Ovarian Cystectomy (Removal of Cysts) 

What is an ovarian cystectomy?  

Ovarian cystectomy is a surgical operation designed to remove one or more cysts from an ovary without removing the entire ovary itself. This procedure is commonly performed to treat ovarian cysts that are causing symptoms or continue to grow over time. Unlike oophorectomy, which involves removal of the entire ovary, ovarian cystectomy allows the ovary to be preserved, which makes it an important option for women who wish to retain fertility or maintain hormonal balance.

Ovarian cysts  are fluid-filled sacs that can form on or within the ovaries. Most cysts are harmless and resolve on their own. However, some may cause pelvic pain, bloating, menstrual irregularities, or complications such as torsion or rupture. When cysts do not respond to conservative management, surgical intervention may be required.

Ovarian cystectomy can be performed using different surgical techniques, each chosen based on factors such as the size and nature of the cyst, its location, the patient’s age, and their desire to preserve fertility. 

Types of Ovarian Cystectomy

• Laparoscopic ovarian cystectomy — this is the most common and least invasive approach. It involves making a few small incisions in the abdomen to insert a camera and surgical instruments. The cyst is carefully separated from the ovarian tissue and removed through one of the small incisions. This method is typically recommended for cysts deemed to be non-cancerous and allows for quicker recovery, minimal scarring, and shorter hospital stays.

• Laparotomy (open ovarian cystectomy) — in cases where the cyst is very large, suspicious for malignancy, or there is significant internal bleeding, an open approach may be necessary. A single larger incision is made in the lower abdomen to allow better access and visualisation. While recovery takes longer than with laparoscopy, this method provides greater surgical control in complex cases and importantly avoids spillage of contents which is relevant in case of suspected cancer as spillage  can cause the cancerous cells from the cyst to spread to the other organs. 

Why is an ovarian cystectomy performed?

Ovarian cystectomy is performed to remove ovarian cysts that are causing symptoms, have features on imaging that are suspicious for cancer, or do not resolve with conservative treatment. While many ovarian cysts are benign and self-limiting, some may persist, enlarge, or interfere with a woman’s health and fertility. The procedure is considered when preserving the ovary is clinically appropriate and desirable.

Key indications for ovarian cystectomy include:

• Persistent or enlarging cysts — cysts that remain beyond two or three menstrual cycles, particularly those larger than 5 cm, are often monitored closely. If they continue to grow or fail to resolve, surgical removal may be advised.

• Symptomatic cysts — cysts that cause ongoing pelvic pain, bloating, pressure symptoms on the bladder or bowel, or painful periods may require removal to alleviate discomfort and improve quality of life.

• Suspected endometriomas — in women with endometriosis, ovarian cystectomy may be needed to remove endometriomas (chocolate cysts), which can damage ovarian tissue and impair fertility if left untreated.

• Risk of ovarian torsion — large or mobile cysts can twist the ovary around its supporting ligaments (ovarian torsion), cutting off blood supply. This results in severe pain and is a surgical emergency, cystectomy needs to be performed to untwist the ovary, remove the cyst or sometimes even the ovary..

• Concern for malignancy — although most cysts are benign, certain features on ultrasound or elevated tumour markers (e.g. CA-125 or CEA) may raise suspicion. In such cases, surgical removal is essential for diagnosis and to rule out cancer.

• Fertility preservation — in women of reproductive age, ovarian cystectomy is preferred over full ovary removal when cysts need to be excised, helping to maintain hormonal function and fertility potential.

What does an ovarian cystectomy treat?

Ovarian cystectomy is primarily used to treat benign ovarian cysts that do not resolve on their own and are causing symptoms, complications, or clinical concern. 

Conditions commonly treated with ovarian cystectomy include:

• Functional cysts — these include follicular cysts and corpus luteum cysts that develop in many women during the menstrual cycle and persist longer than expected or become unusually large. While many resolve naturally, surgery may be necessary if they cause symptoms or complications.

• Endometriomas — these are cysts formed due to endometriosis and are filled with thick, old blood. They are often associated with pelvic pain, painful periods, and subfertility, and may require removal to improve symptoms and reproductive outcomes.

• Dermoid cysts (mature teratomas) — these are benign cysts that contain various types of tissue such as hair, skin, or fat. Although usually non-cancerous, they can enlarge or twist, warranting surgical removal.

• Haemorrhagic cysts — when a cyst bleeds into itself, it can increase in size and cause severe pelvic pain and may require surgery if bleeding is persistent or severe.

• Cysts causing ovarian torsion — if a cyst causes the ovary to twist on its ligament, it can block blood flow, leading to acute pain and potential ovarian damage. Emergency cystectomy may be performed to untwist the ovary and remove the cyst.

• Suspicious or borderline cysts — cysts with features that raise concern for malignancy or borderline tumours are removed to allow for histological diagnosis and appropriate further management.

What are the benefits of an ovarian cystectomy?

Ovarian cystectomy offers several important benefits, particularly for women who wish to treat problematic cysts while preserving their fertility and hormonal function. The key advantages include:

• Preservation of ovarian function — unlike oophorectomy (removal of the ovary), cystectomy removes only the cyst, which allows the ovary to continue producing hormones and eggs.

• Relief from symptoms — women often experience significant relief from pelvic pain, bloating, or menstrual discomfort once the cyst is removed.

• Lower risk of complications — removing cysts that are large, persistent, or likely to twist reduces the risk of ovarian torsion, rupture, or internal bleeding.

• Improved fertility outcomes — in cases of endometriomas or cysts that interfere with ovulation, cystectomy may help restore reproductive potential.

• Clarification of diagnosis — surgically removing the cyst allows for histological analysis, which helps rule out or confirm any underlying abnormality.

• Minimally invasive options — when performed laparoscopically, the procedure is associated with quicker recovery, minimal scarring, and a shorter hospital stay.

Are there any side effects of an ovarian cystectomy?

Like any surgical procedure, ovarian cystectomy carries some risks and potential side effects. While most women recover well without complications, it is important to be aware of what to expect and when to seek medical advice.

Common side effects include:

• Postoperative pain or discomfort — mild to moderate pain around the incision sites or in the lower abdomen is common, especially in the first few days. This is usually managed effectively with pain relief medication.

• Fatigue and bloating — feeling tired or experiencing abdominal pain and bloating for a few days post-surgery is normal, particularly after laparoscopic procedures.

• Shoulder pain — in laparoscopic cystectomy, carbon dioxide gas is used to inflate the abdomen, which irritates the diaphragm and can cause referred shoulder pain. This usually settles within 24–48 hours.

Less common but possible risks include:

• Infection — although rare, there is a risk of wound or pelvic infection. Symptoms may include fever, increased pain, redness around the incision, or unusual discharge.

• Bleeding — minimal bleeding is expected during surgery, but in rare cases, a blood transfusion may be needed if significant blood loss occurs.

• Damage to surrounding organs — there is a small risk of injury to nearby structures such as the bladder, ureter, bowel, or blood vessels, particularly in cases with severe adhesions or complex cysts.

• Ovarian damage or reduced ovarian reserve — in some cases, removal of the cyst may affect the healthy ovarian tissue, especially if the cyst is deeply embedded. This could have implications for future fertility esp in patients with endometriosis.

• Recurrence of cysts — depending on the underlying cause (e.g. endometriosis or dermoid cysts), there is a chance that new cysts may form in the future.

Most side effects are mild and short-lived. Your doctor will discuss the risks with you in detail and provide advice on how to monitor for complications after surgery.

How do I prepare myself for an ovarian cystectomy?

Preparing for an ovarian cystectomy involves a combination of medical assessments, lifestyle adjustments, and practical planning to ensure the surgery and recovery proceed safely. Your gynaecologist will provide tailored instructions, but the following are general steps most patients can expect:

• Preoperative tests and imaging — before the surgery, you may undergo a pelvic ultrasound, MRI, and blood tests (such as CA-125) to assess the nature of the cyst. A general health evaluation, including blood work and possibly an ECG, will also be performed to ensure you are fit for anaesthesia.

• Medication review — inform your doctor about all medications, supplements, or herbal remedies you are taking. Certain blood-thinning medications may need to be paused before surgery.

• Fasting before surgery — you will likely be asked to avoid food and drink for at least 6–8 hours prior to the procedure. This helps reduce the risk of complications related to general anaesthesia.

• Bowel preparation (if advised) — in some cases, your surgeon may recommend a bowel prep if a laparotomy or extensive pelvic surgery is anticipated, though this is not always required.

• Stop smoking and alcohol — if you smoke, it is advisable to stop before surgery, as smoking increases the risk of complications and delays healing. Alcohol intake should also be minimised.

• Practical arrangements — plan for someone to accompany you on the day of surgery and assist you for the first 24–48 hours afterwards. Prepare your home with essentials and comfortable clothing, and take time off work as recommended.

Your care team will guide you through each step and answer any specific concerns you may have. Proper preparation helps minimise risks, ease anxiety, and support a smoother recovery.

What happens during an ovarian cystectomy? 

An ovarian cystectomy is usually performed under general anaesthesia, which means you will be asleep and pain-free throughout the operation. The goal is to remove the cyst while preserving as much healthy ovarian tissue as possible. The surgical approach, either laparoscopic (keyhole) or open (laparotomy), will depend on the size, type, and suspected nature of the cyst.

Here’s what typically happens during the procedure:

• Anaesthesia and preparation — you will be given general anaesthesia. Once asleep, a catheter may be inserted to drain the bladder, and the abdomen will be cleaned with an antiseptic solution.

• Accessing the ovary:

• In laparoscopic surgery, small incisions are made in the abdomen to insert a camera (laparoscope) and surgical instruments.

• In open surgery (laparotomy), a larger incision is made in the lower abdomen to directly access the ovary.

• Removal of the cyst — the surgeon carefully identifies the affected ovary and separates the cyst from the surrounding healthy tissue. The cyst is excised without damaging the rest of the ovary. If the cyst has ruptured or contains thick contents (such as in dermoid or endometriotic cysts), the abdomen and pelvis is cleaned thoroughly to prevent irritation, infection or scarring.

• Closure — once the cyst has been removed, the ovary is inspected to ensure it is not bleeding. Often the bleeding needs to be controlled by stitching the ovary. The skin incisions are then closed with dissolvable stitches or surgical glue, and dressings are applied.

• Recovery and monitoring — after the procedure, you will be moved to a recovery area for monitoring until you wake up from the anaesthesia. Most laparoscopic cystectomies are done as day surgeries or involve an overnight stay, while open procedures may require a longer hospital stay.

The entire operation usually takes between 1-4 hours, depending on the complexity. The removed cyst is typically sent to the laboratory for histological examination to confirm its nature.

What happens after an ovarian cystectomy? 

Recovery after an ovarian cystectomy varies depending on the type of surgery performed, your overall health, and the complexity of the procedure. Most women recover well and are able to return to normal activities within a few weeks, particularly after laparoscopic surgery.

Here’s what typically happens after the operation:

• Immediate recovery — after the surgery, you will be taken to a recovery area where your vital signs will be monitored as you wake from the anaesthesia. You may feel groggy, bloated, or slightly nauseous for a few hours.

• Hospital stay — if the procedure was laparoscopic, you may be discharged the same day or after an overnight stay. Open surgery (laparotomy) usually requires a hospital stay of 2–4 days for monitoring and pain control.

• Pain management — some abdominal discomfort or soreness at the incision sites is expected. Pain relief will be provided, and most women are able to manage with oral medication within a day or two.

• Resuming activities — light activities can typically be resumed within a few days. However, you should avoid heavy lifting, strenuous exercise, or sexual intercourse for around 4–6 weeks, or until your doctor advises it is safe.

• Wound care and hygiene — keep the incision sites clean and dry. You may be advised on how to shower and change dressings if needed. Stitches are often dissolvable, but your doctor will inform you if follow-up removal is required.

• Menstrual changes — your next period may be slightly delayed or different in flow or discomfort. This usually settles over time.

• Follow-up appointment — a review is usually scheduled 1–2 weeks after surgery to assess healing, review histology results (if relevant), and discuss any concerns.

Most women feel significantly better within 1–2 weeks after laparoscopic surgery, though full recovery can take longer after open procedures. If you experience fever, increasing pain, heavy bleeding, or unusual discharge, it’s important to contact your doctor promptly.

Summary 

Ovarian cystectomy is a surgical procedure that removes cysts from the ovary while preserving healthy ovarian tissue, which makes it an important option for women who wish to maintain fertility and hormonal balance. It is typically recommended when cysts are persistent or growing, painful, suspicious in appearance, or have caused complications such as ovarian torsion. Depending on the nature of the cyst, the surgery may be performed using minimally invasive keyhole techniques or through an open abdominal approach. 

Conditions commonly treated include endometriomas, dermoid cysts, haemorrhagic cysts, and functional cysts that fail to resolve over time. Before surgery, patients usually undergo imaging scans, blood tests, and a detailed clinical evaluation to plan the safest approach. Recovery is generally smooth, with most women experiencing mild discomfort and gradually resuming normal activities within one to two weeks after laparoscopic surgery, or slightly longer for open procedures. 

If you are dealing with ongoing symptoms or have been advised to explore surgical options, schedule a consultation with Holistic Gynaecology & Fertility for expert evaluation and personalised care.

Frequently Asked Questions (FAQs)