Ovarian cysts

Dr. Panagiotis Polyzos MD PhD MSc

Obstetrician Gynaecologist
Doctor of Medicine, University of Athens Medical School

Panagiotis Polyzos, Gynaecologist Obstetrician, is active at the Institute of Life - IVF Unit of Iaso Maternity Hospital.

Contents

Ovarian cysts

Ovarian cysts

What are Ovarian Cysts?

Οι Cysts are fluid-filled sacs that develop on a woman’s ovaries. During a normal menstrual cycle, small cysts may form and then disappear once the next period begins.

This occurs throughout the reproductive years for most women. These cysts are usually harmless and cause minimal discomfort. However, some cysts may enlarge, some may contain blood, and others may twist, leading to complications such as bleeding and/or pain, which may require surgical treatment.

Some cysts grow larger and must be treated either with medication or by surgical removal. A small percentage of cysts are serious because they may rupture or become cancerous.

Although young women are more prone to developing cysts, the majority are benign and go away without treatment. Some cysts can cause pain during intercourse or create a feeling of fullness/pressure in the abdomen.

Benign Ovarian Cysts

Most ovarian cysts are benign (non-cancerous). Some types of benign ovarian cysts include:

  • Hemorrhagic cysts
  • Corpus luteum cysts
  • Endometriotic cysts or endometrioma
  • Polycystic ovaries
  • Dermoid cysts

 

Diagnosis may involve a physical examination, blood tests for ovarian tumor markers (CA-125), ultrasound, and laparoscopy.

Types of Ovarian Cysts

    • Functional cysts are common in young women. They typically grow and then shrink during the menstrual cycle.
    • Pathological cysts are less common and occur when cells grow abnormally within the ovary. Most are benign, but some may be cancerous.

    Η endometriosis may contribute to the development of pathological cysts when endometrial tissue becomes displaced and grows on the ovaries. These cysts are often called “chocolate cysts,” because they contain old dark blood.

     

    Each month, this tissue bleeds, but the blood becomes trapped inside the cyst, causing it to grow. Some can grow to the size of a grapefruit! Eventually, these cysts may rupture, potentially damaging the ovary and causing severe pain.

Diagnosis — Laparoscopy for Ovarian Cysts

  • Ultrasound – A transducer glides over the abdomen, sending sound waves through the organs to detect abnormalities displayed on a monitor.
  • Abdominal examination – The doctor palpates the abdomen to assess the size and shape of the pelvic organs.

Treatment Options

Treatment includes monitoring and laparoscopic surgery.

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What is laparoscopic Ovarian Cystectomy?

Ovarian cystectomy is a surgical procedure used to remove one or more cysts from the ovary. Laparoscopic surgery is a minimally invasive technique that requires only a few small incisions in the abdominal area.

Why is this Procedure Performed?

Many women will develop at least one ovarian cyst in their lifetime. Most cysts cause little to no symptoms. However, if a cyst causes painful or bothersome symptoms, surgical removal may be the best treatment option.

An ovarian cyst may need to be removed if it:

  •  Causes severe abdominal pain
  •  Appears suspicious for malignancy
  •  Is large — greater than 2.5 cm in diameter
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What happens during the procedure?

A small incision is made just below the navel, and a laparoscope — a thin tube with a camera — is inserted. Carbon dioxide gas is used to inflate the abdomen for better visualization. Once the cyst is located, one or two additional small incisions are made to insert surgical instruments. The cyst is removed and sent for a pathology examination. If cancer is detected, both ovaries may need to be removed. The instruments are withdrawn, and the incisions are closed with stitches or staples and covered with dressings. If laparoscopy is not feasible, the surgeon may convert to an open abdominal surgery (laparotomy) using a larger incision.

What are the risks?

This procedure has low risks, but some potential complications include:

  • Possible removal of the entire ovary
  • Bleeding during surgery that may require a transfusion
  • Infection of the ovary or surrounding tissues
  • Injury to nearby organs (bladder, uterus, bowel, ureters)
  • Possible need for additional surgery (laparotomy)

How to Prepare

Before the procedure, the surgical team will discuss:

  • Anesthesia options
  • Any allergies
  • Current medications, supplements, and whether any need to be stopped
  • Fasting instructions (no food or drink after midnight before surgery)

 

Pre-operative preparation includes:

  • Arranging for transportation after the procedure
  • Arriving two hours before the scheduled surgery for pre-operative checks
  • Asking the gynecologist any final questions, especially about medication management

Recovery — What to Expect

Full recovery takes up to 2 weeks. Physical activity will be limited during this time. Intercourse should be avoided. Seek assistance with daily tasks and delay returning to work if possible.

Contact your gynecologist if you experience:

  • Signs of infection — fever, chills
  • Redness, swelling, excessive bleeding, or foul-smelling discharge at the incision sites
  • Pain not relieved by prescribed medication
  • Vaginal bleeding soaking more than one pad per hour
  • Pain, burning, frequent urination, or persistent blood in urine
  • Swelling, redness, or pain in the legs

After surgery, abdominal and navel soreness and bruising are common.

Shoulder and back pain may occur due to the gas used during laparoscopy. Some light vaginal spotting may also occur. The abdominal incisions are closed with dissolvable stitches and may be covered with adhesive dressings.

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