Removal of a cyst on an ovary 

PARTS OF THE BODY INVOLVED

Ovary, one or both

REASONS FOR PROCEDURE

To remove a cyst that is:

  • Suspected of being cancerous
  • Large (more than 2 inches in diameter)
  • Solid
  • Filled with debris
  • Irregularly shaped
  • Causing pain
  • Ruptured
  • Twisted

The chance of a cyst becoming cancerous increases with age. Therefore, the older the patient, the more likely an ovarian cyst will be removed.

RISK FACTORS FOR COMPLICATIONS DURING THE PROCEDURE

  • Stress
  • Obesity
  • Chronic or recent illness
  • Excessive use of alcohol
  • Smoking
  • Use of narcotics or other mind-altering drugs
  • Use of certain prescription medications, including muscle relaxants and sedatives, anti-hypertensives, insulin, beta-adrenergic blockers, and cortisone
  • Pregnancy
  • Previous abdominal surgery
  • Endometriosis

WHAT TO EXPECT

Prior to Procedure

Your doctor will likely do the following:

  • Physical exam
  • Review of medications
  • Blood tests
  • Urine test
  • CT scan (a type of x-ray that uses a computer to make pictures of the     inside of the body) of the pelvis and pelvic organs
  • Ultrasound – a test that uses sound waves to visualize the inside of the body
  • X-ray of chest, lower intestinal tract, and lower abdomen
  • Electrocardiogram (ECG, EKG; a test that records the heart's activity by measuring electrical currents through the heart muscle), if over 40 years old
  • Culdocentesis – removal of fluid from the pelvic cavity for exam
  • You should discuss with your doctor what action should be taken during the surgery if evidence of cancer is found. One option is the removal of the ovary.
  • In the days leading up to your procedure:
  • Do not take aspirin, aspirin-containing products, or anti-inflammatory drugs (such as ibuprofen) for one week before the procedure
  • Arrange for a ride to and from the procedure
  • Do not eat or drink for at least 8 hours before the procedure

During Procedure:

  • Anesthesia
  • The tissue that is removed will be examined in the lab during your procedure. If the testing shows evidence of cancer, the ovary or ovaries that the cyst came from may be removed.

Anesthesia – This depends on the type of procedure done. General is used for open surgery, and general or local is used for laparoscopic surgery.

Description of the Procedure - There are two methods to remove an ovarian cyst: laparoscopic surgery and open surgery. The method used depends on the type and condition of the cyst being removed. Open surgery is often done for larger cysts.

Laparoscopic surgery: A very small incision is made in the lower abdomen just below the navel. Through this incision, the surgeon inserts a laparoscope, which is a thin, lighted tube. Carbon dioxide gas is pumped into the abdomen, to inflate it and make it easier for the surgeon to view the organs. The laparoscope is then used to locate the cyst. Once located, one or two more tiny incisions are made, through which surgical instruments are inserted to remove the cyst. Tools for cyst removal can include microscissors, laser, and electrocautery. Depending on the situation, the surgeon may send the removed tissue to the pathology lab for immediate examination. If cancer is detected, the ovary or both ovaries (if cysts are found on both ovaries) may be removed. Depending on the situation, ovary removal (oophorectomy) may be done laparoscopically, or may require a classic open incision. Once the removal of cyst(s) (and, possibly, ovary or ovaries) is complete, the surgical tools are removed and the incisions are closed with stitches or clamps.

Open surgery: An incision is made in the abdomen, the abdominal muscles are separated, and the abdomen is opened. Blood vessels that supply the ovaries are located, clamped, and tied. Once located, the cyst is surgically removed. Tools for cyst removal can include microscissors, laser, and electrocautery. Depending on the situation, the surgeon may send the removed tissue to the pathology lab for immediate examination. If cancer is detected, the ovary or both ovaries (if cysts are found on both ovaries) may be removed. Once removal of cyst(s) (and, possibly, ovary or ovaries) is complete, the surgical tools are removed, the abdomen is closed, the abdominal muscles are sewn together with heavy stitches, and the incision is closed with stitches or clamps.

After Procedure – IV fluids, medications

How Long Will It Take? 1-2 hours

Will It Hurt? Anesthesia prevents pain during surgery. However, you may have abdominal pain or discomfort for 3-4 days after laparoscopic surgery and for 7-10 days after open surgery.

Possible Complications:

  • Infection
  • Excessive bleeding
  • Recurrence of ovarian cysts
  • Recurrence of cancer
  • Need for removal of one or both ovaries
  • Infertility
  • Blood clots
  • Need to change from planned laparoscopic surgery to classic open abdominal incision
  • Shoulder pain from the carbon dioxide gas used during the procedure

Average Hospital Stay: 0-1 days for laparoscopic surgery; 5-7 days for open surgery

Postoperative Care:

  • Move and elevate your legs while resting in bed to decrease chances of developing blood clots
  • Do not take prescription pain medication for more than 7 days
  • After 7 days, take non-prescription pain relievers such as Advil and Naprosyn
  • Avoid strenuous exercise for 2 weeks after a laparoscopic procedure and 6 weeks after an open procedure
  • Do not resume sexual activity, use tampons, or douche until your doctor says it is okay; usually after follow-up exam approximately 2 weeks after surgery
  • Bathe or shower as normal, and wash the incision area gently with mild soap until it heals fully
  • To help speed healing and recovery, resume normal activities (including work) as soon after surgery as you feel able
  • If you have been diagnosed with certain types of cysts that are known to recur, follow your doctor's guidelines for follow-up ultrasound exams to monitor for recurrence

OUTCOME

If no cancer is detected, you will fully recover and can resume all normal activities. Expect 1-2 weeks for full recovery from laparoscopic surgery and 3-4 weeks after open surgery.

If cancer is detected, you may have one or both of your ovaries removed, either during the ovarian cyst surgery, or during follow-up surgery. Your doctor will discuss your condition with you, and outline treatment options. Further treatment may include additional surgery, chemotherapy, and/or radiation therapy.

CALL YOUR DOCTOR IF ANY OF THE FOLLOWING OCCURS

Signs of infection, including fever and chills

  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting
  • Headaches, muscle aches, dizziness, fever, or general ill feeling
  • Nausea, constipation, or abdominal swelling
  • Vomiting
  • New, unexplained symptoms
SOURCES:

Mayo Foundation for Medical Education and Research

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