Ovarian Cystectomy — How It Works, Benefits & Recovery — Procedure Guide, Recovery & Risks | MyMedicPlus

Ovarian cystectomy is a surgical procedure to remove a cyst from an ovary while preserving the ovary itself. It is distinct from oophorectomy (removal of the entire ovary). The procedure is most commonly performed laparoscopically through keyhole incisions, minimising recovery time. Ovarian cystectomy is preferred over oophorectomy for benign cysts in women of reproductive age, as preservation of ovarian tissue maintains hormonal function and fertility potential. The procedure addresses cysts that are symptomatic, large, persistent, or have features that warrant histological examination. Laparoscopic cystectomy is performed under general anaesthesia as a day-case or overnight procedure. The surgeon carefully dissects the cyst capsule from surrounding normal ovarian cortex using hydrodissection and blunt dissection to maximise ovarian cortex preservation. The entire specimen is retrieved in a bag to prevent spillage. Open surgical access via Pfannenstiel or midline incision is reserved for very large cysts, suspected malignancy requiring staging, or when laparoscopic access is contraindicated. The decision between cystectomy and oophorectomy is guided by the woman's age, fertility wishes, cyst characteristics on ultrasound and tumour markers, and intraoperative assessment. Gynaecological oncology input is obtained pre-operatively when malignancy cannot be excluded.

Ovarian cystectomy is recommended for cysts larger than 5 cm that persist beyond 3 menstrual cycles, dermoid cysts (teratomas), endometriomas (chocolate cysts) causing pain or infertility, cysts with suspicious features on ultrasound, or any cyst causing symptoms such as pelvic pain, bloating, or pressure. Women with simple, asymptomatic ovarian cysts under 5 cm on ultrasound are typically managed conservatively with interval ultrasound monitoring. Surgical intervention is recommended when cysts show growth on serial imaging, develop internal solid components, septations, or internal echoes, or when CA-125 is elevated. Women with known or suspected endometriosis planning assisted reproduction are candidates for endometrioma cystectomy to improve ovarian reserve access and IVF outcomes. BRCA mutation carriers undergoing cystectomy require intraoperative frozen section to guide the extent of surgery. Emergency cystectomy or oophorectomy is performed for ovarian torsion if the ovary is viable after detorsion.

Under general anaesthesia, 3–4 small laparoscopic ports are made in the abdomen. The ovary is identified and stabilised. An incision is made in the ovarian surface over the cyst and the cyst wall is carefully dissected away from the normal ovarian tissue without rupturing it. The cyst is placed in a retrieval bag and removed via an extended port site. The ovarian defect is closed with absorbable sutures to ensure haemostasis and encourage normal healing. For endometriomas, the cyst lining is stripped — this technique reduces recurrence compared to drainage alone, though it carries a risk of reducing ovarian reserve (anti-Müllerian hormone falls transiently post-cystectomy). Dermoid cysts require meticulous bag-contained removal to prevent sebaceous spillage which causes peritoneal irritation. Intraoperative spillage of cyst contents, though undesirable, does not worsen prognosis for benign cysts but must be addressed with thorough irrigation. Frozen section histology guides surgical extent when the diagnosis is uncertain. Operative time is 45–90 minutes depending on cyst size, adhesions, and complexity. Haemostasis of the ovarian cortex is secured with bipolar diathermy applied sparingly to minimise thermal damage to residual follicles. Port sites are closed with absorbable sutures. The procedure typically takes 45–60 minutes for uncomplicated laparoscopic cases. Skin and port incisions are closed with absorbable subcuticular sutures.

Laparoscopic ovarian cystectomy resolves cyst-related symptoms in over 90% of patients. Endometrioma cystectomy improves spontaneous conception rates and reduces IVF cycle cancellations due to pain. Recurrence rates vary: dermoid cysts recur in under 5%, endometriomas recur in 20–30% over 5 years without adjuvant medical therapy. Preserving the ovary protects hormonal function and fertility compared to oophorectomy. The laparoscopic approach reduces post-operative pain, hospital stay, and recovery time compared to open surgery. Histological confirmation of cyst pathology guides further management and ensures malignancy is not missed. Medical therapy with combined oral contraceptive pill or progestins post-cystectomy for endometriomas reduces recurrence risk. Fertility counselling following cystectomy is essential for women planning conception, particularly after bilateral or repeat endometrioma surgery where ovarian reserve may be reduced.

Risks include cyst rupture during removal spilling contents (particularly important with dermoid or endometrioma cysts), ovarian tissue damage potentially affecting fertility, bleeding, infection, adhesion formation, and the need to convert to open surgery. In cases of suspicious features or unexpected intraoperative malignancy findings, wider surgery including oophorectomy, salpingectomy, or full staging may be required. Reduction in ovarian reserve (anti-Müllerian hormone) is documented after endometrioma cystectomy, particularly for bilateral disease. Intraoperative frozen section may alter the surgical plan. Repeat cystectomy for recurrent endometriomas carries higher risk of ovarian reserve damage with each subsequent procedure. Women with endometriosis should be counselled that cystectomy does not eradicate the underlying disease process, and adjuvant medical treatment with progestin or GnRH agonists may be required post-operatively to reduce recurrence risk.

Most patients are discharged within 24 hours. Laparoscopic cystectomy causes minimal pain managed with oral analgesics. Light activity is possible within a few days. Strenuous exercise and heavy lifting should be avoided for 2–3 weeks. The removed cyst is sent to pathology. A pelvic ultrasound is performed at 6–8 weeks to confirm healing. For endometriomas, medical suppression therapy is discussed to reduce recurrence risk. Women wishing to conceive are referred to fertility services if conception does not occur within 6–12 months post-operatively. Fertility assessment including AMH level is recommended after bilateral or repeat cystectomy. Women with endometriosis are encouraged to begin adjuvant hormonal therapy within 4 weeks of surgery to suppress disease activity. Symptom recurrence — pelvic pain, dysmenorrhoea — after 6 months warrants reassessment with transvaginal ultrasound.