In this educational video, we present a detailed laparoscopic removal of a huge ovarian cyst. The video covers patient preparation, trocar placement, cyst decompression, and specimen retrieval using modern laparoscopic methods.

Laparoscopic surgery has been increasingly applied to different gynecologic ovaries surgical problems with excellent surgical outcome and rapid recovery. Large ovarian cysts, a relatively common gynecologic problem, pose certain challenges to laparoscopic management. Laparoscopy is a safe technique for managing patients with large ovarian cysts and is associated with low conversion and complication rates. The chance of finding unexpected ovarian cancer varies according to the patients’ selection criteria but is low overall. With proper patient selection, the size of an ovarian cyst should not constitute a contraindication to laparoscopic surgery. Experience in advanced laparoscopic surgery and the availability of a gynecologic oncologist should make the procedure safely applicable to a broader patient population.

Ovarian cysts are fluid-filled sacs that develop on or inside the ovaries and are commonly seen in women of reproductive age. While many ovarian cysts are small and resolve spontaneously, some can grow to a large or “huge” size, causing pain, abdominal distension, pressure symptoms, or menstrual irregularities. Traditionally, large ovarian cysts were treated through open surgery (laparotomy). However, with advances in minimally invasive surgery, laparoscopic removal of huge ovarian cysts has emerged as a safe, effective, and patient-friendly option in selected cases.

Understanding Huge Ovarian Cysts

A huge ovarian cyst is generally defined as one measuring more than 10 cm in diameter. These cysts may be benign, such as serous cystadenomas, mucinous cysts, dermoid cysts, or endometriomas. Proper preoperative evaluation is essential to rule out malignancy and to plan the most appropriate surgical approach.

Common symptoms include:

• Abdominal swelling or bloating

• Pelvic or lower abdominal pain

• Pressure on bladder or bowel causing urinary or bowel symptoms

• Menstrual disturbances

• Difficulty in physical activity or breathing in very large cysts

Preoperative Evaluation

Before opting for laparoscopic surgery, a thorough assessment is mandatory. This typically includes:

• Ultrasound and CT/MRI scans to assess size, nature, and origin of the cyst

• Tumor markers (such as CA-125) to evaluate malignancy risk

• Clinical examination and patient history

• Counseling regarding fertility preservation and surgical options

Patients with features suggestive of malignancy are usually advised open surgery for safety reasons.

Laparoscopic Technique for Huge Ovarian Cyst Removal

Laparoscopic surgery involves small keyhole incisions through which a camera and specialized instruments are introduced. Even very large cysts can be managed laparoscopically by experienced surgeons.

Key steps include:

1. Port Placement: Strategic placement of trocars to allow safe access despite the large cyst size.

2. Controlled Decompression: The cyst is carefully aspirated under vision to reduce its size and avoid spillage.

3. Cyst Enucleation or Oophorectomy: The cyst is dissected from the ovarian tissue, preserving the ovary whenever possible, especially in young women.

4. Specimen Retrieval: The cyst wall is removed using an endobag to prevent contamination.

5. Hemostasis and Inspection: Ensuring complete removal and checking for bleeding or spillage.

Advantages of Laparoscopic Removal

Compared to open surgery, laparoscopic management of huge ovarian cysts offers several benefits:

• Minimal postoperative pain

• Smaller scars and better cosmetic results

• Reduced blood loss

• Faster recovery and shorter hospital stay

• Lower risk of wound infection and adhesions

• Early return to normal activities

Postoperative Care and Recovery

Most patients can resume oral intake within hours of surgery and are discharged within 1–3 days. Light activities can be resumed early, with full recovery typically within 2–3 weeks. Histopathological examination of the cyst is essential to confirm the diagnosis.

Conclusion

Laparoscopic removal of huge ovarian cysts represents a significant advancement in gynecological surgery. With proper patient selection, thorough preoperative evaluation, and skilled surgical expertise, even very large ovarian cysts can be safely and effectively managed using minimally invasive techniques. This approach not only ensures excellent clinical outcomes but also enhances patient comfort, recovery, and overall satisfaction.