Ovarian cysts are a common gynecological condition, and among them, dermoid cysts—also known as mature cystic teratomas—are one of the most frequently encountered benign ovarian tumors. They are germ cell tumors containing a mixture of tissues such as hair, fat, sebaceous material, or even teeth and bone. These cysts can occur on either ovary, but when specifically localized to the right ovary, laparoscopic ovarian cystectomy offers a safe and effective treatment approach. With the growing popularity of minimally invasive surgery, laparoscopic cystectomy has become the standard of care for women of reproductive age who wish to preserve ovarian tissue and fertility.

Understanding Dermoid Cysts

Dermoid cysts originate from totipotent germ cells, which have the ability to differentiate into various tissue types. They are slow-growing, benign in nature, and most commonly diagnosed in women of reproductive age. Although usually asymptomatic, they may present with abdominal pain, pelvic mass, menstrual irregularities, or acute complications such as torsion, rupture, or infection. The right ovary is slightly more predisposed to torsion due to its greater mobility compared to the left side. Therefore, a right-sided dermoid cyst often demands timely surgical intervention to prevent emergency situations.

Indications for Surgery

While small and asymptomatic dermoid cysts may be monitored conservatively with imaging, surgical management becomes essential in the following situations:

Persistent pain or discomfort in the right lower abdomen.

Increasing cyst size, usually larger than 5 cm.

Risk of torsion, rupture, or infection.

Diagnostic uncertainty where malignancy needs to be excluded.

Desire to preserve ovarian function in young women planning pregnancy.

Role of Laparoscopy

Laparoscopic ovarian cystectomy has emerged as the gold standard for managing dermoid cysts, replacing traditional open surgery in most cases. This minimally invasive approach offers several advantages, including smaller incisions, reduced postoperative pain, minimal adhesion formation, faster recovery, and superior cosmetic results. Importantly, it allows for meticulous dissection of the cyst while preserving as much healthy ovarian tissue as possible, thereby maintaining fertility potential.

Surgical Technique

The procedure begins under general anesthesia, with the patient placed in the lithotomy and Trendelenburg position to allow better visualization of the pelvis. After establishing pneumoperitoneum, trocars are inserted strategically. Usually, a three-port technique is used, though some surgeons may perform the surgery with two ports depending on expertise.

Inspection of the pelvis: The right ovary is visualized to assess the dermoid cyst and its relation to surrounding structures such as the fallopian tube, uterus, and bowel.

Ovarian incision: A small incision is made on the ovarian surface using laparoscopic scissors or an energy device.

Cyst enucleation: The cyst wall is carefully dissected and separated from normal ovarian tissue by traction and counter-traction. Care is taken to minimize spillage of cyst contents, as dermoid cysts contain sebaceous material and hair that may cause chemical peritonitis.

Specimen retrieval: The cyst is placed inside an endoscopic retrieval bag and removed through a port site to prevent contamination.

Ovarian reconstruction: The ovarian capsule is sutured or coagulated to achieve hemostasis and restore normal ovarian anatomy.

Peritoneal lavage: In case of spillage, thorough irrigation of the peritoneal cavity is performed to reduce the risk of postoperative adhesions or granulomatous reaction.

Precautions During Surgery

One of the key challenges in laparoscopic dermoid cystectomy is avoiding rupture of the cyst. Even with utmost care, spillage may occur in 30–40% of cases. However, with prompt suctioning and irrigation, the long-term consequences are minimal. Surgeons must also be vigilant in preserving ovarian reserve, especially in younger women, by avoiding excessive cauterization.

Postoperative Care

Recovery after laparoscopic ovarian cystectomy is typically smooth and rapid. Patients are usually discharged within 24–48 hours. They may experience mild abdominal discomfort, which can be managed with oral analgesics. Early ambulation and resumption of diet are encouraged. Most women can return to normal activities within a week. Follow-up includes histopathological confirmation of the benign nature of the cyst and periodic ultrasound surveillance to monitor ovarian function.

Advantages of Laparoscopic Approach

Fertility preservation: Healthy ovarian tissue is conserved, ensuring continued hormonal function and reproductive potential.

Minimal scarring: Small keyhole incisions provide excellent cosmetic outcomes.

Reduced hospital stay: Early discharge minimizes disruption to daily life.

Fewer adhesions: Minimally invasive surgery lowers the risk of pelvic adhesions, which can otherwise cause infertility or chronic pain.

Rapid recovery: Patients regain normal activity much faster compared to open surgery.

Prognosis and Long-Term Outcomes

The prognosis following laparoscopic ovarian cystectomy for a right-sided dermoid cyst is excellent. Recurrence is rare but can occur if dermoid tissue is inadvertently left behind. Fertility outcomes remain favorable, with many women successfully conceiving postoperatively. The risk of malignant transformation is exceedingly low, but histological confirmation remains mandatory.

Conclusion

Laparoscopic ovarian cystectomy for right-sided dermoid cyst is a safe, effective, and fertility-sparing procedure that combines the advantages of minimally invasive surgery with precise management of ovarian pathology. It not only alleviates symptoms and prevents complications but also ensures preservation of reproductive health in young women. With proper surgical technique and postoperative care, patients can look forward to a quick recovery, excellent cosmetic results, and long-term well-being.