This video demonstrates Laparoscopic Ovarian Cystectomy for right-sided ovarian Endometrioma. Laparoscopic Ovarian Cystectomy, a conservative surgical procedure for endometriomas due to the invasive nature of the surgery it should be performed inside endobag. The laparoscopic procedure strips the cyst wall – the portion of the cyst containing the endometrial tissue. The benefits of this procedure include decreased recurrence rates, increased chance of spontaneous pregnancy and a significant reduction in pelvic pain.

Endometrioma, commonly known as “chocolate cyst,” is a type of ovarian cyst formed due to endometriosis. Endometriosis is a condition where the tissue similar to the lining of the uterus grows outside it, often affecting the ovaries, fallopian tubes, and pelvic lining. Endometriomas can cause chronic pelvic pain, menstrual irregularities, infertility, and complications like rupture or torsion. Laparoscopic ovarian cystectomy has emerged as the gold standard for the surgical management of endometriomas due to its minimally invasive nature and excellent outcomes.

Indications for Surgery

Laparoscopic cystectomy is recommended in the following scenarios:

Symptomatic cysts: Patients with pelvic pain, dysmenorrhea, or dyspareunia.

Infertility: Presence of endometrioma affecting ovarian function or access to assisted reproductive techniques.

Cyst size: Typically >4–5 cm or enlarging cysts.

Suspicion of malignancy: Rarely, complex cysts may require surgical evaluation.

Preoperative Preparation

Imaging: Ultrasound (transvaginal preferred) or MRI to assess cyst size, morphology, and ovarian reserve.

Blood tests: CBC, coagulation profile, CA-125 (if malignancy suspected).

Counseling: Discussion about surgery, risks, recurrence, fertility implications, and recovery.

Anesthesia: General anesthesia is administered for laparoscopic procedures.

Laparoscopic Surgical Technique

Step-by-Step Procedure:

Port Placement:

Umbilical port for camera.

Two to three accessory ports in the lower abdomen for instruments.

Exploration:

Inspect pelvis, uterus, fallopian tubes, and both ovaries.

Assess adhesions and cyst characteristics.

Cyst Identification:

Grasp the ovary carefully.

Identify the plane between ovarian cortex and cyst wall.

Cyst Enucleation:

Incise ovarian cortex using scissors or energy device.

Carefully strip the cyst from ovarian tissue, preserving maximum ovarian tissue.

Hemostasis:

Minimal bipolar cautery is used to prevent ovarian damage.

Inspect ovary for bleeding and restore anatomy.

Specimen Retrieval:

Cyst is placed in an endoscopic bag and removed through a port to avoid spillage.

Peritoneal Lavage:

Wash pelvis with saline to remove debris and reduce adhesion formation.

Closure:

Port sites are closed, and the patient is monitored in recovery.

Postoperative Care

Patients usually go home the same day or after 24 hours.

Mild pain managed with analgesics.

Early ambulation encouraged.

Avoid strenuous activity for 1–2 weeks.

Follow-up ultrasound after 3–6 months to check ovarian healing and recurrence.

Benefits of Laparoscopic Cystectomy

Minimal postoperative pain.

Reduced adhesion formation.

Faster recovery and shorter hospital stay.

Preservation of ovarian tissue and fertility.

Enhanced visualization for complete cyst removal.

Risks and Complications

Bleeding or injury to surrounding organs (bladder, bowel, ureter).

Recurrence of endometrioma (10–20% cases).

Ovarian reserve reduction if extensive ovarian tissue is removed.

Infection, port site hernia, or adhesion formation.

Conclusion

Laparoscopic ovarian cystectomy is a safe, effective, and fertility-preserving procedure for patients with endometriomas. With proper surgical technique and postoperative care, most patients experience significant relief from symptoms and improved quality of life. Early diagnosis, skilled laparoscopic surgery, and ongoing monitoring are key to long-term success.

For more information log on to https://www.laparoscopyhospital.com/