Dermoid ovarian cysts, also known as mature cystic teratomas, are one of the most common benign ovarian tumors found in women of reproductive age. These cysts are unique because they contain elements from all three germ layers, including hair, teeth, skin, and fat. Although usually asymptomatic, they can cause pain, torsion, or rupture, necessitating surgical removal.

With the advancement of minimally invasive surgery, laparoscopic cystectomy has become the gold standard for managing ovarian dermoid cysts. Dr. R. K. Mishra, an internationally recognized laparoscopic surgeon and educator, has refined techniques to make laparoscopic dermoid cystectomy safe, effective, and fertility-preserving. His lectures and live surgical demonstrations are highly valued by gynecologists and laparoscopic trainees worldwide.

Introduction to Dermoid Ovarian Cysts

Dermoid cysts account for up to 20% of all ovarian tumors. They are slow-growing, usually unilateral, and are more common in women between the ages of 20 and 40 years. Most patients present with abdominal discomfort, pelvic pain, or are diagnosed incidentally during ultrasound for other reasons. Complications like torsion, rupture, or infection make surgical management essential.

Dr. Mishra emphasizes that laparoscopic removal of dermoid cysts not only eliminates the pathology but also preserves ovarian tissue, which is vital for maintaining fertility in young women.

Preoperative Considerations

Before surgery, patients undergo detailed evaluation:

Imaging: Ultrasound and MRI help confirm the diagnosis and differentiate from malignant masses.

Laboratory tests: Tumor markers like CA-125 may be checked, though dermoid cysts are generally benign.

Counseling: Patients are informed about the procedure, risks, and the possibility of conversion to open surgery if necessary.

According to Dr. Mishra, meticulous planning and preparation are key to preventing intraoperative complications such as cyst rupture and spillage of sebaceous material.

Surgical Technique

Dr. Mishra describes laparoscopic dermoid ovarian cystectomy as a step-by-step, precision-based procedure.

Patient Positioning and Port Placement

The patient is placed in the lithotomy position under general anesthesia. A standard three- or four-port laparoscopic setup is established: one umbilical port for the camera and two or three working ports in the lower abdomen.

Exploration of the Pelvis

The ovaries, uterus, and adnexa are inspected. The affected ovary is identified, and adhesions, if any, are gently released.

Ovarian Incision

An incision is made on the ovarian cortex overlying the cyst using laparoscopic scissors or monopolar energy. Dr. Mishra highlights the importance of minimal thermal damage to preserve ovarian tissue.

Enucleation of the Cyst

The cyst is carefully dissected from the surrounding ovarian stroma using traction and counter-traction. The “stripping technique” is often employed, where the ovarian tissue is gently pulled away from the cyst wall.

Preventing Spillage

Dermoid cysts contain greasy, sebaceous material that can cause chemical peritonitis if spilled. To avoid this:

Endobags are used to retrieve the cyst.

If the cyst ruptures inadvertently, copious irrigation and suction are performed to clean the peritoneal cavity.

Ovarian Reconstruction

After the cyst is removed, the ovarian edges are approximated using fine absorbable sutures. This step is crucial to preserve fertility and restore normal ovarian anatomy.

Specimen Retrieval

The cyst is extracted through an endobag via the umbilical port or a slightly extended incision. This prevents contamination of the abdominal cavity with cyst contents.

Final Inspection

The pelvis is irrigated thoroughly, hemostasis is checked, and ports are closed.

Advantages of Laparoscopic Dermoid Cystectomy

Dr. Mishra outlines several benefits of the laparoscopic approach:

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

Fertility preservation: Careful dissection spares healthy ovarian tissue.

Better visualization: Magnified laparoscopic view aids precise surgery.

Cosmetic outcome: Minimal scarring, which is important for young women.

Shorter hospital stay: Most patients can be discharged within 24–48 hours.

Challenges and Complications

While the procedure is safe in experienced hands, Dr. Mishra notes potential challenges:

Cyst rupture and spillage, requiring meticulous irrigation.

Adhesions from previous surgeries or pelvic infections that complicate dissection.

Recurrence, if part of the cyst wall is inadvertently left behind.

Rare complications like infection, bleeding, or injury to adjacent organs.

He emphasizes that adequate training and adherence to standard laparoscopic principles minimize these risks.

Teaching and Training

At World Laparoscopy Hospital, Dr. Mishra integrates didactic lectures, 3D video demonstrations, and live surgical workshops for trainees. He stresses hands-on practice in simulation labs before attempting real procedures. His teaching style combines theoretical knowledge with practical tips, such as the importance of using endobags and careful ovarian suturing, making complex procedures easier for learners.

Conclusion

Laparoscopic dermoid ovarian cystectomy is the procedure of choice for managing benign ovarian dermoid cysts, especially in young women where fertility preservation is critical. Dr. R. K. Mishra’s expertise and innovative teaching methods have made this surgery safer and more accessible worldwide.

By combining meticulous surgical technique with advanced laparoscopic skills, he demonstrates how dermoid cysts can be removed effectively with minimal complications, faster recovery, and excellent cosmetic results. His contribution continues to inspire gynecologic surgeons to adopt minimally invasive surgery as the standard of care.