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Saturday, July 3, 2021

Ovarian Cyst Surgery

                                         
Ovarian Cyst Surgery


Most ovarian cysts go away without treatment or intervention. The gynecologist may recommend surgical removal of the ovarian cyst that is large, persistent, or symptomatic:
  • Causes discomfort
  • Irregular menstrual periods
  • Bleeding

When the cyst has suspicious features that cause the gynecologist to want to rule out ovarian cancer. Although ovarian cysts are non-cancerous and rarely become cancerous, they can coexist with cancerous tumors. Additionally, ovarian cancer tumors often have cystic characteristics. Often, the procedure to remove ovarian cyst can be securely without damaging the ovary

Ovarian Cyst Surgery


Surgical removal of ovarian cyst is usually recommended even if there is concern that the cyst may be cancerous or become cancerous. When an ovarian cyst growth or needs to be examined carefully, the surgeon may use to remove the ovarian cysts:

 Laparoscopy: Two to 3 small incisions are made in the abdomen. Most cysts can be removed laparoscopically. laparoscopy cyst removal is considered when it is necessary to remove small cysts. A laparoscope (a narrow light tube with a camera) is inserted through one of the incisions to guide the surgeon with the help of images transmitted to a large monitor, and other surgical instruments are inserted through the other incisions. All this after introducing carbon dioxide to inflate the abdomen so that the surgical area can be viewed clearly 
 
 Laparotomy: A large incision is made in the abdomen to access the surgical site. This type is considered when it is necessary to remove large cysts and when it is necessary to remove the affected ovary or uterus

Both types of surgery can be used to diagnose problems such as ovarian cysts, adhesions, fibroids, and pelvic infections. But if there is any doubt about the cancer, you may have a laparotomy. It offers the best view of the female abdominal and pelvic organs. So, if your doctor finds ovarian cancer, he can safely remove it

An ovarian cyst can be removed from an ovary (cystectomy), preserving the ovary and its fertility. But it is possible that a new cyst will form on the same or opposite ovary after a cystectomy. When the cyst is large or questionable, the surgeon may need to remove the entire ovary (oophorectomy). New cysts can only be completely prevented by removing the both ovaries. As long as the remaining ovary is healthy and functional, removing a single ovary does not affect the menstrual cycle or fertility

When is ovarian cyst procedure surgery needed?


• If there is a solid lesion with no tumor markers available and no evidence of malignancy intraoperatively (extracapsular extension, lymph node, omental involvement):
Perform cystectomy with posterior salpingooophorectomy if tumor markers return elevated or final path malignant.

• If dermoid is suspected, the surgeon perform dermoid cyst ovary removal (shadowing echodensity/regional bright echoes on ultrasound):
Laparoscopy / laparotomy for ovarian cystectomy

• IF tumor markers are negative and the ovary appearance is suspect at the time of surgery but the section cannot be frozen to confirm malignancy:
Consult parents about the possible need for a second surgical procedure if the final path is malignant.
Perform a unilateral salpingooophorectomy with a second staging procedure if the final pathology is malignant

• IF tumor markers are positive, CT/MRI indicative of malignancy:
  • Consult preoperatively with pediatric surgery and/or oncology
  • Use sequential compression stockings
  • Use a vertical incision to allow for surgical staging
  • Preserve sexual/reproductive function as much as possible
  • Perform adequate staging with unilateral salpingooophorectomy:
  • Examine ascites for malignant cells
  • Inspect peritoneal/solid organ surfaces/biopsy of suspicious areas
  • Remove omentum
  • Sample periaortic/pelvic lymph nodes
  • Biopsy other ovary if suspicious

laparoscopic ovarian cystectomy


laparoscopic cystectomy is performed under general anesthesia. An incision is made through the ovarian cortex around the base until the plane of the cleavage is found, after which getting ovarian cyst removed. Some traction is usually required, and any connective tissue that passes from the substance of the ovary to the capsule of the cyst can be divided by sharp dissection

The surgeon may suggest an laparoscopy ovarian cystectomy in the following cases:

  • Ovarian cyst size for surgery > 7 cm
  • It is not a functional cyst
  • Presence of pain or other symptoms
  • The cyst continues to grow
  • The cyst does not resolve in two or three menstrual cycles
  • Ovarian Cancer Exclusion
  • Cysts in both ovaries

The goal of ovary laparoscopic surgery is to remove the cyst with the capsule intact, although this can be technically difficult, especially if the cyst has thin-walls. If the cyst ruptures, the lining of the cyst must be gently peeled off its bed. It is important to remove, even if necessarily in parts, the entire lining of the cyst to avoid recurrence. The cyst is then placed in a laparoscopic bag, where it can be aspirated if necessary before removing it through one of the ports. Alternatively, the intact cyst can be removed through the vagina or it can be collected and decompressed inside a retrieval bag, minimizing the possibility of the contents of the cyst spilling into the pelvic cavity. Ovarian repair can be done with thin non-absorbable sutures, which cause minimal inflammatory

Oophorectomy


Oophorectomy is the term used for the removal of an ovary. Oophorectomy can be bilateral (removal of both ovaries) or unilateral (removal of one ovary). The affected ovary is separated from blood supply and the surrounding tissues. The ovary has two blood supplies: the ovarian ligament on the uterine side and the ovarian artery which arises from the aorta and runs in the infundibulopelvic ligament. These are usually easily identified separately. The division of the two sides of the broad ligament enables the pedicles to be skeletalised, in turn, to identify, divide and fix them. The affected ovary is removed through the incision or placed in a bag prior to removal. Indications for Oophorectomy include the following:

● Ovarian cancer active treatment
● Ovarian cancer prophylactic treatment for high-risk women, especially those carrying the BRCA1 or BRCA2 genes. Oophorectomy not only eliminates the risk of ovarian cancer, but also significantly reduces the risk of developing breast cancer
● large ovarian cyst removal
● As an accompaniment to hysterectomy

Hysterectomy


Hysterectomy is the term for the surgical procedure to remove the uterus. Indications for a hysterectomy include the following:

● Cancer of the ovary, uterus or cervix
● As a prophylactic treatment in combination with oophorectomy and salpingectomy for people with a strong family history of reproductive system cancers
● Severe menorrhagia when treatments have failed
• Severe endometriosis or adenomyosis where other treatments have failed.
● As an emergency procedure to save lives in certain postpartum situations, for example; accrete placenta or severe postpartum haemorrhage

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