Description

The management of ovarian cysts has evolved significantly over the past few decades, with laparoscopy becoming the gold standard for diagnosis and treatment. Among these, a left-sided ovarian cyst presents a unique set of anatomical and surgical considerations due to its proximity to the sigmoid colon, ureter, and surrounding pelvic structures. Understanding Left-Sided Ovarian Cysts Ovarian cysts are fluid-filled sacs that develop within or on the surface of the ovary. While many are benign and resolve spontaneously, certain cysts—particularly those that persist, enlarge, or cause symptoms—require surgical intervention. A cyst located on the left ovary may sometimes be more challenging to approach laparoscopically due to bowel loops and the anatomical curvature of the sigmoid colon. Laparoscopic Approach: Step-by-Step Preoperative Evaluation Ultrasound or MRI is performed to assess the size, type, and characteristics of the cyst. Blood tests, including tumor markers such as CA-125, are considered in cases of suspected malignancy. Patient Positioning and Port Placement The patient is placed in lithotomy position with Trendelenburg tilt to allow bowel displacement. A 10 mm umbilical port is usually created for the laparoscope, with additional 5 mm ports strategically placed in the lower abdomen for optimal access to the left adnexa. Adhesiolysis and Exposure Gentle mobilization of the sigmoid colon is performed if required to visualize the left ovary clearly. Adhesions, if present, are carefully released to prevent damage to surrounding structures. Cystectomy Procedure The ovarian cortex is incised using monopolar or bipolar energy. The cyst wall is carefully dissected from normal ovarian tissue using traction-countertraction techniques. Special attention is paid to hemostasis to preserve ovarian function and minimize bleeding. Specimen Retrieval The cyst is placed in an endoscopic retrieval bag to prevent spillage. If the cyst is large, controlled aspiration may be performed inside the bag to reduce its size for removal. Final Inspection and Closure Hemostasis is reconfirmed, and irrigation is performed to clear any residual fluid. The ports are closed meticulously to minimize postoperative complications. Advantages of Laparoscopy Minimally invasive: Smaller incisions, less pain, and quicker recovery. Ovary-sparing: The procedure allows maximum preservation of ovarian tissue, important for women desiring future fertility. Reduced adhesions: Advanced laparoscopic techniques minimize postoperative adhesion formation. Enhanced visualization: Magnified view allows precise dissection and safeguarding of nearby structures like the ureter and bowel. Postoperative Recovery Patients undergoing laparoscopic ovarian cystectomy usually experience faster recovery, minimal scarring, and shorter hospital stays compared to open surgery. Early ambulation, resumption of diet, and return to daily activities are common within a few days. Conclusion The laparoscopic approach to a left-sided ovarian cyst is a safe, effective, and fertility-preserving technique that has transformed gynecological surgery. With meticulous preoperative planning and surgical expertise, it provides excellent outcomes, minimizes complications, and enhances patient recovery.