reserve and fertility. In cases of large or complex cysts, additional techniques such as controlled decompression, cyst wall stripping, or use of specialized retrieval bags may be employed. Conversion to laparotomy is rarely required but may be necessary in cases of extensive adhesions, uncontrolled bleeding, or suspicion of malignancy.

Postoperative Care

Recovery following laparoscopic ovarian cystectomy is typically rapid. Patients are usually discharged within 24–48 hours, depending on their clinical condition. Postoperative pain is mild and managed with oral analgesics. Early ambulation is encouraged to reduce the risk of thromboembolism, and patients are advised to avoid strenuous physical activity for a few weeks. Follow-up includes pelvic ultrasonography to monitor ovarian healing and detect recurrence. Women desiring pregnancy may be counseled on timing conception postoperatively and the impact on ovarian reserve.

Complications

Although laparoscopic ovarian cystectomy is considered safe, potential complications include:

Bleeding from the ovarian stroma.

Infection or abscess formation.

Adhesion formation within the pelvis.

Spillage of cyst contents, which may cause chemical peritonitis.

Injury to adjacent structures such as bowel, bladder, or blood vessels.

Recurrence of ovarian cysts, particularly with endometriomas or functional cysts.

Preservation of healthy ovarian tissue is critical to avoid diminished ovarian reserve and maintain fertility. Surgeons may use anti-adhesion barriers or careful surgical techniques to minimize long-term complications.

Advantages of Laparoscopy

Laparoscopic ovarian cystectomy offers several advantages over open surgery, including:

Minimally invasive approach with smaller incisions.

Reduced postoperative pain and faster recovery.

Improved visualization of ovarian and pelvic structures.

Better preservation of ovarian tissue and fertility.

Shorter hospital stay and earlier return to daily activities.

Lower risk of adhesion formation and superior cosmetic outcomes.

Conclusion

Laparoscopic ovarian cystectomy is a safe, effective, and fertility-preserving procedure for managing benign ovarian cysts. With careful patient selection, meticulous surgical technique, and appropriate postoperative care, women can expect excellent outcomes, including relief from symptoms, rapid recovery, and maintenance of reproductive potential. Advances in laparoscopic technology and surgical expertise have firmly established this approach as the standard of care for ovarian cyst management in women of reproductive age.