Each woman has two ovaries connected to the uterus, Fallopian tubes and pelvis.
The ovaries are highly active organs and produce chemical messengers called hormones. Ovarian hormones are responsible for puberty, the menstrual cycle including ovulation and then menopause. The ovarian hormones also help with brain, bone and heart health. This activity can lead to ovarian cysts forming.
It is important to remember that most ovarian cysts do not need surgery, as the body will resorb them spontaneously.
Read more about ovarian cysts.
When necessary, ovarian cysts can typically be surgically removed off the ovary. This allows the ovary to remain inside the pelvis and continue to function. This is especially important for women who intend to fall pregnant and women who have not yet gone through menopause (premenopausal).
When is an ovarian cystectomy needed?
An ovarian cystectomy may be necessary to manage an ovarian cyst that is:
- recurrent, persistent or growing in size
- painful and problematic
- suspected to be an endometrioma
- suspected to be a dermoid cyst (as these don’t typically go away on their own)
- associated with a pelvic infection
The decision to have an ovarian cystectomy is also informed by the woman’s age and pregnancy intentions. Women who are considering pregnancy, benefit from retaining their ovaries to allow ovulation and support a developing pregnancy.
How is an ovarian cystectomy performed?
An ovarian cystectomy requires a general anaesthetic from the anaesthetist. The abdomen and pelvis are swabbed with antiseptic cleaning solution and sterile drapes are applied to reduce the risk of infection. A urinary catheter is placed to drain the bladder. An instrument (called a uterine manipulator) is placed through the cervix and rests in the uterus.
An ovarian cystectomy is commonly performed by minimally invasive (‘keyhole’) surgery. Through 5-10mm cuts on the abdomen, medical gas is circulated into the abdomen and pelvis. Key-hole ‘ports’ are inserted into the abdomen which act like passageways for the thin surgical camera and instruments to enter into the abdomen so the procedure can be performed.
The ovarian cyst is identified and using electrical surgical instruments, the ovary is partially opened and the cyst dissected away from the healthy ovary. Once the cyst is separated from the ovary, it is placed into an extraction bag and removed from the body through one of the abdominal skin incisions. The tissue removed is then sent to the laboratory for microscopic assessment.
The health of the remaining ovary is then assessed and any bleeding carefully controlled. The ovary is usually stitched closed with an absorbable suture. This stitch can’t be felt.
Less commonly, a larger skin incision (called a laparotomy) is needed to complete the procedure instead of ‘keyhole’ surgery.
If there has been an ovarian cyst observed on ultrasound during pregnancy, an ovarian cystectomy is performed at the time of a Caesarean section because the ovaries are both visible and accessible through the Caesarean incision.
FAQs about Ovarian Cystectomy…
HOW LONG DOES AN OVARIAN CYSTECTOMY TAKE?
It will typically take between 30-60 minutes depending on size of the ovarian cyst, adhesions or scar tissue and individual anatomy.
In some circumstances, the cystectomy forms part of another operation like excision of endometriosis, and so the total operating time might be longer.
CAN PREGNANCY STILL OCCUR AFTER AN OVARIAN CYSTECTOMY?
Yes. Ovarian cystectomy is the preferred approach for managing problematic ovarian cysts amongst women who intend on falling pregnant.
Any operation on or involving the ovary however can potentially adversely impact on ovarian function. This is because of the microscopic trauma associated with removing a cyst from the ovary and the necessary surgical techniques of achieving control of any bleeding from the ovary during the procedure.
To limit the adverse impact on precious ovarian cells (called oocytes), the defect in the ovary (from where the cyst was removed) is closed using an absorbable suture. This technique, in addition to the use of medical products, limits harm to the ovary and controls bleeding, instead of using excessive destructive electrical current (called ‘diathermy’).
WHAT ARE THE BENEFITS OF AN OVARIAN CYSTECTOMY?
Reducing pain and discomfort from the cyst
Obtaining a diagnosis of the type of ovarian cyst
Preventing the cyst from developing into cancerous cells
Reducing the risk of ovarian torsion or cyst rupture, and subsequent emergency surgery
Improve pregnancy prospects (especially if an ovarian endometrioma is removed)
WHAT ARE THE RISKS OF AN OVARIAN CYSTECTOMY?
Reduced ovarian function and possible difficulty falling pregnant
Recurrence of ovarian cysts
Pre-cancerous or cancerous cells diagnosed after surgery requiring further surgery or treatment
Bleeding from the ovary and need for oophorectomy (removal of ovary)
Anaesthetic and other surgical risks (Read more on the Patient Information pages)
WHAT ARE THE OPTIONS INSTEAD OF AN OVARIAN CYSTECTOMY?
Surgery isn’t for everyone and fortunately, most ovarian cysts don’t need surgery. This is because they either don’t bother the woman or cause any pain or discomfort, or the ovarian cyst is small and is likely to spontaneously be resolved by the body.
The decision to have an ovarian cystectomy is also informed by the woman’s age and pregnancy intentions. Women who are considering pregnancy, benefit from retaining their ovaries to allow ovulation and support a developing pregnancy.
Surveillance – It might be appropriate to monitor the ovarian cyst with ultrasound and blood tests (for tumour markers) for any changes like increase in size or abnormalities.
Oophorectomy – Instead of removing the cyst off the ovary, the entire ovary and the cyst can be removed together. This might be considered if the ovary and cyst is very large, if there is concern for cancerous cells in the cyst, the ovary is no longer needed (postmenopausal) or to reduce the risk of future problems with the ovary.
No Treatment – Some women might not want to doing anything about the cysts.
WHAT IS THE RECOVERY AFTER AN OVARIAN CYSTECTOMY?
Recovery after ovarian cystectomy is typically short and well tolerated. This is because most ovarian cystectomies are performed by a minimally invasive (‘keyhole’) approach. This means the skin incisions are 1cm or less, and there are minimal internal stitches or organs at risk after surgery.
Your key-hole skin incisions on your abdomen will be tender for about one week and can be managed with paracetamol and ibuprofen. You might experience bothersome shoulder tip pain that will ease in the days after surgery. You will be able to eat and drink as usual. Your bowels might be slower than usual and can be eased with stool softeners (like Movicol® or Coloxyl®). You are unlikely to notice any difference in bladder function, but any changes are typically temporary and mild.
You might experience vaginal bleeding but this typically will be less than a period. Sometimes your period can start shortly after surgery and this is OK.
Hospital stay: Your hospital stay might be only for the day of surgery, or you might need overnight admission for observation and recovery. If you have a laparotomy (larger skin incision), you will likely 1 to 2 nights in hospital.
Returning to work: This depends on the type of work you are returning to. Women can return to office-based work usually within 1 -2 weeks after minimally invasive laparoscopic surgery and after 2-4 weeks following a laparotomy. More physically demanding work may require longer recovery. Consider if there are alternative, less-physically demanding roles you can do to ease your return to work.
Driving and travel: Typically, you can drive about 2 weeks after your minimally invasive surgery and 4-6 weeks after a laparotomy. Always check with your vehicle insurance provider and comply with any instructions they provide you. Before flying, you typically need to wait at least 2 days after minimally invasive surgery and at least 5 days after a laparotomy. Check with your airline so you can safely time your surgery and travel.
Read more in the Patient Information pages, including When to Seek Help after Surgery
Recovery from an ovarian cystectomy is typically very short and well tolerated. This is because most commonly a minimally invasive (‘key-hole’) approach is used. This means the skin incisions are small (5-10mm), and there are minimal internal stitches or organs at risk after surgery.
Your key-hole skin incisions on your abdomen will be tender for about one week and can be managed with paracetamol and ibuprofen. You might experience bothersome shoulder tip pain that will ease in the days after surgery. You will be able to eat and drink as usual. Your bowels might be slower than usual and can be eased with stool softeners (like Movicol® or Coloxyl®). You are unlikely to notice any difference in bladder function, but any changes are typically temporary and mild.
Hospital stay: Typically, you may need to stay in hospital after your ‘key-hole’ surgery for 1 night. If your procedure was uncomplicated and you feel well to go home, you can often leave hospital the same day as surgery and recover at home with pain relief medication. If you have a laparotomy (larger skin incision), you will likely have 2-3 nights in hospital.
Returning to work: This depends on the type of work you are returning to. You can return to office-based work usually within 1 -2 weeks after minimally invasive laparoscopic surgery and after 2-4 weeks following a laparotomy. More physically demanding work may require longer recovery. Consider if there are alternative, less-physically demanding roles you can do to ease your return to work.
Driving and travel: Typically, you can drive 2 weeks after your minimally invasive surgery. Always check with your vehicle insurance provider and comply with any instructions they provide you. You typically need to wait at least 2 days before flying. Check with your airline so you can safely time your surgery and travel.
Intimacy, exercise and other activities: You should defer penetrative intercourse for 2 weeks and until any abnormal vaginal bleeding has settled. You can resume your usual physical activity and exercises 2-3 weeks after your surgery.
Please remember your recovery is individual. Each day following surgery you can expect to have made some improvement in how you feel. Dr Dunn will happily discuss your specific recovery circumstances.
Please read more about recovery in the Patient Information pages
WHAT SORT OF SCARS ARE LEFT AFTER AN OVARIAN CYSTECTOMY
This depends on the surgical approach required to complete the ovarian cystectomy.
Minimally invasive (‘keyhole’) surgery will typically mean there are 3 or 5 scars across the abdomen. Theses will each be 5-10mm in size. Usually the scar at the umbilicus (belly button) is the bigger one (about 10mm).
Less commonly, a laparotomy is required to perform an ovarian cystectomy. A laparotomy requires a bigger incision on the front of the abdomen. This might be across ways (left to right) at the pubic hairline or up and down in the middle (between the belly button and the pubic bone). The scar from this sort of incision can be 20cms in length or more.
Healing and scaring from surgery is individual. The outcome of scaring is difficult to predict. Caring for the incision sites after surgery can help minimise inflammation and unpleasant scaring.
Please read more about recovery in the Patient Information pages
