Removal of a large cyst of one ovary
Through a 10–12 cm incision, the cyst is removed into the wound entirely (without a puncture, so as not to spill the contents), the capsule is separated from the ovarian cortex, the bed is sutured with thin sutures to restore the shape of the ovary; if the signs are questionable, the fragment is sent for urgent histology, and if benignity is confirmed, the operation is completed in an organ-preserving manner. Ovarian function and fertility are preserved; the second ovary is examined. If malignancy is detected, the volume is expanded according to oncological principles, which is discussed with the patient before surgery.
Indications
- cysts and benign tumors of the ovaries of large sizes (more than 10–15 cm), not subject to laparoscopy;
- suspicion of a borderline or malignant tumor - the need for revision and urgent histology;
- pronounced adhesions, repeated operations, concomitant diseases that exclude laparoscopy;
- giant cystomas involving the omentum and stretching of the abdominal wall.
Open surgery for cysts
Laparotomy for ovarian cysts is used today for very large and suspicious formations: open access allows you to remove the entire tumor without rupture (essentially in case of possible malignancy), examine and palpate all organs, perform an urgent histological examination and, if necessary, expand the volume. In young women, ovarian tissue is preserved as much as possible; In case of a unilateral tumor, the second ovary must be examined. The bikini incision is sutured cosmetically.
When to choose laparotomy
Open access through a transverse Pfannenstiel incision (along the bikini line) remains the method of choice for very large sizes of the uterus and formations, multiple fibroids with deep nodes, severe adhesions after many operations, suspected malignancy with the need for revision, severe heart and lung diseases in which pneumoperitoneum is undesirable, as well as when laparoscopy is unavailable. Laparotomy gives the surgeon direct control of the tissue and a reliable multi-layer suture on the uterus; the scar after cosmetic suturing is barely noticeable. Recovery is longer than after laparoscopy: hospital stay 3–6 days, exercise limitation 1.5–2 months.
