Bilateral and recurrent cysts
Bilateral cysts are characteristic of endometriosis (“kissing” ovaries) and dermoids; surgery on both ovaries requires minimal coagulation and, if possible, suturing of the ovaries to preserve the supply of follicles - AMH is assessed before the intervention; in women with a low reserve, oocyte cryopreservation is discussed. A secondary (repeated) operation is performed in conditions of adhesions after the first - the surgeon first restores the anatomy, then removes the cyst. In both cases, experience is important: unnecessary ovarian trauma reduces fertility. After surgery for endometriosis, anti-relapse therapy is prescribed.
Indications
- ovarian cysts that persist for more than 2–3 cycles or are larger than 4–5 cm (endometrioid, dermoid, serous, mucinous);
- paraovarian cysts, cysts with signs of torsion, rupture or growth;
- cysts during infertility and before IVF (endometriomas), recurrent and bilateral cysts;
- cysts in menopause, formations with questionable signs according to ultrasound and tumor markers (with urgent histology).
Ovarian preservation
Cystectomy - desquamation of the cyst capsule while preserving healthy ovarian tissue: under magnification, the surgeon separates the cyst wall from the ovarian cortex, carefully coagulates the bed (minimally to preserve the follicular reserve) and removes the cyst in a container through a puncture, without spilling the contents into the abdominal cavity. This technique is especially important for endometriomas and in young women planning pregnancy. The cyst must be examined histologically; If malignancy is suspected, an urgent examination is performed during surgery.
Benefits of laparoscopy
Laparoscopy is the standard of modern operative gynecology: magnifying the image by 10–15 times allows you to work more accurately than an open operation and is more gentle on the ovarian tissue and tubes, blood loss is minimal, adhesions form less frequently (important for future pregnancy), the pain after the operation is mild, and the patient gets up on the day of the operation and is discharged on the 1st–3rd day; Instead of a cut, three barely noticeable scars remain. In the clinics below, laparoscopic operations are performed by gynecological surgeons with extensive experience on modern endoscopic stands.
Risks and contraindications
- rare complications: bleeding, injury to neighboring organs, infection, thrombosis - prevention and the experience of the surgeon reduce the risk to a minimum;
- contraindications: severe heart and lung diseases, coagulation disorders, severe adhesions after many operations, large tumors (>15–20 cm) - then laparotomy is chosen;
- Obesity and previous operations are not a contraindication, but require an experienced team.
