Ovarian Cyst Removal By Laparoscopic Surgery: Pros And Cons

Ovarian cysts as well as tumors can occur in all stages of a woman's life. While dysgerminomas are the most common ovarian tumors at early age, functional cysts, endometriotic cysts, dermoids and benign epithelial tumors dominate during her childbearing or reproductive age. At times, removal of some of the cysts or tumors becomes necessary when they prove life-threatening. Open abdominal surgery was the only way left to people for tackling these cases which involved trauma, fair amount of risk, postoperative complications and long hospital stay. But things have undergone sea change during the current years.

On account of several beneficial factors, ovarian cyst removal through laparospic surgery is becoming more and more popular in theUnited States. It involves making a pencil-thin hole in the navel and a further two or more similar holes near the groin. Instruments, camera, illuminators, etc are inserted into the abdomen of the patient for removal of the cyst while the attending surgeon takes the necessary action, sitting in front of the monitor. Termed also as 'key-hole surgery', this new surgical process do not create a large scar in the abdomen which used to be the usual trade mark in abdominal surgery prior to the advent of laparoscopy. It is suitable for cysts whose risk of cancer is low, and when the size of the cyst is not overly large.

It has also been observed that laparoscopic surgery is associated with significantly less postoperative pain, lesser adverse effects by way of inadvertent surgical injury or postoperative complications and a shorter length of hospital stay. However, in terms of laparoscopy, it may take a little longer time (11 minutes more) than laparotomy (open surgery). Nevertheless, laparoscopy approach towards the outcome still has controversies relating to the spillage of ovarian cyst contents during removal of the cyst that might adversely affect the prognosis. Controversy also haunts the issue as to why laparoscopy would not be applied towards removal of borderline or low malignant potential ovarian cysts, as currently it is applied only for removal of benign ovarian cysts.

However, not everyone is a candidate for laparoscopic surgery. Preoperative assessment is one of the significant issues in qualifying for laparoscopic surgery. It includes transvaginal ultrasonography for morphologic scoring, Color Doppler transvaginal ultrasonography: vascular quality is assessed by vascular resistance index along with pulsatility index less than one or resistance index less than 0.4. A patient would be eligible for laparoscopic surgery only if she can score successfully in these tests.

Despite several significantly plus points that lie in favor of laparoscopic surgery, there are others that are not so encouraging. These include inadvertent cyst rupture and lack of tactile sense. In spite of the fact that it has excellent vision, laparoscopy has a distinct drawback in its perceptible senses. This disagreeable shortcoming may result in missing plaques and nodules on the peritoneum that would have surely palpated at laparotomy. Shortage of people skilled in advanced laparoscopic procedures is yet another stumbling block in the spread of this wonderful surgical technique.