Watch this detailed video demonstrating the laparoscopic resection of a torted ovarian dermoid cyst. This surgery showcases minimally invasive techniques for safe and effective removal of ovarian cysts, highlighting key steps, surgical instruments, and best practices.

Torsion or rupture of an ovarian cyst may present as an acute abdomen. A case is presented where the diagnosis was made at laparoscopy and laparoscopic resection was done. Controlled aspiration of the cyst contents allowed the cyst to be easily removed from the abdomen. Ovarian dermoid cysts may present as an emergency after torsion or rupture and from time to time general surgeons will encounter such a case. Laparoscopic management is beneficial and preservation of ovarian tissue and the fallopian tube is usually possible. We would recommend placing the cyst into a bag and externalizing it prior to the aspiration to avoid any risk of contamination.

Ovarian dermoid cysts, also known as mature cystic teratomas, are common benign ovarian tumors that contain tissues such as hair, skin, or fat. While usually asymptomatic, they can sometimes undergo torsion, a condition in which the ovary twists around its supporting ligaments. Torsion is a surgical emergency because it can compromise blood flow, leading to severe pain and potential ovarian damage.

Understanding Ovarian Torsion

Ovarian torsion often presents as sudden-onset lower abdominal pain, nausea, and vomiting. Early diagnosis is crucial to preserve ovarian function. Ultrasound with Doppler flow studies is typically used to identify reduced blood flow to the affected ovary, while MRI or CT scans may be used in complex cases.

Why Laparoscopy is Preferred

Traditionally, ovarian surgery involved open laparotomy, but laparoscopy has become the gold standard for managing ovarian cysts, including torted dermoid cysts. Laparoscopic surgery offers multiple advantages:

Minimally invasive with smaller incisions

Reduced post-operative pain

Shorter hospital stay and faster recovery

Better cosmetic outcomes

Magnified view of the pelvic structures for precise surgery

Preoperative Preparation

Before surgery, the patient undergoes routine blood tests, imaging studies, and anesthetic evaluation. Informed consent is obtained, emphasizing the benefits and risks of laparoscopic surgery. Patients are advised to fast for several hours prior to the procedure.

Surgical Procedure

Anesthesia and Positioning: The patient is placed under general anesthesia in a supine or lithotomy position.

Trocar Placement: Small incisions are made in the abdominal wall for the laparoscope and surgical instruments.

Exploration: The pelvic cavity is carefully examined to identify the torted ovary and cyst.

Detorsion: The ovary is gently untwisted to restore blood flow, if viable.

Cyst Resection: The dermoid cyst is carefully dissected from the ovarian tissue. Techniques such as cyst aspiration may be used to reduce spillage risk.

Specimen Removal: The cyst is removed using a laparoscopic bag to prevent contamination of the abdominal cavity.

Hemostasis and Closure: Bleeding is controlled, and the incisions are closed with sutures or adhesive strips.

Postoperative Care

Patients usually recover quickly after laparoscopic surgery. Pain is managed with mild analgesics, and most can resume normal activities within a week. Follow-up includes ultrasound to ensure proper healing and assess ovarian function.

Risks and Considerations

Although laparoscopy is safe, potential risks include:

Bleeding or infection

Injury to surrounding organs (bladder, bowel)

Spillage of cyst contents causing chemical peritonitis (rare)

Recurrence of ovarian cysts

Experienced surgeons minimize these risks through meticulous technique and careful handling of the cyst.

Conclusion

Laparoscopic resection of a torted ovarian dermoid cyst is a safe, effective, and minimally invasive approach that preserves ovarian function and promotes faster recovery. Early diagnosis and timely surgical intervention are critical for optimal outcomes. This procedure exemplifies how modern gynecologic surgery combines precision, safety, and patient-centered care.