The management of ovarian cysts has evolved significantly with the advent of minimally invasive surgery. While many ovarian cysts can be treated with conservative approaches or laparoscopic cystectomy, there are cases where the size, complexity, or recurrence of the cyst necessitates removal of the ovary and fallopian tube—a procedure known as salpingo-oophorectomy. Performing this surgery laparoscopically for a huge ovarian cyst is both a technical challenge and a demonstration of advanced surgical skill. At World Laparoscopy Hospital, under the expertise of Dr. R. K. Mishra, laparoscopic salpingo-oophorectomy has been perfected into a safe, effective, and patient-friendly procedure even in cases of massive ovarian cysts.

Understanding Huge Ovarian Cysts

Ovarian cysts are common gynecological findings, often discovered during routine ultrasounds. While small cysts may remain asymptomatic, huge ovarian cysts—sometimes reaching more than 10–15 cm in diameter—can cause:

Abdominal distension or bloating

Pelvic pain or pressure

Difficulty in urination or bowel movements due to compression

Menstrual irregularities

Acute complications like torsion or rupture

Large cysts are more difficult to manage conservatively, and the risk of malignancy must always be considered. For postmenopausal women or when ovarian preservation is not possible, salpingo-oophorectomy becomes the procedure of choice.

Why Laparoscopic Salpingo-Oophorectomy?

Traditionally, huge ovarian cysts were removed via open laparotomy, leaving patients with prolonged recovery, significant pain, and large scars. The laparoscopic approach, however, provides several advantages:

Minimally invasive: Small incisions and reduced tissue trauma.

Enhanced visualization: High-definition magnified view aids precise dissection.

Lower morbidity: Less postoperative pain, fewer adhesions, and faster recovery.

Cosmetic benefits: Minimal scarring compared to open surgery.

Quicker discharge: Most patients leave the hospital within 24–48 hours.

Dr. R. K. Mishra has demonstrated that even very large ovarian cysts, which were once considered unsuitable for laparoscopy, can now be safely managed with advanced techniques and instruments.

Surgical Technique by Dr. R. K. Mishra
Preoperative Preparation

Comprehensive imaging (ultrasound, CT, or MRI) to evaluate size, origin, and potential malignancy.

Tumor markers (CA-125 and others) to exclude ovarian cancer.

Bowel and bladder preparation as needed.

Patient Positioning and Access

The patient is placed in lithotomy with Trendelenburg tilt.

Pneumoperitoneum is established using the Veress needle technique or open access depending on adhesions and anatomy.

Port Placement

A supraumbilical or Palmer’s point entry is often preferred in very large cysts.

Accessory ports are placed under direct vision for instrument handling.

Decompression of the Cyst

If the cyst is too large to manipulate, controlled aspiration of cyst fluid is performed using a suction cannula or endobag to prevent spillage.

This step reduces bulk and creates working space inside the abdomen.

Salpingo-Oophorectomy

The infundibulopelvic ligament is identified and sealed using bipolar energy or advanced vessel-sealing devices.

The mesosalpinx and utero-ovarian ligament are coagulated and divided.

Care is taken to avoid injury to adjacent structures such as the ureter and bowel.

The ovary and fallopian tube are completely detached.

Specimen Retrieval

The specimen is placed in an endobag and extracted through an extended port site to avoid spillage.

For very large cysts, the bag may be delivered partially, and the contents aspirated before removal.

Closure

Hemostasis is ensured.

Peritoneal lavage may be done in case of spillage.

Ports are closed meticulously.

Postoperative Care

Recovery: Patients generally ambulate within hours and resume diet the same day.

Hospital Stay: Most patients are discharged within 24–48 hours.

Restrictions: Heavy lifting and strenuous activity are avoided for 2–3 weeks.

Follow-up: Histopathological confirmation of cyst type is essential.

Outcomes and Benefits

Dr. R. K. Mishra’s laparoscopic salpingo-oophorectomy for huge ovarian cysts has consistently shown:

Excellent patient outcomes with minimal complications.

Lower recurrence rates since both ovary and tube are removed.

Significant pain relief and restoration of abdominal comfort.

Faster return to daily activities compared to open surgery.

Challenges and Considerations

Risk of malignancy: Thorough preoperative workup is crucial.

Spillage: Meticulous technique with endobag retrieval minimizes risks.

Adhesions: Common in recurrent cysts, requiring skilled dissection.

Learning curve: This advanced laparoscopic procedure requires specialized training and expertise.

Conclusion

Laparoscopic salpingo-oophorectomy for huge ovarian cysts, as performed by Dr. R. K. Mishra at World Laparoscopy Hospital, is a safe and effective surgical option. With the advantages of minimal invasiveness, superior visualization, and rapid recovery, this approach has transformed the management of large ovarian cysts. By combining modern laparoscopic technology with expert surgical technique, Dr. Mishra ensures optimal patient outcomes while setting a benchmark in advanced gynecological surgery.