These are fluid filled sacs or pockets on the surface or inside of ovary. These cysts can be solid also called ovarian masses. Most cysts are asymptomatic and resolve naturally.
The most common ovarian cysts are Functional cysts (Follicular cyst and Corpus luteal cyst). These are benign in nature and self resolving. These are seen during the reproductive age group due to the impact of female hormones estrogen and progesterone. These cysts produce abdominal pain when there is bleeding inside the cyst or when there is rupture of this hemorrhagic cyst. If pain is controlled with painkillers and woman is stable, then observation is sufficient. If symptoms are severe and ultrasound shows blood collection inside the abdomen, she may require Laparoscopic surgery to control bleeding from the cyst and clearance of the collection.
Chocolate cyst or Endometriotic cyst – These are cysts containing fluid appearing like chocolate or dark brownish colored fluid. These cysts can spread to the pelvic areas causing adhesions to the tube, uterus, pelvic walls, rectum and intestines. They can be asymptomatic or present with painful periods, brownish discharge after the menstrual flow is over, pain abdomen with pain while passing motions, infertility
Dermoid cyst – these cysts can be in one or both ovaries containing sebum / fat, hair, teeth, bone. These are asymptomatic and produce pain abdomen when it undergoes torsion (twisting of ovary due to enlargement), rupture (leakage of contents into the abdomen), infection
Dermoid cyst of Right Ovary
Cystadenomas – These cysts are noncancerous containing serous fluid (straw colored clear fluid), mucinous fluid (mucin type fluid). Mucinous cystadenoma has tendency to grow into large size presenting as mass in the abdomen
Polycystic Ovaries – The ovaries are filled with multiple small sized cysts which prevent the release of egg regularly. PCO generally co-exists with sex hormone imbalance like reversal of FSH/LH ratio, increased levels of male hormones (androgens), abnormal blood sugars, high levels of blood cholesterol. They present with irregular menstrual cycles, delayed cycles, increase in weight, excess hair growth over face, acne (pimples) over face, male type baldness of hair. The impact of this condition PCOS has long term implications like development of Ty 2 Diabetes Mellitus, Metabolic syndrome, Heart disease.
The use of minimal invasive surgery like laparoscopy has helped in a major way to the patients with ovarian cysts.
The advantages of laparoscopy in the treatment of ovarian cysts
- Minimal damage to healthy ovary- fertility is preserved
- Short hospital stay, faster recovery
- Minimal pain, less painkillers
- No stitches, cosmetic scar
- Less adhesions following surgery
Laparoscopic surgery for ovarian cysts offer all the advantages of laparoscopy along with the advantage of minimal loss of normal ovarian tissue. The role of laparoscopy is limited in the primary treatment of malignant cancers of ovary, rest all types of ovarian cysts can be safely treated laparoscopically. The nature of surgery depends on the type of cyst in the particular patient.
Cystectomy – The entire cyst wall with its contents are separated from the normal ovarian tissue and it is removed out. The normal ovary is looked for bleeding and ovarian reconstruction is done whenever necessary.
Cystostomy – An incision is made over the cyst and its contents sucked out. The edges of the wall are buzzed using electrosurgery. This is done for cysts that are densely adherent where peeling of cyst wall reduces the ovarian reserve.
Ovarian drilling – This is offered for polycystic ovaries not responding to medicines in infertile women. A needle with monopolar pure cutting current 40W is used for puncturing the cysts and letting out fluid rich in LH hormone. Immediate cooling of ovary with irrigation is done. This is generally offered for PCOS infertile women and not recommended for unmarried girls with PCO.
The cyst wall is introduced in a sterile bag inside the abdomen and removed to avoid spillage of the cyst contents near the port site.