Ovarian cysts are a common gynecological condition affecting women of reproductive age. Among the various types of ovarian cysts, dermoid cysts—also known as mature cystic teratomas—are one of the most frequently encountered benign ovarian tumors. Dermoid cysts arise from germ cells and can contain diverse tissue types such as hair, skin, teeth, or fat. While often asymptomatic, these cysts can sometimes cause abdominal pain, bloating, menstrual irregularities, or complications like torsion and rupture. Laparoscopic ovarian cystectomy has become the preferred surgical treatment for dermoid cysts due to its minimally invasive nature, safety, and excellent outcomes in preserving ovarian function.

Indications for Surgery

The primary indication for surgical intervention in dermoid cysts includes cysts that are symptomatic, growing in size, or raising suspicion for malignancy based on imaging and tumor markers. In women of reproductive age, preserving ovarian tissue is a critical consideration, making cystectomy—a procedure that removes the cyst while conserving the healthy ovarian tissue—an optimal choice. Laparoscopic surgery is particularly favored for patients with dermoid cysts due to its advantages over traditional open surgery, including smaller incisions, reduced postoperative pain, faster recovery, and better cosmetic outcomes.

Preoperative Evaluation

A thorough preoperative assessment is essential. This includes a detailed medical history, physical examination, and pelvic ultrasonography to determine cyst size, morphology, and presence of any solid components. Tumor markers such as CA-125 may be evaluated, particularly in postmenopausal women or when malignancy is suspected. Preoperative counseling about the benefits, risks, and possible conversion to laparotomy is crucial to set realistic expectations and obtain informed consent.

Surgical Technique

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

Once the ovary is visualized, careful inspection of the cyst and surrounding structures is performed. To minimize spillage of cyst contents, which could cause chemical peritonitis, the cyst is often placed in an endoscopic retrieval bag before aspiration. A careful incision is made on the ovarian cortex overlying the cyst using cold scissors or a harmonic scalpel. The cyst is then gently dissected from the ovarian stroma, preserving as much healthy ovarian tissue as possible. Meticulous hemostasis is achieved using bipolar cautery or fine sutures. The cyst, once excised, is removed from the abdominal cavity using a retrieval bag to prevent contamination.

Intraoperative Considerations

Laparoscopic management of dermoid cysts requires attention to several critical factors. Dermoid cysts often contain sebaceous material, hair, or other tissues that can be sticky and difficult to remove. Spillage must be minimized to prevent chemical peritonitis and adhesion formation. Surgeons must also be vigilant for inadvertent injury to adjacent structures, including the bowel, bladder, and major vessels. In cases of large cysts, decompression inside a retrieval bag before extraction may be necessary. Conversion to open surgery is rarely required but should be considered if extensive adhesions or unexpected findings are encountered.

Postoperative Care and Recovery

Patients undergoing laparoscopic ovarian cystectomy typically experience shorter hospital stays, often being discharged within 24–48 hours. Postoperative pain is mild compared to open surgery and can be managed with oral analgesics. Early ambulation is encouraged to reduce the risk of thromboembolism. Patients are advised to avoid strenuous activities for a few weeks. Follow-up includes ultrasound evaluation to ensure ovarian healing and assess for any recurrence. Fertility considerations are discussed, as ovarian cystectomy preserves ovarian function and hormonal production.

Complications

Although laparoscopic ovarian cystectomy is safe, potential complications include bleeding, infection, adhesion formation, and accidental spillage of cyst contents. Chemical peritonitis, though rare, can occur if dermoid material is not adequately contained. Recurrence of dermoid cysts is uncommon but possible, necessitating routine follow-up. Preservation of ovarian tissue reduces the risk of premature ovarian failure, an important consideration for women desiring future fertility.

Advantages of Laparoscopy

Laparoscopic cystectomy offers several advantages over open surgery: smaller incisions, reduced postoperative pain, faster recovery, shorter hospital stay, lower risk of adhesion formation, and better cosmetic outcomes. Additionally, laparoscopy provides enhanced visualization of pelvic anatomy, allowing precise dissection and minimal trauma to healthy ovarian tissue.

Conclusion

Laparoscopic ovarian cystectomy for dermoid cysts is a safe, effective, and fertility-preserving surgical approach for managing benign ovarian tumors. With careful patient selection, meticulous surgical technique, and attention to minimizing spillage, outcomes are excellent, allowing women to recover quickly while preserving ovarian function. Advances in laparoscopic technology and surgeon expertise continue to make this the gold standard for treating dermoid cysts in women of reproductive age.