Ovarian cysts are one of the most frequently encountered gynecological conditions in women of reproductive age. Most ovarian cysts are benign and asymptomatic, discovered incidentally during routine examinations or ultrasound scans. However, some cysts cause pain, menstrual disturbances, infertility, or acute complications such as torsion or rupture. In these cases, surgical intervention is often required. Over the last three decades, laparoscopic surgery has revolutionized the management of ovarian cyst diseases, providing safe, effective, and minimally invasive solutions.

Understanding Ovarian Cyst Diseases

An ovarian cyst is a fluid-filled sac within or on the surface of the ovary. They are broadly classified into:

Functional cysts: Follicular cysts and corpus luteum cysts, often resolving spontaneously.

Benign neoplasms: Dermoid cysts (mature teratomas), serous cystadenomas, mucinous cystadenomas.

Endometriotic cysts (chocolate cysts): Associated with endometriosis and infertility.

Pathological cysts: Rarely malignant, requiring careful evaluation.

Clinical symptoms include:

Lower abdominal or pelvic pain

Bloating or fullness

Menstrual irregularities

Dyspareunia (painful intercourse)

Infertility in cases like endometrioma

Acute abdomen when complicated by torsion, rupture, or hemorrhage

Indications for Surgery

Not all ovarian cysts require surgical removal. The decision depends on size, type, symptoms, and risk of malignancy.

Laparoscopic surgery is indicated when:

Cysts are persistent or enlarging (>5–6 cm)

Cysts cause significant pain or menstrual disturbances

Endometriomas are suspected in infertile women

Torsion or rupture occurs

Malignancy cannot be excluded (after appropriate evaluation)

Why Laparoscopy?

Laparoscopy is considered the gold standard for ovarian cyst management due to its distinct advantages:

Minimally invasive: Small incisions result in less pain and faster recovery.

Fertility preservation: Healthy ovarian tissue is spared during cyst removal.

Enhanced visualization: High-definition magnification aids precise dissection.

Reduced adhesions: Lower risk compared to open laparotomy.

Better cosmetic outcomes: Minimal scarring improves patient satisfaction.

Short hospital stay: Most women are discharged within 24 hours.

Surgical Techniques

The specific laparoscopic procedure depends on the cyst type and patient’s reproductive goals.

Laparoscopic Ovarian Cystectomy

Preferred for benign cysts in young women desiring fertility.

The ovarian cortex is incised, and the cyst wall carefully enucleated.

Hemostasis is achieved with bipolar energy, preserving maximum ovarian tissue.

The cyst is retrieved in an endobag to prevent spillage.

Laparoscopic Oophorectomy

Indicated for very large cysts, recurrent cysts, or when ovarian tissue cannot be preserved.

Entire ovary with the cyst is removed, often in peri- or postmenopausal women.

Laparoscopic Management of Endometriomas

Involves careful excision of the cyst wall to reduce recurrence.

Meticulous hemostasis minimizes damage to ovarian reserve.

Often combined with adhesiolysis to improve fertility outcomes.

Emergency Laparoscopy

For torsion or rupture, immediate laparoscopy is performed.

The twisted ovary is detorsed, and cystectomy or oophorectomy carried out depending on viability.

Steps of Laparoscopic Surgery

Patient preparation: General anesthesia with appropriate counseling and imaging studies.

Port placement: Typically one umbilical port for the laparoscope and two to three accessory ports.

Exploration: Pelvic cavity is inspected for cyst location, adhesions, or endometriosis.

Cyst removal: Depending on technique, cystectomy or oophorectomy is performed.

Specimen retrieval: Always in an endobag to avoid chemical peritonitis from dermoid or mucinous cyst spillage.

Closure: Hemostasis is ensured, and ports are closed.

Postoperative Care

Hospital stay: Usually 1 day.

Pain relief: Managed with oral analgesics.

Diet: Normal diet resumed within 24 hours.

Activity: Normal activities in a week; strenuous exercise avoided for 2–3 weeks.

Follow-up: Histopathology report is reviewed to confirm diagnosis.

Outcomes and Prognosis

Laparoscopic surgery for ovarian cysts has excellent outcomes when performed by skilled surgeons:

Symptom relief: Significant improvement in pain and menstrual regularity.

Fertility preservation: Especially important in young women and those with endometriomas.

Low recurrence rates: Particularly with complete cyst excision.

Complications: Minimal, though risks include bleeding, adhesions, or inadvertent ovarian damage.

Conclusion

Laparoscopic surgery for ovarian cyst diseases represents the standard of care, offering a minimally invasive, fertility-preserving, and highly effective solution. It allows precise diagnosis, safe removal of cysts, and rapid recovery while minimizing complications.

At world-class centers like World Laparoscopy Hospital, under the expertise of specialists such as Dr. R. K. Mishra, these procedures are performed with state-of-the-art technology and international surgical standards. For women suffering from ovarian cyst diseases, laparoscopy not only restores health and fertility but also ensures comfort, safety, and a quicker return to daily life.