Ovarian cysts are fluid-filled sacs that form on or within the ovaries. They are common in women of reproductive age and are usually benign. However, when cysts become large, symptomatic, or persistent, surgical management may be required. In cases where cysts are present in both ovaries, the procedure performed is a laparoscopic bilateral ovarian cystectomy. This minimally invasive surgery allows for the removal of cysts from both ovaries while preserving as much healthy ovarian tissue as possible, thus maintaining hormonal function and fertility potential.

Indications for Bilateral Ovarian Cystectomy

Surgery is indicated in the following situations:

Persistent or enlarging cysts that do not resolve spontaneously.

Symptomatic cysts causing pelvic pain, bloating, or pressure symptoms.

Complex cysts suspicious of endometriomas, dermoid cysts, or borderline tumors.

Cysts associated with infertility in women undergoing evaluation for reproductive issues.

Bilateral ovarian involvement where conservative treatment fails or risk of complications like torsion or rupture is high.

Advantages of the Laparoscopic Approach

Compared to open surgery, laparoscopic bilateral ovarian cystectomy offers multiple benefits:

Small incisions and minimal scarring – cosmetically favorable for young women.

Shorter hospital stay – most patients are discharged within 24–48 hours.

Faster recovery – return to daily activities within 1–2 weeks.

Less postoperative pain – reduced trauma to abdominal muscles.

Preservation of ovarian tissue – careful dissection allows healthy ovarian tissue to remain intact.

Enhanced visualization – high-definition laparoscopy enables precise dissection, even in complex cases.

Surgical Technique
Preoperative Preparation

Patients undergo a thorough evaluation including ultrasound or MRI, hormonal profile, and tumor markers (like CA-125) to rule out malignancy. Preoperative counseling regarding fertility preservation and risks is essential.

Anesthesia and Positioning

The surgery is performed under general anesthesia. The patient is placed in the lithotomy position with Trendelenburg tilt, which allows bowel loops to fall away from the pelvis for better visualization.

Port Placement

Typically, a three- or four-port technique is used:

Umbilical port for the laparoscope.

Two lateral ports for operative instruments.

Sometimes an additional port for assistance or suction.

Steps of the Procedure

Creation of pneumoperitoneum – carbon dioxide is insufflated to create working space.

Inspection of pelvic anatomy – both ovaries are examined to assess the size, number, and nature of cysts.

Incision on the ovarian cortex – a small cut is made on the ovarian surface using monopolar cautery or scissors.

Cyst enucleation – the cyst wall is carefully separated from the surrounding healthy ovarian tissue using traction and counter-traction.

Hemostasis – small bleeding points are coagulated.

Ovarian reconstruction – the ovary is closed using fine sutures or left to heal naturally, depending on the extent of dissection.

Repeat on the opposite ovary – the same steps are followed for the cyst on the other ovary.

Specimen retrieval – cysts are placed in an endoscopic retrieval bag and removed to prevent spillage, especially in dermoid cysts or endometriomas.

Postoperative Care

Recovery after laparoscopic bilateral ovarian cystectomy is usually smooth.

Pain management – mild analgesics are generally sufficient.

Diet – liquids are started the same day, followed by normal diet the next day.

Mobilization – patients are encouraged to walk early to prevent clots.

Hospital stay – most are discharged within 24 hours.

Return to activity – light activity within a few days, complete recovery in 1–2 weeks.

Follow-up includes histopathological examination of the cyst wall to rule out malignancy and periodic ultrasound monitoring of ovarian function.

Risks and Complications

Although safe, potential risks include:

Bleeding or injury to surrounding organs.

Adhesion formation which can affect fertility.

Recurrence of cysts, particularly functional or endometriotic cysts.

Loss of ovarian tissue, which may affect ovarian reserve.

Conversion to laparotomy in cases of unexpected complications or suspicion of malignancy.

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One of the major goals of laparoscopic bilateral ovarian cystectomy is to preserve fertility. By removing the cyst while conserving ovarian tissue, hormonal function and ovulatory cycles are usually maintained. In women with endometriomas or dermoid cysts, surgery can significantly improve chances of natural conception or success with assisted reproductive techniques.

Long-term outcomes are generally favorable, with:

High rates of symptom relief.

Low recurrence when cysts are completely excised.

Good preservation of ovarian function, especially with careful surgical technique.

Conclusion

Laparoscopic bilateral ovarian cystectomy is a safe, effective, and fertility-preserving procedure for women with bilateral ovarian cysts. It combines the advantages of minimally invasive surgery with the precision required to remove cysts while sparing healthy ovarian tissue. The laparoscopic approach ensures faster recovery, minimal pain, and better cosmetic results compared to open surgery. When performed by skilled laparoscopic surgeons, it offers excellent outcomes in terms of symptom relief, ovarian conservation, and improved reproductive potential.

This procedure highlights the remarkable progress of minimally invasive gynecologic surgery in addressing complex ovarian pathology while prioritizing women’s long-term health and fertility.