Large ovarian and tubal cysts

This last Tuesday I performed a surgery on a patient in her late twenties who had a large, cystic mass involving her left ovary. On ultrasound it measured approximately 8 centimeters. Her ovarian tumor markers were normal. The decision was made to remove the ovary and tube on the left. With all complex ovarian masses there is a concern for malignancy. For this reason, traditionally these surgeries are performed with a large, “open” incision.

With careful laparoscopic technique these masses and ovarian large ovarian cysts can be managed laparoscopically. With careful attention to keeping the cyst from rupturing and with careful removal techniques, patients can be treated with same day surgery with a much easier recovery.

AT the time of surgery this patient was noted to have an 8 cm cyst on her fallopian tube and a 6 cm cyst in her left ovary. The surface of both tube and ovary were otherwise normal appearing. The tube and ovary were removed separately to facilitate removal from the abdomen. Both cysts were unruptured throughout the surgery.

Once the tube and ovary were removed, a sterile bag was placed into the abdomen through the small incision at the belly button. The bag was then opened and the tube with was placed inside the bag. A laparoscopic needle was then used to aspirate the cyst fluid. Any spilled fluid remained in the bag. The cyst and tube were then removed through the belly button incision.

Because there is often more concern for malignancy with ovarian cysts, the ovary was placed in the bag. The belly button incision was then extended to approximately 3 cm. The opening of the bag was brought through the incision and the ovarian cyst was incised and drained into the bag. The ovary and its contents were then easily removed through this small incision.

The patient went home that same day and was doing very well at a follow up call two days later. Both cysts were benign. She incidentally had a small amount of endometriosis around her left ovary that was removed at the time of surgery.