Ovarian cysts are common gynecological conditions that affect women of reproductive age. While many cysts are harmless and resolve spontaneously, complications can arise when they enlarge, rupture, or undergo torsion. Ovarian torsion is a medical emergency that occurs when the ovary, often with a cyst or mass attached, twists around the supporting ligaments. This twisting cuts off blood supply to the ovary and fallopian tube, leading to severe abdominal pain and the risk of permanent ovarian damage if not treated promptly.

Laparoscopic surgery has become the gold standard for diagnosing and managing torsion of ovarian cysts. It is minimally invasive, provides rapid symptom relief, and allows preservation of ovarian function, which is particularly important for young women and those wishing to maintain fertility.

Understanding Torsion of Ovarian Cyst

Torsion occurs when the ovary or adnexa rotates around its ligamentous supports, most often due to the presence of a cyst or tumor that makes the ovary heavier.

Common causes include:

Benign ovarian cysts (functional, dermoid, or serous cysts)

Ovarian hyperstimulation during fertility treatment

Ovarian enlargement in pregnancy

Symptoms usually present suddenly and include:

Severe, sharp lower abdominal or pelvic pain (often unilateral)

Nausea and vomiting

Abdominal tenderness and distension

Low-grade fever (in some cases)

Because these symptoms mimic other acute abdominal conditions such as appendicitis or ectopic pregnancy, early imaging with ultrasound is critical. However, definitive diagnosis is often made during surgery.

Why Laparoscopic Surgery?

Traditionally, laparotomy (open surgery) was performed for ovarian torsion. Today, laparoscopy offers clear advantages:

Minimally Invasive – Small incisions mean less trauma, reduced postoperative pain, and faster healing.

Accurate Diagnosis – High-definition laparoscopic cameras allow direct visualization of the ovary and adnexa.

Ovary Preservation – In many cases, detorsion (untwisting) of the ovary restores blood flow, allowing conservation rather than removal.

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

Fertility Protection – Laparoscopy enables cyst removal while preserving healthy ovarian tissue.

Surgical Steps in Laparoscopic Management

The goal of laparoscopic surgery is to confirm torsion, restore blood supply, and remove the causative cyst if needed.

Anesthesia and Port Placement

The patient is given general anesthesia.

A laparoscope is inserted through a small incision at the umbilicus, with additional ports placed for working instruments.

Inspection of Pelvis

The ovary and adnexa are inspected to confirm torsion.

Surgeons assess the number of twists and the viability of the ovary.

Detorsion

The ovary is gently untwisted using laparoscopic instruments.

Even if the ovary appears dark or congested, it is usually preserved because blood flow often returns within minutes to hours.

Cystectomy

If a cyst is responsible for torsion, it is carefully excised.

Healthy ovarian tissue is preserved, and hemostasis is achieved.

Oophorectomy (if necessary)

In rare cases where the ovary is necrotic and unsalvageable, removal of the ovary (oophorectomy) may be performed.

Surgeons strive to avoid this outcome, especially in younger women.

Closure

Ports are removed, and small skin incisions are closed with sutures or adhesive strips.

Recovery After Surgery

Recovery from laparoscopic surgery for torsion of ovarian cyst is generally quick.

Most patients return home within a day or two.

Light activities can be resumed within a week, while full recovery occurs in 2–3 weeks.

Postoperative discomfort is mild and manageable with oral pain medications.

Regular follow-up is advised to ensure ovarian function has returned and to monitor for recurrence of cysts.

Risks and Considerations

Although laparoscopy is safe and effective, certain risks must be considered:

Bleeding or infection

Injury to adjacent organs (bowel, bladder, ureters)

Recurrence of ovarian torsion if cysts reappear

Loss of the ovary if it is non-viable

Prompt intervention is crucial. Delayed surgery increases the likelihood of ovarian necrosis and reduces the chances of saving the ovary.

Fertility and Prognosis

One of the most significant benefits of laparoscopic management is fertility preservation. By detorsing the ovary and excising the cyst while leaving healthy tissue intact, women can maintain normal ovulation and reproductive potential. Studies have shown that even ovaries that initially appear ischemic often regain function after detorsion.

Long-term prognosis is excellent when torsion is managed early with laparoscopy. Patients typically regain normal ovarian function, and recurrence rates are low if underlying cysts are properly treated.

Conclusion

Torsion of an ovarian cyst is a gynecological emergency requiring immediate surgical intervention. Laparoscopic surgery has transformed the management of this condition by offering a minimally invasive, fertility-preserving approach with rapid recovery and excellent outcomes.

By enabling accurate diagnosis, safe detorsion, and cyst removal through tiny incisions, laparoscopy not only relieves acute symptoms but also safeguards a woman’s reproductive health. Timely access to skilled laparoscopic surgeons is key to ensuring that women experiencing ovarian torsion receive optimal care and a swift return to health.