Laparoscopic ovarian cystectomy

Abstract

Laparoscopy has enabled the laparoscopic gynecologic surgeon to manage many gynecologic surgical challenges in a minimally invasive manner. The laparoscopic approach has become the gold standard in the surgical management of ovarian cysts due to innovative changes in surgical instrumentation and the development of new surgical techniques. Benign ovarian cysts such as persistent and symptomatic functional ovarian cysts, corpus luteum cysts, and cystic ovarian neoplasms such as endometriomas or mature cystic teratomas are now managed as an outpatient procedure decreasing cost and recovery time to the patient. Pelvic ultrasound is the most useful imaging tool in the evaluation of an ovarian cyst. Complex ovarian cysts should be considered for removal in the symptomatic premenopausal woman and in all postmenopausal women. The decision to intervene surgically may be complicated and should be individualized for each patient. Aspiration of ovarian cysts is associated with a high rate of recurrence; therefore, cystectomy is the procedure of choice. Ovarian conservation is preferred in the premenopausal woman if at all feasible, and laparoscopic salpingo-oophorectomy is usually the procedure of choice for the postmenopausal woman. Laparoscopic entry into the abdomen requires a detailed understanding of the vasculature of the anterior abdominal wall. Techniques may need to be altered depending on a patient's BMI (body mass index), past history of abdominal surgeries, and history of bowel obstruction or hernias. Laparoscopic removal of the ovarian cyst should facilitate intact removal and avoid intraoperative spillage.