Ovarian cyst — when surgery is needed and treatment methods

Diagnosis before surgery

The decision to operate is always based on thorough ultrasound diagnosis, the patient’s medical history and laboratory test results (e.g. tumour markers). At our practice at ul. Słowackiego 10 in Sopot we provide diagnosis and treatment of disorders of the ovaries and fallopian tubes. In the practice we perform gynaecological examination and pelvic ultrasound.

When does an ovarian cyst qualify for surgery?

Indications for surgical treatment are divided into elective and emergency (acute).

Elective indications

• Size of the lesion — cysts larger than 4–5 cm in diameter that do not shrink or disappear after several months of observation.
• No response to conservative treatment.
• Ultrasound appearance suggesting a lesion other than a simple cyst, e.g. the presence of septa, solid components, tissue growths inside the cyst or abnormal blood flow.
• Endometrial (“chocolate”) cysts — associated with endometriosis; they rarely disappear on their own, can adversely affect fertility and cause severe pain.
• Dermoid cysts (mature teratomas) — contain mature tissues (e.g. hair, skin, teeth), do not respond to drug treatment and tend to grow slowly.
• Abnormal marker results — raised blood marker levels (e.g. CA 125, HE4) or a high risk score on IOTA / ROMA assessment, particularly in postmenopausal women.
• Patient’s age — any newly detected ovarian lesion in a postmenopausal woman requires increased vigilance and is more often referred for surgical verification.

Endometrial cysts are in most cases accompanied by endometriosis at other sites. Not every endometrial cyst requires surgery, and when surgery is necessary, it should be performed at a centre dedicated to the treatment of endometriosis.

Emergency indications (urgent)

• Torsion of the ovary or cyst pedicle — causes sudden, severe, sharp pain in the lower abdomen, often with nausea and vomiting. It requires immediate surgery to save the blood supply to the ovary.
• Cyst rupture with bleeding into the abdominal cavity — may lead to signs of shock or peritoneal irritation and requires urgent surgical intervention.

Methods of surgical treatment of ovarian cysts

The choice of surgical technique depends on the size and nature of the lesion, the patient’s age, reproductive plans and general health.

VNOTES — scarless minimally invasive method

The least invasive method of removing benign cysts. The surgeon gains access to the abdominal cavity through the vagina via a special access port, through which the laparoscope and laparoscopic instruments are introduced. Advantages:

• minimal pain after surgery
• much shorter hospital stay (often discharge on the same day or on the first day after surgery)
• quick return to everyday activities
• no visible scars, lower risk of abdominal adhesions

Laparoscopy — minimally invasive method

The preferred and most commonly used method of removing benign cysts. The surgeon makes 3–4 small incisions in the abdominal wall (0.5 to 1 cm), through which the laparoscope and laparoscopic instruments are introduced. Advantages:

• minimal pain after surgery
• much shorter hospital stay (often discharge on day 1–2)
• quick return to everyday activities
• minimal scarring and lower risk of abdominal adhesions

Laparotomy — conventional (open) surgery

Used less often, in strictly defined clinical situations. It involves a traditional incision of the abdominal wall, most often transverse above the pubic symphysis, or vertical. It is used:

• for very large cysts that make safe laparoscopic access difficult
• when a neoplastic (malignant) process is reasonably suspected or confirmed
• in the case of extensive adhesions after previous abdominal surgery

Extent of the procedure — what is removed?

During the procedure (VNOTES, laparoscopic or conventional), the surgeon aims to be as conservative as possible.

• Cystectomy (enucleation of the cyst) — removal of the lesion alone, preserving healthy ovarian tissue. This is the priority option for women of reproductive age who are planning a pregnancy; it preserves the hormonal function of the ovary.
• Removal of the ovary or adnexa (oophorectomy, adnexectomy) — removal of the ovary together with the cyst, or of the ovary together with the fallopian tube. Used mainly when the lesion has completely destroyed the ovarian tissue, when there is a high risk of malignancy, or in postmenopausal women.

In women who have completed their family, the fallopian tubes can be removed during surgery to prevent serous ovarian cancer — this reduces the risk of ovarian cancer by up to 80%.

All tissue removed during surgery is sent for histopathological examination (routine examination under a microscope). This confirms the nature of the lesion and allows any further management to be planned.

Do you have indications for surgical treatment?

Operations are performed by Mateusz Świątkowski, specialist in obstetrics and gynaecology. We invite you to book an appointment by phone.