Laparoscopic Cystectomy (Ovarian Cyst Removal)

Dr. Wei-Wei Wee-Stekly

Senior Consultant Obstetrician & Gynaecologist

MBBS (London), MRCOG (United Kingdom), MMed (O&G) (Singapore), FAMS (Singapore), FRCOG (United Kingdom)

Ovarian cysts are fluid-filled sacs that form on or inside the ovaries. In many cases, they are harmless and resolve on their own. However, when a cyst becomes large, painful, or persistent, or if there’s concern about its nature, surgical removal may be recommended.

Laparoscopic cystectomy is a minimally invasive procedure to remove ovarian cysts while preserving the healthy ovarian tissue. It is an effective treatment that offers relief from symptoms, helps confirm a diagnosis, and supports fertility goals when needed.

What Is a Laparoscopic Cystectomy?

Laparoscopic cystectomy is a keyhole surgery that involves the removal of an ovarian cyst through small incisions in the abdomen. The procedure is performed using a laparoscope (a small camera) and fine surgical instruments that allow the surgeon to carefully remove the cyst while keeping the ovary intact whenever possible.

This approach is minimally invasive, offering a quicker recovery, less pain, and smaller scars compared to traditional open surgery. It is often the preferred option for managing benign ovarian cysts.

When Is Ovarian Cyst Removal Needed?

Many ovarian cysts — especially functional cysts — go away on their own within a few weeks or months. However, surgery may be recommended if:

• The cyst is large (typically over 5–10 cm)
• It causes persistent pain or pressure symptoms
• There is a risk of rupture or torsion (twisting of the ovary)
• The cyst does not go away with time or hormone treatment
• The cyst appears complex or suspicious on imaging
• The cyst is affecting fertility or interfering with IVF
• There is concern about possible malignancy (though most cysts are benign)

The goal of surgery is to remove the cyst, confirm the diagnosis, relieve symptoms, and preserve as much normal ovarian tissue as possible.

What Symptoms Can It Treat?

Laparoscopic cystectomy is commonly used to treat cysts that cause:

• Pelvic pain or pressure
• Bloating or abdominal distension
• Pain during intercourse
• Irregular menstrual cycles
• Pain during bowel movements or urination
• Sudden onset pain due to ovarian torsion
• Difficulty conceiving (in some cases)

Even if cysts are not painful, removal may be advised to prevent complications if they continue to grow or show unusual features on scans.

What Types of Ovarian Cysts Can Be Removed?

Laparoscopic cystectomy is effective for a wide range of benign ovarian cysts, including:

• Functional cysts (follicular or corpus luteum)
• Dermoid cysts (mature cystic teratomas)
• Endometriomas (chocolate cysts associated with endometriosis)
• Cystadenomas (fluid- or mucus-filled cysts)
• Hemorrhagic cysts (containing blood)

Cysts that are malignant or highly suspicious may require a different surgical approach and referral to a gynaecological oncologist.

Who Is a Suitable Candidate for Laparoscopic Cystectomy?

Most women with benign ovarian cysts are suitable for laparoscopic cystectomy. You may be a candidate if:

• Imaging suggests the cyst is benign
• You are experiencing ongoing symptoms
• The cyst is growing in size or showing complex features
• You want to preserve fertility
• You are in generally good health for anaesthesia and laparoscopic surgery

Your doctor will perform an assessment, including ultrasound and sometimes blood tests, to evaluate your suitability for the procedure.

What Happens Before Laparoscopic Cystectomy?

In preparation for your laparoscopic cystectomy, your doctor will guide you through a preoperative process that may include:

• Pelvic ultrasound or MRI to evaluate the cyst
• Blood tests to assess hormone levels, ovarian reserve, and rule out cancer markers
• Review of your medical and surgical history
• Pre-anaesthesia assessment
• Instructions on fasting, medications, and what to expect on the day of surgery

If endometriosis or multiple cysts are suspected, your doctor may also discuss the potential need for additional procedures during the surgery.

What Happens During Laparoscopic Cystectomy?

Laparoscopic cystectomy is performed under general anaesthesia and usually takes between 45 minutes to 2 hours, depending on the complexity.

• Small incisions are made in the lower abdomen
• A laparoscope is inserted to visualise the ovaries and pelvic organs
• The cyst is carefully separated from the ovary and removed
• The ovary is repaired and preserved where possible
• The cyst is placed in a special bag and removed through one of the small incisions
• The incisions are closed with dissolvable stitches or surgical glue

If a cyst appears suspicious during surgery, it may be sent for immediate testing (frozen section), and further steps will be taken based on the results.

What Is Recovery Like?

Recovery from laparoscopic cystectomy is typically quick and well tolerated. Most patients can:

• Go home the same day or after an overnight stay
• Return to light activities within 2–5 days
• Resume work within 1–2 weeks
• Avoid heavy lifting and exercise for about 4 weeks
• Expect full recovery within 4–6 weeks

Some mild abdominal discomfort, bloating, or shoulder tip pain (from gas used during the procedure) is normal and should settle within a few days. Your doctor will provide pain relief and clear post-operative instructions.

Does It Affect Fertility?

One of the main advantages of laparoscopic cystectomy is that it allows preservation of the ovary. In fact, for women with cysts interfering with ovulation or IVF cycles, removing the cyst may improve fertility.

However, in some cases — such as repeated surgeries or endometriomas — there may be a reduction in ovarian reserve. Your doctor will discuss this in detail and may recommend fertility counselling or egg preservation in selected cases.

Are There Any Risks?

Laparoscopic cystectomy is generally safe, especially when performed by an experienced gynaecologist. However, as with any surgery, there are potential risks, including:

• Bleeding
• Infection
• Injury to nearby organs (bowel, bladder, ureters)
• Adhesion formation (scar tissue)
• Recurrence of cysts, particularly with endometriosis
• Conversion to open surgery if the laparoscopic approach is not feasible

Your doctor will take all necessary precautions to minimise risks and ensure a smooth procedure.

When Should You Consider Laparoscopic Cystectomy?

You should discuss this procedure with your gynaecologist if you:

• Have a persistent ovarian cyst that is not resolving
• Experience pain, pressure, or irregular bleeding
• Have a cyst that is affecting your fertility
• Have been advised that the cyst has complex features on scan
• Prefer a minimally invasive solution for symptom relief or diagnostic clarity

Early evaluation and treatment can help prevent complications such as torsion or rupture and provide peace of mind about the nature of the cyst.