What are Ovarian cysts?
Ovarian cysts are most often fluid-filled growths of the ovaries. They can be functional (not cancerous), neoplastic (benign or cancerous), or endometriotic (also called endometriomas or chocolate cysts, which are very rarely cancerous).
Before initiating treatment, a physician should take into consideration the size and appearance of cyst on an ultrasound exam, the patient’s age, presence or absence of symptoms, and any risk factors. If a cyst is discovered in a woman of reproductive age, it is most commonly the functional type; endometriotic cysts are the second most common type. Neoplastic cysts are the least common type in this age group. The lifetime risk for a woman developing ovarian cancer is less than 2%.
- Most common type in women of reproductive age
- Three types: follicular, corpus luteum, and theca luteal cysts
- Caused by fluctuations of hormones throughout a woman’s menstrual cycle
- Usually regress spontaneously
- Rarely bigger than 10 cm
- May break and cause pain or intra-abdominal bleeding, necessitating surgery (cystectomy)
Endometriotic ovarian cysts (endometriomas)
- Present in 60% of women with endometriosis
- Only 1% of women with endometriosis has the disease present only in the ovaries
- Can cause infertility and severe pain
- Best treatment recommended for improved fertility, relief of pain, and to minimize recurrences is a cystectomy (excision of the cyst). This surgery is performed in our center using minimally invasive (laparoscopic) surgery.
Neoplastic cysts (benign or malignant)
- Most common neoplastic cyst is a mature cystic teratoma (dermoid cyst) which is benign
- As women age, the risk of a malignant ovarian cyst increases. Postmenopausal woman are at the highest risk for developing ovarian cancer
- There are no good screening tests for ovarian cancer, but ultrasound combined with certain blood tests can aide in diagnosis
- Most neoplastic cysts should be treated surgically
- Ovaries containing large cysts may undergo torsion (twisting around their base), which results in arrest of blood flow to the ovary and severe pain. Torsion requires emergency surgery.
- Cysts that remain unchanged or grow over a period of observation most often need surgical removal. Sizes of cysts range from a few mm to over 30 cm (1 foot). In general, most cysts over 8cm, regardless of appearance, have to be removed.
Laparoscopically treating ovarian cysts without compromising fertility
Surgeries to treat ovarian cysts are quite common. However, it takes uncommonly advanced surgical skill to treat this condition in a minimally invasive manner without compromising fertility, without causing more pain or scar tissue, and without increasing the risks for the cysts to recur. Unfortunately, some surgeons are still using outdated technologies and techniques for treating ovarian cysts which studies have shown can cause these and other long-term complications, including increases in pain and/or compromised fertility by damaging a woman’s ovarian reserve.
That’s why it’s important to ensure that your surgeon not only has advanced laparoscopic skills, but also has available the most modern surgical equipment (and is trained to use them). Some important questions you can ask your surgeon are:
- What instruments does he or she use to treat ovarian cysts? (Since studies have found that unipolar electro-surgical devises can cause more serious complications, you’ll want to make sure that your surgeon will not use these types of instruments)
- What methods does he or she use to ensure that the contents of the cysts do not spill into the abdomen
- What methods does he or she use to ensure that no part of the ovarian reserve is damaged?
- What methods does he or she use to treat ovaries that are completely encased in scar tissue (adhesions)?
- Does he or she have the advanced laparoscopic skills necessary to perform minimally invasive surgery even when extensive adhesions or large cysts are present?
- Does he or she have the advanced laparoscopic skills necessary to excise ovarian cysts that have attached to the bowel?
- What methods or special instruments does he or she use to reduce the chance for complications, post-operative adhesion-formation, pain, and/or the recurrence of the cysts?
These are just a few of the many important questions that should be asked of your surgeon before moving forward with surgery. Please feel free to contact us at firstname.lastname@example.org if you’d like to learn about these and other very important differences in the surgical management of ovarian cysts; differences that do make a difference.
Experience is crucial for treating ovarian cysts minimally invasively
Dr. Nezhat are among the most experienced surgeons in the world in laparoscopic management of ovarian cysts. The Nezhat’s reported laparoscopic removal of a dermoid cyst (benign neoplastic cyst) for the first time in 1992, in the journal Obstetrics and Gynecology. Later, in 2002, they reported on 10 years of experience in laparoscopically treating highly complex cases, including dermoid cysts, endometriomas that were encased in scar tissue, and many other types of ovarian cysts.
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