Ovarian cysts are fluid-filled sacs or masses that develop on or within the ovaries. While many cysts are benign and resolve spontaneously, some require surgical removal due to size, symptoms, or suspicion of malignancy. Traditionally, ovarian cystectomy was performed via open surgery or conventional laparoscopy. However, the advent of Da Vinci robotic surgery has transformed the management of ovarian cysts by combining minimally invasive access with enhanced precision, superior visualization, and greater dexterity.

Dr. R. K. Mishra, a globally recognized expert in robotic and minimally invasive gynecologic surgery, has demonstrated the advantages of robotic ovarian cystectomy, particularly for complex cases involving dense adhesions, endometriotic cysts, or cysts in challenging anatomical locations.

Indications for Ovarian Cystectomy

Surgical removal of an ovarian cyst is indicated in the following scenarios:

Persistent or large cysts (>5–6 cm) causing pain or pressure symptoms

Complex cysts with solid components or septations raising suspicion for malignancy

Endometriomas causing chronic pelvic pain or infertility

Torsion or risk of ovarian torsion

Recurrent cysts unresponsive to medical management

The primary goal is removal of the cyst while preserving healthy ovarian tissue, especially in reproductive-age women who wish to maintain fertility.

Advantages of Da Vinci Robotic Surgery

Robotic surgery provides several advantages over traditional laparoscopy:

Three-Dimensional High-Definition Visualization – The robotic camera offers magnified, 3D views of ovarian and surrounding structures, allowing precise identification of cyst walls and critical anatomy.

Articulating Instruments – Robotic instruments mimic the human wrist, providing seven degrees of freedom for delicate dissection in confined spaces.

Stable Platform – Robotic arms eliminate surgeon tremors and allow sustained precision during complex procedures.

Minimally Invasive Approach – Small port incisions reduce postoperative pain, scarring, and recovery time.

Enhanced Safety in Adhesive or Endometriotic Cases – Dense adhesions or endometriotic cysts can be dissected with reduced risk of injury to bowel, bladder, ureters, or ovarian tissue.

Preoperative Preparation

Imaging Studies – Ultrasound or MRI helps delineate cyst size, location, and characteristics.

Laboratory Evaluation – Tumor markers (CA-125, AFP, beta-HCG) may be assessed if malignancy is suspected.

Patient Counseling – Discussing risks, benefits, potential need for conversion to open surgery, and fertility preservation.

Bowel and Bladder Preparation – In select cases to optimize visualization.

Surgical Technique: Step by Step
Patient Positioning

The patient is placed under general anesthesia in a dorsal lithotomy or supine position, with slight Trendelenburg tilt to allow bowel displacement from the pelvis.

Port Placement and Docking

Robotic trocars are placed strategically based on cyst location and patient anatomy.

The camera port is usually at the umbilicus, with robotic arms on either side and an assistant port for suction, irrigation, or specimen retrieval.

The Da Vinci robot is docked, providing full instrument articulation and visualization.

Pelvic Exploration

A thorough inspection identifies:

The affected ovary and cyst

Contralateral ovary and fallopian tube

Pelvic adhesions, endometriotic implants, or other pathology

Cyst Dissection

Gentle traction and counter-traction allow careful separation of the cyst from normal ovarian tissue.

Sharp and blunt dissection, aided by robotic articulation, ensures cyst wall integrity.

For endometriomas, cyst contents are aspirated carefully if necessary, ideally using an endobag to prevent spillage.

Hemostasis and Ovarian Reconstruction

Bipolar cautery or fine suturing is used for meticulous hemostasis.

The ovarian cortex is reconstructed with absorbable sutures to preserve ovarian function.

Specimen Retrieval and Closure

The cyst is removed through a port, sometimes using a retrieval bag to prevent spillage.

Ports are closed with absorbable sutures, leaving minimal scarring.

Benefits for Patients

Preservation of Fertility – Only cyst tissue is removed, sparing healthy ovarian tissue.

Reduced Pain and Faster Recovery – Compared to open surgery.

Lower Risk of Adhesions – Minimally invasive dissection and careful tissue handling reduce adhesion formation.

Excellent Visualization and Safety – Complex cases are managed with precision and minimal complications.

Risks and Considerations

While robotic ovarian cystectomy is highly safe, potential risks include:

Bleeding or hematoma formation

Injury to adjacent structures such as bowel, bladder, or ureters

Cyst rupture with potential spillage (especially in dermoid or endometriotic cysts)

Need for conversion to open surgery in rare cases

Dr. R. K. Mishra emphasizes that careful patient selection, meticulous technique, and use of protective measures like endobags minimize these risks.

Conclusion

Da Vinci robotic ovarian cystectomy represents a significant advancement in gynecologic surgery. It allows precise excision of ovarian cysts while preserving ovarian tissue, minimizing complications, and enhancing recovery. Under the guidance of experts like Dr. R. K. Mishra, robotic surgery has become a preferred approach for complex, endometriotic, or recurrent cysts, combining safety, efficacy, and patient-friendly outcomes.

With continuous advancements in robotic technology, ovarian cystectomy is now performed with unprecedented precision, safety, and minimally invasive efficiency, improving both short-term recovery and long-term reproductive health.