Ovarian cysts are fluid-filled sacs that develop within or on the surface of an ovary. While small ovarian cysts are common and often resolve without intervention, huge ovarian cysts—those measuring more than 10 cm—pose significant clinical challenges. Traditionally, large cysts were removed through open surgery (laparotomy). However, with advances in minimally invasive surgery, laparoscopic removal of huge ovarian cysts has become a safe and effective alternative, offering patients faster recovery and improved outcomes.

Understanding Ovarian Cysts

Ovarian cysts can be classified into several types:

Functional Cysts: Follicular cysts or corpus luteum cysts, often benign and self-limiting.

Pathological Cysts: Including dermoid cysts, endometriomas, and cystadenomas.

Malignant Ovarian Tumors: Though rare, they must always be ruled out in the evaluation of a large ovarian mass.

Huge ovarian cysts may cause abdominal distension, pelvic pain, bloating, urinary frequency, or even difficulty breathing due to pressure on surrounding organs. In some cases, complications like torsion, rupture, or hemorrhage may occur, requiring urgent surgical intervention.

Diagnostic Evaluation

Before surgery, a detailed evaluation is crucial to distinguish between benign and malignant cysts. This usually includes:

Ultrasound Imaging: First-line tool to determine cyst size, wall thickness, septations, and contents.

CT or MRI: To assess very large cysts and their relation to surrounding organs.

Tumor Markers: Blood tests such as CA-125, CEA, or AFP to rule out malignancy.

Clinical Assessment: Symptoms, age, and medical history guide the decision for surgical management.

If malignancy is suspected, open surgery is preferred. But in cases where the cyst appears benign, laparoscopic removal is the technique of choice—even for huge ovarian cysts.

Laparoscopic Technique for Huge Ovarian Cyst Removal

The laparoscopic approach for giant ovarian cysts requires meticulous planning and advanced surgical expertise. The key steps include:

Patient Positioning and Anesthesia

The patient is placed under general anesthesia in the lithotomy position with Trendelenburg tilt to facilitate pelvic access.

Port Placement

A small incision is made at the umbilicus (or supraumbilical site if the cyst is very large) to insert the laparoscope.

Additional 5 mm ports are placed laterally for operative instruments.

Cyst Decompression

Since a huge cyst occupies most of the abdominal cavity, safe decompression is often necessary. A trocar or suction device is used to aspirate cyst fluid under controlled conditions. This reduces cyst size and creates working space while minimizing spillage.

Cystectomy or Oophorectomy

Cystectomy: The cyst wall is carefully dissected from the ovary, preserving as much normal ovarian tissue as possible.

Oophorectomy: If the ovary is extensively damaged, removal of the ovary may be necessary.

Specimen Retrieval

The cyst wall and contents are placed in an endoscopic retrieval bag and removed through the port site to prevent contamination or spillage into the abdominal cavity.

Hemostasis and Closure

Bleeding points are coagulated, and the ovary is reconstructed with fine sutures if preserved. Ports are closed with minimal scarring.

Advantages of Laparoscopic Removal

Compared to laparotomy, laparoscopic management of huge ovarian cysts offers:

Smaller Incisions: Better cosmetic results and reduced surgical trauma.

Minimal Blood Loss: Enhanced precision reduces intraoperative bleeding.

Faster Recovery: Shorter hospital stay (usually 1–2 days) and quicker return to daily activities.

Lower Risk of Adhesions: Important for women desiring future fertility.

Reduced Pain: Postoperative discomfort is significantly less.

Challenges and Considerations

Risk of Malignancy: Surgeons must carefully evaluate preoperative imaging and tumor markers. If cancer is suspected, conversion to open surgery is recommended.

Cyst Spillage: Rupture of the cyst inside the abdomen may cause chemical peritonitis or spread of malignant cells if the lesion is cancerous. Use of retrieval bags minimizes this risk.

Technical Expertise: Managing huge cysts laparoscopically requires advanced skills in dissection, suturing, and specimen retrieval.

Patient Outcomes

Several studies have demonstrated that laparoscopic removal of ovarian cysts larger than 15–20 cm is not only feasible but also safe in selected patients. Success rates are high, complication rates are low, and fertility preservation is possible in most cases. Patients benefit from rapid recovery and minimal postoperative morbidity compared to traditional surgery.

Conclusion

The laparoscopic removal of huge ovarian cysts represents a significant advancement in gynecological surgery. With proper preoperative evaluation, careful intraoperative technique, and skilled surgical expertise, laparoscopic surgery offers patients excellent outcomes, minimal complications, and quicker return to normal life.

By replacing traditional open procedures with minimally invasive approaches, surgeons today provide safer and more patient-friendly options, ensuring that even complex cases such as giant ovarian cysts can be managed effectively with laparoscopy.