Ovarian cysts are common gynecological conditions, and among them, dermoid cysts (also called mature cystic teratomas) are the most frequent benign tumors in young women. These cysts are unique because they contain tissues derived from different germ layers, such as hair, skin, teeth, fat, or even bone. While often asymptomatic, dermoid cysts can cause abdominal pain, menstrual irregularities, or complications such as torsion or rupture.

With the advancements in minimally invasive gynecologic surgery, laparoscopic removal of dermoid cysts has become the preferred treatment. Particularly in cases of left ovarian dermoid cysts, laparoscopy allows precise dissection, preservation of ovarian tissue, and faster recovery compared to traditional open surgery.

Understanding Dermoid Cysts

Dermoid cysts are benign ovarian neoplasms that typically occur in women of reproductive age, though they may be found at any stage of life. They usually grow slowly and may range in size from a few centimeters to over 15 cm.

Clinical presentation may include:

Dull or sharp pelvic pain, often localized to the left side if the cyst is on the left ovary

Palpable pelvic mass detected during clinical or imaging examination

Menstrual irregularities in some cases

Acute pain if complicated by torsion, rupture, or infection

Diagnosis is confirmed through:

Ultrasound imaging – The most reliable tool, showing a characteristic “dermoid plug” or echogenic shadow.

MRI or CT scan – Used in complex cases to better define contents.

Tumor markers – Occasionally ordered to rule out malignancy.

Indications for Surgery

Not all dermoid cysts require surgery. However, laparoscopic excision is indicated in the following cases:

Cyst size larger than 5 cm

Symptomatic cysts causing pain or menstrual irregularities

Rapidly growing cysts

Complications such as torsion, rupture, or infection

Uncertainty in diagnosis where malignancy cannot be ruled out

Why Laparoscopy?

Laparoscopic surgery has become the gold standard for dermoid cyst management because of its numerous advantages:

Minimally Invasive – Small incisions reduce postoperative pain.

Ovarian Preservation – Allows meticulous cyst enucleation while sparing healthy ovarian tissue, essential for young women desiring fertility.

Shorter Hospital Stay – Patients are usually discharged within 24–48 hours.

Lower Risk of Adhesions – Reduces chances of infertility caused by postoperative adhesions.

Better Visualization – High-definition cameras allow precise dissection and control of bleeding.

Cosmetic Benefit – Minimal scarring compared to open laparotomy.

Surgical Technique for Left Ovarian Dermoid Cyst
Preoperative Preparation

General anesthesia is administered.

Prophylactic antibiotics are given.

The patient is positioned in lithotomy with Trendelenburg tilt for pelvic exposure.

Port Placement

A 10 mm umbilical port for the laparoscope.

Two or three additional 5 mm ports placed in the lower abdomen for working instruments.

Exploration

The left ovary is identified, and the dermoid cyst is visualized.

Any adhesions between the cyst and surrounding structures are carefully dissected.

Cystectomy

The ovarian cortex is incised, and the cyst is gently enucleated using atraumatic instruments.

Care is taken to avoid rupture, as dermoid cysts may release sebaceous material, hair, or fat, which can cause chemical peritonitis.

If spillage occurs, copious irrigation and suction are performed to minimize complications.

Hemostasis and Ovarian Reconstruction

Bleeding points are coagulated with bipolar energy.

The ovary is reconstructed with fine sutures if necessary, preserving maximum healthy ovarian tissue.

Specimen Retrieval

The cyst is placed in an endobag and removed through the umbilical port.

This prevents contamination of the peritoneal cavity with cyst contents.

Final Inspection and Closure

The pelvic cavity is thoroughly irrigated.

Port sites are closed with absorbable sutures.

Postoperative Care

Hospital Stay: Most patients are discharged within 24 hours.

Pain Management: Oral analgesics are usually sufficient.

Diet: Normal diet is resumed the same day or next morning.

Activity: Light activity within 1–2 days; full recovery in about a week.

Follow-up: Regular gynecological visits ensure no recurrence or complications.

Outcomes and Prognosis

High Success Rates: Laparoscopic dermoid cystectomy has a very high success rate with low recurrence.

Preservation of Fertility: Ovarian tissue is preserved, maintaining hormonal and reproductive function.

Complication Rates: Very low when performed by experienced surgeons; risk of peritonitis is minimized with careful specimen handling.

Conclusion

Laparoscopic surgery for left ovarian dermoid cyst is a safe, effective, and fertility-preserving procedure. It combines the benefits of minimally invasive techniques with precise surgical control, offering excellent outcomes and quicker recovery.

At advanced centers like World Laparoscopy Hospital, under the guidance of experts such as Dr. R. K. Mishra, this procedure is performed with cutting-edge technology and strict surgical protocols. For women affected by dermoid cysts, laparoscopic management not only relieves symptoms but also ensures preservation of reproductive health and improved quality of life.