Why is Ovarian Cyst Removal Surgery Required?
Ovarian cysts are outgrowths on the ovarian surface. They are generally soft, solid, and fluid filled. But they also may be hard at times. Indications for ovarian cyst removal surgery are given below:
Poly Cystic Ovarian Syndrome is a commonly seen condition. Due to abnormality in hormone levels, there is inability of the ovaries to release the female egg for fertilization by the male sperm. These unreleased eggs along with surrounding fluid, form small cysts on the ovarian surface.
They may progressively worsen to form larger cysts. If medicines do not help to curb this condition, surgery is done to remove the cysts.
Endometriosis is a condition in which normal cells which line the uterine cavity migrate outside and get deposited on other organs. They could deposit on the ovaries and undergo normal changes in coordination with the menstrual cycle. They will eventually bleed during the menses. The accumulated blood collects around the ovary to form a chocolate cyst. This is a painful condition and needs to be treated with corrective surgery for cyst removal.
- Ruptured Cysts
Ovarian cysts could increase in shape and eventually burst. Fluid from the cysts spills into the pelvic cavity. This could lead to serious complications and needs to be managed surgically.
- Symptomatic Cysts
Many a times, ovarian cysts do not have any presenting symptoms. At times however, symptoms like pain in the lower abdomen, increased frequency of urination due to pressure on the bladder, heaviness in the abdomen, nausea, vomiting, pain in the pelvic region during sexual intercourse may be experienced.
Depending upon the associated hormonal disturbance, there could be menstrual abnormalities as well.
- Ovarian cancer
Cysts on the ovary are not cancerous most of the times. But in some instances, ovarian cancer may be present in the form of cyst. Ovarian cancer surgery can be performed to remove the cyst.
Patients presenting with cyst on the ovary are referred to gynecologists for further investigation. The gynecologist will evaluate and examine the patient properly to determine the cause of cyst. After running diagnostic tests and determining the extent to which ovaries are involved, surgery can be planned.
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Before ovarian cyst removal surgery, planning of the procedure is needed. This ensures that the entire surgery is executed with minimum obstacles and complications. Some of the important pre-operative steps are mentioned below:
- Discussion With Patient
Ovarian cyst removal surgery is performed by gynecologists. The patient and gynecologist discus the procedure in detail. All advantages and drawbacks of the surgery are explained to the patient. She is also informed about the care she will need to take before and after surgery. She can get all her questions answered prior to deciding if she would like to proceed with the surgery. A written consent, signed by the patient, is required before performing the surgery.
The patient has to undergo a battery of tests before the operation. These help to determine patient's general health. White blood cell count and blood sugar should be within normal limits. Blood group determination is done. Blood type matching the patient is kept ready to be used in case of emergency. Blood tests are done to determine clotting time and bleeding time for the patient. An ECG will help to determine cardiac functions. Chest X-Ray is done to visualize the lungs and heart for any change in shape, size or appearance.
- Pre-operative Medicines
Mild sedative may be prescribed to the patient to relieve any anxiety and to help her sleep better. Pain killers and antibiotics may be prescribed before hand to prevent any pain and infection after surgery. If the patient is on any medicines for other health conditions, she should inform the surgeon about the same.
Day Before Surgery
The patient is generally advised to get hospitalized one day prior to the surgery. This ensures that the patient is not late for surgery. Also, it helps the patient to get accustomed to the hospital environment where she will be operated and retained for a day or two after surgery. The patient is advised to eat very light food. After dinner on the night before surgery, she is not supposed to eat or drink anything till after surgery. This is advised because, under the effect of general anesthesia, the intestines are completely relaxed. Intestinal contents may spill out of the esophagus or anus and could lead to inconvenience or complications during surgery. Antacids and laxatives may be prescribed to the patient.
On the day of surgery, the patient has to be prepped well in advance. She is transferred to the operating room. A clean, sterilized surgical gown provided by the hospital is to be worn during surgery. General anesthesia is administered via a vein in the arm or in the form of nasal fumes. If the procedure is performed by abdominal approach, the abdominal skin is cleaned with an antiseptic solution. Blood pressure, respiratory rate, pulse, and body temperature are monitored while the anesthesia is being administered and also later, throughout the operation.
Methods/Techniques of Ovarian Cyst Removal Surgery
Ovarian cyst removal can be done by open method or by minimally invasive method. Both methods have their advantages and drawbacks. But both are equally effective. The procedures are described below in detail.
- Open Surgery
This is an invasive surgical procedure. An incision is given on the skin of lower abdomen. The underlying muscles, fascia, blood vessels are carefully separated. Once the ovaries and the cyst is visualized, it is either surgically cut and removed, or the tissue is burnt with a laser beam. The muscles which were separated are replaced to their original position. Skin incision is closed using a surgically suitable thread.
- Laparoscopic Cyst Removal
This procedure involves minimum invasion into the abdominal cavity. As opposed to a large single incision, multiple smaller incisions are given on the abdominal skin. Through these incisions, surgical instruments are introduced inside the abdominal cavity. A video camera is inserted inside through an incision. This helps to visualize the internal organs and give a greater precision while performing the surgery. Further steps are the same as seen in open surgery.
During both these procedures, care has to be taken to avoid rupturing the cyst. If this happens, then the cystic fluid will collect into the pelvic cavity and this could give rise to complications.
Open surgery is more invasive and hence, the chance of infection is much greater after this method. But it has an advantage of being the surgery of choice if the ovarian cyst is large. Also, in cases where cancer of ovary is suspected, laparoscopy is contraindicated (not used). That time, open surgery is the only method which can be opted for.
Laparoscopy has the advantage of having a better recovery period due to smaller surgical incisions. Blood loss is also minimized due to this. Both procedures have the same end result, i.e. removal of the ovarian cyst.
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Care has to be taken for some days after ovarian cyst removal surgery to ensure quick recovery with minimal complications. Post operative care begins the moment patient is transferred into the recovery room. The patient is kept under observation for 1-2 days after surgery.
- Hospital Care
After the surgery, patient will remain unconscious for sometime. Once the effects of anesthesia wear off and the patient is conscious and alert, a physical examination is performed. The surgical incision is checked and covered with cotton and gauze. The patient's blood pressure, body temperature, pulse and respiratory rate are monitored regularly. The patient is not allowed to eat immediately after surgery. Nutritional status is maintained by providing glucose or saline via an I.V line in a vein of the arm. After the intestinal movement resumes normally, food can be consumed orally.
- Home Care
The patient is kept under observation for 1-2 days after surgery. She can then be allowed to go home, depending on her recovery. The surgical wound has to be kept clean and dry. The dressing should be changed as advised by the surgeon. Any signs of bleeding, pain and infection should be reported immediately.
- Physical Activity
After surgery, the patient is expected to recover in a few weeks. In this duration, the patient is advised not to undergo excessive physical strain. She should avoid doing work which will put a strain on the abdominal muscles. This could cause complications which may need another surgery for treatment.
As described above, medication is given to combat pain and infection. Sometimes, blood thinning medicines are given to the patient. This is to avoid formation of blood clots.
After surgery, the patient is required to visit the doctor at regular intervals for follow up. Her recovery after surgery and healing of the surgical incision is assessed during this period. Once the surgical incision heals satisfactorily, the stitches are removed.
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Risks And Complications
Every surgical procedure is associated with some pros and cons. The same applies true for ovarian cyst removal surgery. Sometimes, there could be unexpected complications during the surgery. At times, despite the best post-operative care, there could be some complications during recovery period. They need to be treated separately. Some of them have been described below:
- Bleeding: A blood vessel near to the ovary which is being operated upon, can be accidentally injured during surgery which can lead to bleeding. The blood which accumulates in the pelvis needs to be drained so that it doesn't obstruct the surgeon's view. If there is excessive blood loss, blood transfusion is done to replenish the lost blood.
- Infection: Infection in the internal organs or at the site of surgical incision is known to occur after surgeries. It happens if hygiene and sterilization is not maintained well during surgery. As described above, antibiotics can be used to deal with such cases.
- Rupture of Cyst: The cyst could accidentally be damaged while it is being removed and it could rupture. If fluid from the cyst gets collected into the pelvic cavity, it could lead to health complications. In such cases, the fluid is drained immediately. A stronger dose of antibiotics might be recommended to combat any pelvic infection.
- Accidental Damage to Other Organs: Organs like the bladder, uterus, rectum which surround the ovaries may get damaged during the surgery. Corrective surgery is needed to repair the damage to these organs.
These are some of the commonly occurring complications after ovarian cyst removal surgery. But this does not imply that they essentially occur in every case after surgery. It is essential for the patient to be aware about them before undergoing the procedure.
Ovarian cyst removal surgery does not guarantee that the cyst will never recur. There is the possibility that the cysts may develop again. Though this procedure is not a permanent cure for cysts, it guarantees relief for a long time