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Ovarian Cyst

What is an ovarian cyst?

An ovarian cyst is a fluid filled sac or pouch which forms on the ovary. Ovarian cysts, in most cases are harmless and resolve on their own. If the cyst is cancerous, it may cause problems and thus needs medical intervention. Ovarian cysts are common in women of childbearing age.

What are the symptoms?

Ovarian cysts are symptomless most of the time but may cause variable abdominal or pelvic pain or pain during intercourse. If the cyst is large, it may cause twisting of the ovary that leads to pain.

How are ovarian cysts diagnosed?

Ovarian cysts may be diagnosed during a routine pelvic examination, such as a Pap smear. Your doctor may recommend tests such as vaginal ultrasound, CT or MRI scan. If you are a menopausal woman, then in addition to ultrasound your gynecologist may order blood tests to measure tumor markers (substances produced by certain types of cysts) which give useful information in the diagnosis and prognosis.

What are the treatment options?

Most ovarian cysts will resolve on their own without any treatment. Birth control pills may be prescribed to reduce the formation of new ovarian cysts. Surgery to remove the cyst is an option if the cyst does not go away, is larger in size, or causes pain. Cystectomy is a surgical excision of an ovarian cyst.

How is cystectomy done?

Cystectomy is a surgical procedure during which the ovarian cyst is removed either using laparoscopy or an open surgery approach. A laparoscopic cystectomy procedure is a minimally invasive surgery during which a laparoscope, a long thin instrument with a camera attached at one end is used. The procedure is usually done under general anesthesia and a small incision is made below the navel. A laparoscope is inserted through this incision to see the inside of your pelvis and abdomen. Carbon dioxide gas is introduced into the abdominal cavity to create more space to work. Your surgeon identifies the cyst through the scope and removes the cyst. This technique is usually used to remove small cysts.

A laparoscopic cystectomy removes only the cyst leaving the ovaries intact. However, if the cyst is too large or connected to ovarian tissue, your surgeon removes all or part of the ovary.

What should I expect after this procedure?

Following ovarian cyst removal, complete recovery usually takes about one to two weeks. Your doctor may prescribe anti-inflammatory medications to help relieve your pain. The ovaries return to normal function after a cystectomy is performed.

Hysterectomy is a surgical method in which the uterus of a woman is removed. The uterus, also referred to as the womb, is where a baby grows inside their mother. Sometimes, the ovaries and fallopian tubes are also removed and is called salpingo-oophorectomy.

A laparoscopic supracervical hysterectomy (LH) is a minimally invasive procedure, which involves removal of the uterus while keeping the cervix intact. The cervix is the lower narrow end of the womb.

Once a woman has had a hysterectomy, she will no longer menstruate and cannot become pregnant.

Indications of LSH:

Your doctor may suggest you undergo a laparoscopic hysterectomy if you have the following conditions:

  • Uterine fibroids
  • Endometriosis not cured by medicine or surgery.
  • Uterine prolapse - when the uterus descends into the vagina.
  • Cancer of the uterus, cervix, or ovaries.
  • Vaginal bleeding that continues despite treatment.
  • Chronic pelvic pain

Diagnosis:

Your doctor will recommend you have the following tests before having a hysterectomy:

  • Pelvic ultrasound: It is an advanced imaging test that uses high-frequency sound waves to create pictures of the female pelvic organs.
  • Pap smear: This is a test that involves collection and sampling of cervical cells to detect cervical cancer.
  • Endometrial biopsy: It is a procedure that involves sampling of the cells lining the uterus (endometrium) for any abnormalities.

Surgery:

The procedure is usually performed with the patient under general anesthesia.

Your surgeon will make a few small incisions on the abdomen in or around the belly button. A laparoscope, a thin instrument with a light and camera at the tip is inserted through one of these incisions. The images from the camera are displayed on a monitor to help the surgeon view the internal pelvic organs.

Small surgical instruments are inserted through the other abdominal incisions made. The soft tissues are retracted to gain access to the uterus. The surgeon detaches the ligaments, tissues, and blood vessels surrounding the uterus. The uterus is then removed in pieces through the tiny incision leaving the cervix intact. The ovaries and fallopian tubes may or may not be removed depending on the patient and surgeon’s preference. At the end of the procedure, the incisions are closed and a sterile dressing is placed over the incisional areas.

The advantages of minimally invasive surgery over the open traditional “open” incision include:

  • Smaller incisions
  • Minimal soft tissue trauma
  • Less post-operative pain
  • Faster healing time
  • Lower infection rate
  • Less scarring
  • Usually performed as outpatient day surgery

Post-operative care:

Your recovery depends on the type of surgery performed and the progress of your healing. Following are the post-surgical guidelines:

  • You will be prescribed pain medications to keep you comfortable and antibiotics to prevent infection.
  • You will be instructed to get adequate rest and avoid heavy lifting after your surgery.
  • You can continue normal activities once the pain, bleeding, and abdominal pressure have resolved.
  • You will be instructed to get adequate rest and avoid heavy lifting after your surgery.
  • Sexual activity can be resumed about six weeks following surgery.
  • Exercises should be avoided until 3 weeks after surgery.

Risks and Complications:

Most women recover without any complications from the surgery. However, risks and complications associated with laparoscopic hysterectomy include the following:

  • Infection
  • Bleeding
  • Blood clots
  • Urinary incontinence: Loss of bladder control
  • Vaginal prolapse: A condition in which the vagina protrudes from the vaginal opening.
  • Chronic pain
  • Bladder or ureter injury
  • Painful intercourse
  • Early menopause if ovaries were removed

Call your doctor if you experience any of the following signs:

  • heavy vaginal bleeding
  • pain, redness, swelling, or discharge around the incisions
  • fever over 101° F
  • nausea and vomiting
  • Shortness of breath

Our Providers: Gynecology