The danger of the formation of an ovarian cyst is that when it increases, complications arise, and infertility can occur. It happens that a woman does not even know about the existence of a neoplasm, and after a visit to the doctor she learns that she needs surgery. If a baby is planned to be born, there are concerns that complications will appear after the operation, others are afraid of cosmetic defects in the form of a scar. The method of laparoscopy allows you to remove the tumor quickly and without unpleasant consequences for reproductive health, while doing without incisions.
- Indications for surgical removal of ovarian cysts
- Features of the laparoscopy of the ovary
- Benefits of laparoscopy
- Preparation for surgery
- Performing an operation
- Postoperative period
- Possible complications after surgery
- Contraindications for laparoscopy
Indications for surgical removal of ovarian cysts
There are varieties of ovarian cysts that resolve themselves. These are the so-called functional cysts, the formation of which is associated with hormonal changes occurring in the body during the menstrual cycle. The most common cause is a small hormonal failure. As a rule, the body copes with such a disorder within 2-3 cycles, and the cyst disappears.
But there are other, more dangerous types of such tumors, which can grow up to 12 cm in diameter, causing the development of serious complications. Such cysts are not amenable to medical treatment, they must be surgically removed. If we consider that the pathology usually occurs in young women, it is of great importance to perform the operation in such a way that the reproductive function of the body does not suffer, after treatment the woman was able to conceive and give birth to a child. This gentle way to remove an ovarian cyst is laparoscopy.
Surgically remove a cyst of any kind, if it is not absorbed after 3 months, it grows quickly, there is a risk of complications:
- twisting legs, the risk of peritonitis,
- cyst rupture, which results in internal bleeding,
- suppuration of cyst contents,
- squeezing of nearby organs and vessels
- malignant rebirth.
Surgery is the only effective treatment in the presence of endometrioid, dermoid, paraovarial ovarian cysts. Laparoscopy of an ovarian cyst is performed if its size is more than 2 cm. In this case, the task of the surgeon is to remove the tumor in such a way that the ovary can fully function.
If a cyst is detected during pregnancy, it is noticed that it continues to grow, then laparoscopy is performed, but not earlier than 16 weeks, since in earlier periods the threat of miscarriage is too high. In the event of a life-threatening condition, the operation is performed at any stage of the pregnancy.
Features of the laparoscopy of the ovary
Depending on the size of the cyst, its location, the degree of damage to the surrounding tissues, laparoscopic surgery is performed in various ways.
Cystectomy. Only a cyst is removed, it is husked. At the same time, the tissues of the ovary itself remain.
Note: Even if an overgrown cyst absorbs a significant part of the ovary, try to keep at least the remnants of healthy tissue, which are sometimes capable of regeneration.
Wedge resection - the cyst is removed along with part of the ovary.
Ovariectomy (adnexectomy). Complete removal of the ovary together with the cyst. Such an operation is performed by women who have gone out of childbearing age, or in the case when a malignant degeneration of the neoplasm is found.
Often, during laparoscopy of an ovarian cyst, associated pathologies are eliminated, for example, removal of adhesions in the abdominal cavity or myoma nodes. The effectiveness of the operation depends on how thoroughly the elimination of the affected tissues is performed. For example, when cutting out an endometrioid cyst, it is very important to completely remove all the particles of the endometrium, otherwise the cysts will reappear, the endometriosis will spread to the peritoneum, intestine. It is important not to damage the membrane of the cyst, so that its contents do not fall into the abdominal cavity.
Benefits of laparoscopy
The method of laparoscopy has several advantages compared with conventional abdominal surgery. So, to remove a cyst, it is not necessary to make an incision in the abdominal muscles, to displace internal organs that prevent access to the ovary. Only 3 small punctures in the peritoneum are made through which the instruments are inserted.
As a result, the operation itself is less painful and takes less time. Healing occurs much faster, there is no rough scar on the skin. Traces of punctures are hardly noticeable.
If after the usual dissection of the muscles and their displacement a postoperative hernia may occur, then after the operation through punctures such a danger is absent. During laparoscopy, there is a minimal effect on neighboring organs, therefore there are no complications in the form of a violation of the bowel.
Preparation for surgery
Before laparoscopy, a woman should be examined to detect inflammatory and infectious diseases of the genital organs, determine the composition, coagulation and blood group, as well as detect abnormalities in general health.
The survey includes:
- general urine and blood tests
- biochemical blood test for sugar, protein, bilirubin, urea,
- blood test for syphilis, HIV, hepatitis B and C,
- blood coagulation test (coagulogram), group and Rh factor,
- analysis of a vaginal smear to detect harmful microflora and determine the content of leukocytes,
- Ultrasound of the pelvic organs,
- electrocardiography, ECG,
- x-ray or x-ray examination of the lungs.
For a week, a woman needs to switch to a diet (exclude cabbage, legumes, and other foods that increase gas formation in the intestines from the diet). When performing laparoscopy of ovarian cysts, the patient should have an absolutely empty stomach. 10 hours before the operation, the ingestion of food and fluid intake is stopped.
Cleansing the stomach and intestines is achieved with the help of laxatives and enemas. Such measures facilitate manipulation, improve access to the ovaries, reduce the risk of accidental damage to organs. 2 days before the operation, the blood thinning medication is stopped.
During the operation, the patient should wear compression stockings to prevent the formation of microthrombi in the veins of the legs, which can get into the vessels of the heart and lungs. They are recommended to be worn for the next 7-10 days after surgery.
Performing an operation
Laparoscopy is performed under general anesthesia. Pre-anesthesiologist finds out that a woman is allergic to any drugs in order to choose a method of pain relief. Before it is administered, the patient is given an intravenous injection of a sedative drug with a slight hypnotic effect. The catheter remains in the vein in case of the need for additional administration of drugs during surgery.
The table on which the patient lies is tilted at an angle of 30 ° so that the head is lower than the legs. At the same time, the intestine shifts to the diaphragm, which makes the ovary more accessible.
Through a puncture in the navel, carbon dioxide is injected into the peritoneal cavity, which allows the organs to be divided among themselves and to increase the working space. A tool is introduced into the same hole with which the cavity is illuminated, the image is transmitted to the screen by a video camera located in it. This device is called a laparoscope.
2 additional openings are made in the groin area, controlling the process with a laparoscope. There are introduced manipulators with tools for the removal of cysts. After examining the abdominal cavity and ovary, the doctor decides on the nature of the surgical intervention, the possibility of preserving the ovary, makes conclusions about the risk of complications.
At the site of cyst removal, the tissues of the ovary are sutured. If there is no bleeding, the instruments are removed, the gas is released, and the holes are sewn up.
The whole procedure takes 20-40 minutes, if there are no complications.
Within 5-6 days after laparoscopy of an ovarian cyst was performed, the woman remains in the hospital to monitor her well-being. To prevent inflammation of the seams, to facilitate and speed up the healing process, antibiotics, painkillers and vitamins are prescribed to her.
The seams are treated with "Betadine" (an antiseptic solution containing iodine), lubricated with ointment "Levomekol." After healing, use of the ointment "Contratubex", which contributes to the resorption of scars.
Slight malaise and mild pain in the ovary can occur for 2-4 days. During the operation, gas irritation of the nerve endings in the area of the diaphragm occurs. Therefore, in the first days after the operation, the woman feels a slight pain in her shoulders, body aches. Abdominal distension and constipation may occur.
To prevent re-formation of a cyst and normalize hormonal background, oral contraceptives, homeopathic and herbal remedies are prescribed. Dose and duration of treatment are determined by the results of blood tests for hormones.
As a rule, the first menstruation occurs at the usual time. It can be plentiful and painful, but by the next month the side effects disappear. If menstruation is delayed, there are unusual discharge, pain, then it is necessary to consult a doctor.
The speed of postoperative recovery depends on the complexity of the operation, the age of the woman, the presence of other diseases in her.
Possible complications after surgery
The occurrence of complications is possible both during laparoscopy and in the following days. Possible complications include:
- bleeding due to accidental damage to adjacent organs or vessels at the puncture sites,
- damage to the shell of the cyst and the spread of its contents in the pelvic cavity,
- inflammation of the seams (external and internal),
- the occurrence of inflammatory processes in the internal genital organs as a result of their infection during surgery.
In case of occurrence of a dangerous complication during the operation, laparoscopy is stopped and laparotomy is performed (an incision is made under the navel for urgent elimination of bleeding and other consequences).
Doctors emphasize that after the operation, the woman is recommended to refrain from physical exertion and sports for several months. Moderate physical activity, on the contrary, is necessary so that adhesions do not form in the abdominal cavity. It is not recommended to visit the sauna in the postoperative period, take a bath, stay in the sun for a long time.
In most cases, after the operation with the preservation of the ovaries, pregnancy is quite possible, but within 1 month you cannot have sex, and doctors recommend pregnancy planning not earlier than in 3-5 months.
Contraindications for laparoscopy
In some cases, laparoscopy is contraindicated. For example, in severe diseases of the heart, organs of the respiratory system, and in hypertension, life-threatening seizures may occur. Blood disorders cause severe bleeding.
Surgery is contraindicated if adhesions are detected in the abdominal cavity by ultrasound. Laparoscopy is not performed if the patient has a fever, she is sick with the flu or a respiratory viral infection, other colds or infectious diseases. To carry out the operation can only be a month after recovery.
Contraindication is obesity, the presence of a thick fat on the abdomen. They do not have surgery and exhaustion, as a weakened body is susceptible to any infections, unpredictable complications are possible during and after the intervention.
Laparoscopy is not performed if cancer cells are found in a cyst in an emergency situation (if a cyst ruptures, peritonitis occurs, intra-abdominal bleeding, severe pain). To eliminate such consequences it is necessary to conduct an autopsy of the abdominal cavity.
Before the operation is prescribed, treatment is carried out for any inflammatory and infectious diseases of the genital organs.
Definition and general characteristics of the operation
Ovarian laparoscopy - surgical intervention into the abdominal cavity using a laparoscope equipped with a video system. Practically safe surgery - laparoscopy of an ovarian cyst is performed under general anesthesia.
Three or four small incisions are made on the woman's abdomen, through which surgical instruments and a miniature video camera are inserted.
Some women get a positive side effect after the operation - they manage to lose weight after laparoscopy of the ovaries, observing the regimen and diet.
General indications and contraindications
Ovarian laparoscopy, like any other surgical operation, has both indications and contraindications. Indications - removal of cysts, carrying out notches on the ovaries, rupture of a cyst or twisting the legs. Incisions on the ovaries during laparoscopy are carried out with the aim of destroying the follicle membrane, which impedes the release of the egg and the onset of pregnancy.
Laparoscopy should not be performed in such cases:
- in the presence of malignant neoplasms,
- severe pathologies of the cardiovascular, respiratory system,
- hypertension, blood disorders,
- the presence of adhesions in the pelvic cavity,
- obesity or vice versa, exhaustion.
Before preparing for laparoscopy of ovarian cyst, the patient must be cured of infectious or inflammatory diseases.
Kystoma benign neoplasm
Kistoma is a benign tumor that can degenerate into a malignant one. It has a leg with which it joins the ovary. Torsion of the legs leads to impaired blood circulation and rupture of the ovary. The treatment method is laparotomy of the ovarian cyst.
If the cyst is very large, its removal is possible only with the ovary. This surgical intervention is called oophorectomy.
During adhesions, ovarian apoplexy and twist the legs of the cyst, laparoscopy is performed. Apoplexy requires immediate surgical intervention.
Rapid cyst growth may be an oncologic process, so some patients are prescribed additional examinations before surgery, for example, gastro, rheoencephalography, irrigoscopy, duodenoscopy.
On the first day after laparoscopy of the ovarian cyst, the patient is under the constant supervision of the medical staff. This is due to not miss any possible complications and start the necessary treatment in time. For severe pain, analgesics are prescribed.
In the afternoon, the first treatment of postoperative wounds is performed. If necessary, antibiotics are prescribed to prevent inflammation.
After 7-8 hours, you are allowed to carefully get out of bed, drink clean, non-carbonated water, juices or compotes that do not cause bloating of the intestines.
Attention: On the first day sharp, active movements are prohibited. The movements should be slow so that the head does not become dizzy and there is no loss of consciousness.
On the second day after surgery, the patient is recommended to move more. This is necessary in order to prevent stagnation in the pelvic organs, the intestine was working effectively.
Every day, the patient is treated with antiseptic sutures and the dressings are updated. Usually on the seventh day, the stitches are removed and the patient is prepared for discharge.
After discharge from the hospital, the patient for a period of incapacity for work prolongs the sick-list and gives recommendations on what rules to follow after laparoscopy.
But the recovery period of the body after laparoscopy of ovarian cysts and discharge from the hospital does not end there. For three or four weeks, the processes of normalization of the vital activity of the female body continue.
After laparoscopy, a woman needs to abstain from sex for at least two weeks. Also it is necessary to postpone for a while active sports, visiting the pool.
After laparoscopy of the ovary, during the rehabilitation period, it is not recommended to take a hot bath, carry heavy bags, move furniture, lift the stroller, baby. Subject to all recommendations of the doctor, the recovery period after laparoscopy of an ovarian cyst passes quickly.
If the patient had to undergo laparotomy (resection of the abdominal cavity to remove a cyst), the end of the recovery period is lengthened.
What you can eat after laparoscopy of ovarian cysts
Nutrition after laparoscopy of ovarian cyst is aimed at improving the functioning of the intestines, reducing increased gas formation, and preventing constipation.
On the first day after surgery, food is not provided. You can only drink clean, non-carbonated water. On the second day, mashed soups, light broths, rare porridges are allowed. Позже в рацион можно добавить молочнокислые продукты, некислые фрукты, отварные или тушенныеовощи.
For the recovery period, meals with fatty, spicy, fried foods are not allowed. Portions should be small. Food can be taken often, at least 5 or 6 times a day.
How long is the operation?
The duration of the operation depends on the type and complexity, qualifications (experience) of the surgeon. On average, the duration of the operation is 40 minutes - one hour. If we consider the preparatory stage in the operating room, the whole procedure can take from two to three hours of time.
“I recently had surgery for a cyst. The cyst, as my gynecologist said, was functional. But the treatment did not give results, so I decided on an operation. The operation was done in our district hospital. Everything went well. The stitches healed on day 7 completely. My husband and I are planning to conceive a child. But the doctor recommends a couple more months to abstain from pregnancy. "
“In a week I will have laparoscopy of the ovary. I have no cysts, but the doctors said that with the help of this procedure, it is possible to destroy the follicle envelope and I will have the opportunity to become pregnant. I hope that everything will be successful, because my husband and I have been waiting for the baby for 5 years. ”
“I have health problems, the right ovary has been removed. But a month ago, a cyst was removed on the left ovary. The operation was done in our capital, in a private clinic. Although the procedure is not cheap, but I decided to do so in order to preserve the hope of becoming a mother. ”
Cost of surgery
The cost of surgery to remove a cyst depends on many factors. When contacting a public medical institution, having an insurance policy and referral to a hospital, laparoscopy is free.
The cost of surgery in a private gynecological center depends on many factors:
- goals, complexity,
- operating surgeon qualifications,
- technical equipment of medical institutions,
- territorial location, features of the region.
The highest price for laparoscopic services is observed in the capital - about 40-50 thousand rubles. In regional centers, the operation costs between 20-30 thousand. In small cities - from 15 to 20 thousand rubles. In any case, the choice remains for the woman.
What secretions are considered normal
After the operation on the ovary, the woman has a weak spotting. After two or three days they become yellowish, slimy, without an unpleasant odor. Allocations can be long (up to three weeks), but it’s not worthwhile for a woman to worry - this is a natural process.
If the discharge after laparoscopy of the ovary has become green or brown, there is an unpleasant odor, abdominal pain, you should immediately consult a doctor. These symptoms can cause inflammation or infection in the body.
What day are the stitches removed
Seams after laparoscopy of the ovary are removed after 7 or 9 days. In place of the seams remain almost invisible scars. To make punctures heal faster, their treatment with a scar sucking agent, Contractubex, is used.
Attention: Kontraktubeks - gel, on the basis of extracts of onion, heparin and allantoin. Contraindicated in case of hypersensitivity to these components.
When using the drug should avoid exposure to cold, ultraviolet radiation on areas of fresh postoperative scars.
How much to stay in the hospital
Discharge from the hospital, depending on the characteristics of the postoperative period, may occur after the first - seventh day. In case of complications, this period is extended.
Upon admission to the hospital, a temporary disability document is issued to a woman, the duration of which is determined by the attending physician. Roughly, if there were no complications, the sick leave is issued for 7-10 days.
Ovarian adhesions - possible risk of infertility
One of the complications after laparoscopy of ovarian cysts is the formation of adhesions. The cause may be an inflammatory process that began after the operation. Therefore, if a woman has persistent, nagging pains that are not amenable to analgesics, you should immediately consult a doctor.
Early treatment can prevent the development of adhesions and save the opportunity to become pregnant. When polycystic doctors recommend not to postpone the birth of a child for a long time.
When can you plan a pregnancy
There is no need to hurry with pregnancy after laparoscopic removal of a cyst, despite the fact that healthy ovarian tissue is not damaged during surgery. The functions of the glandular part of the ovaries are restored after a month, but to begin planning a pregnancy, preferably not earlier than in 3-6 months.
You need to wait for the full recovery of the body, to undergo the necessary medical examination.
Removal of an endometriotic cyst is usually supplemented with hormone therapy, sometimes long, up to six months. It is clear that planning a pregnancy during this period is also not recommended.
But with polycystic (multiple cysts), the ability to conceive is restored quickly, so a small period of sexual rest is enough, and you can begin to implement your plans.
Laparoscopic removal of an ovarian cyst is a shad operation. Appointed to women in the absence of contraindications and full examination. But if you do not remove the cause of the formation of cysts, they can be formed again. Therefore, preventive gynecological examinations and examinations are a necessary condition for the preservation of women's health.
Types of ovarian cysts
A cyst is a round dense formation in the form of a small bladder on a thin stalk. The composition of the cavity content depends on the structure and origin of the growth.
The gradual accumulation of fluid leads to the growth of cysts. Most of them are benign, but there are dangerous species that are reborn into cancerous tumors and negatively affect reproductive health.
The main reason for the formation of pathological formations is hormonal imbalance. Failures occur at any age and accompany women throughout their lives. Frequent stress, chronic illness, poor diet, contraceptive use, irregular sex life, excessive exercise and many other factors can affect the lack or excess of hormones.
Any imbalance of hormones disrupts all organs and knocks down the menstrual cycle. Regular delays, out-of-regulation discharge, prolonged periods are one of the main causes of the formation of cystic tumors in the ovaries.
Functional (luteal and follicular) formations are the safest cysts. They do not belong to oncogenic and are able to dissolve. If after 2-3 cycles of education do not disappear, they bring discomfort and grow, they are removed.
Follicular cyst develops during ovulation. The dominant follicle does not rupture, as a result of which a small cavity is formed, in which fluid accumulates with streaks of blood.
Progressive formations, whose growth does not stop, are treated conservatively. If this does not help, laparoscopy is prescribed.
Luteal cystic abnormalities occur in the corpus luteum. The female egg leaves the follicle, the hole closes. If this occurs prematurely, a liquid with blood impurities accumulates in the gland. It grows and may increase to 5 cm.
The presence of neoplasms does not cause any discomfort, but serious complications can occur (hemorrhage, torsion of the legs and rupture). To avoid the effects of an ovarian cyst is removed.
Endometrial formations are formed during cell multiplication of the uterine lining outside the endometrial layer. This pathology belongs to one of the manifestations of endometriosis. Inside the cavity a dark secret of thick consistency is formed. Such a cyst grows slowly and painfully. Depending on the period of the menstrual cycle, it can be modified. The longer the formation is not treated, the faster it grows in size. There is a danger of adhesions, rupture of the tumor, the development of infertility.
Indications for surgery
Surgery to remove an ovarian cyst is prescribed in the following cases:
- Progressive follicular, luteal cysts.
- Large cystic endometrial cavities.
- The growth of pathological formations.
- Risk of malignancy (degeneration of a benign tumor into a malignant).
- The threat of complications (cavity rupture, bleeding, torsion of the legs).
- Deformity and purulent-inflammatory process in the ovaries.
The success of the procedure depends largely on the state of health of the woman. She should prepare for laparoscopy and undergo a thorough outpatient examination.
After examining the clinical picture, the doctor determines the number and volume of preoperative studies. Sometimes at the preparation stage, infectious and inflammatory diseases, disorders in the respiratory and cardiovascular systems, problems with blood clotting and other abnormalities are detected. In such cases, the specialist may postpone the procedure or prescribe another treatment.
How is the operation?
A few days before the operation, the woman is given recommendations for the correction of nutrition.
Diet before laparoscopy is based on the use of light, low-calorie foods. It is forbidden to take spicy and fatty foods that can cause liver failure and indigestion.
Laparoscopic removal of an ovarian cyst is performed under general anesthesia. Anesthetic tranquilizers are administered intravenously or masked anesthesia. To provide a review, the peritoneal cavity is filled with carbon dioxide.
With the help of manipulators, the surgeon makes 3 necessary punctures. One camera is installed, the other two are needed to control the instruments and remove pathological tissues from the abdominal cavity. Focusing on the video image, a specialist examines the state of the ovary, cysts, adjacent tissues and decides on the type of operation. It may be:
- wedge resection (partial removal of the ovary),
- adnexectomy (removal of cysts and ovaries),
- cystectomy (body exfoliation of a cystic tumor with preservation of the ovary).
In the absence of bleeding, the doctor removes the tools and pumps out carbon dioxide. Cuts during laparoscopy do not. On the places damaged by punctures, put seams.
Pregnancy after laparoscopy
After laparoscopy to remove a functional cyst, conception may occur in the next menstrual cycle. It takes 2-3 months to fully restore the ovary. During this period, doctors advise not to plan a pregnancy and abstain from sex for 3-4 weeks. This is especially the case when the endometrioid formation was removed, which requires postoperative drug therapy.
Even if one of the ovaries is removed, pregnancy is possible in 85 cases out of 100. Dishormonal failures are compensated, but the probability and timing of conception are individual and depend on the diagnosis.
The operation may be contraindicated even with a threat to the life and health of the patient. Laparoscopy of the ovaries is prohibited in the following cases:
- severe course of infectious and viral diseases,
- the last stages of cancer
- reduced blood clotting,
- high degree obesity
- adhesions in the peritoneum,
- skin dermatitis, ulcers and other lesions,
- intolerance to anesthetics,
- diseases of the heart and blood vessels
- shock condition.
For the purpose of this operation, the size of ovarian cysts should not exceed 14 cm.
Some contraindications do not exclude the possibility of other types of surgery.
It is a mandatory component of the preparatory process. During the examination a method of treating a pathology is chosen, the risks of its implementation are determined.
The list of tests before laparoscopic surgery to remove an ovarian cyst:
- Ultrasound - determining the size of education, the degree of damage to the genital organs,
- general and biochemical blood tests - a general picture of the state of the body,
- general analysis of urine and bakposev - assessment of the work of the kidneys, detection of infections,
- screening for the elimination of the course of hepatitis, syphilis, HIV,
- biopsy of the ovaries and their formations
- gynecological smear - determination of the state of microflora,
- colonoscopy - intestinal examination, mandatory before laparoscopy of ovarian cysts,
- determination of the Rh factor and blood group,
- assessment of blood coagulation,
- fluorography - the exception of tuberculosis,
- determination of hormonal levels,
- Tolerance testing of anesthetics.
Laparoscopy can be prescribed for biopsy - according to the testimony of the doctor, it is possible to continue the operation to completely eliminate the pathology.
3-4 days before the intervention, it is necessary to adjust the diet. Diet before laparoscopy of ovarian cyst excludes food that promotes bloating.
To do this, abandon soda, bread, beans, peas, cabbage. In the presence of bowel abnormalities, the physician should be notified in order to prescribe the appropriate drugs. For constipation the day before treatment, it is advisable to take an enema or take a laxative.
Dinner should be no earlier than 12 hours before intervention. Clean water should stop drinking for 8 hours. During thirst it is permitted to moisten lips and rinse out mouth. These rules for preparing for surgery to remove an ovarian cyst will prevent nausea, vomiting, diarrhea, and constipation, often occurring during discharge from anesthesia.
To fully prepare for a planned operation to remove an ovarian cyst, you must adhere to several additional rules. Most often, the attending physician notifies them of their need:
- shaving the perineum and pubis immediately before the intervention,
- rejection of sex life in 2-3 days,
- a ban on the use of any cosmetics on the day before surgery, applied to the stomach,
- taking a shower a few hours before the surgical removal of an ovarian cyst.
When taking any medication, including oral contraceptives, you should notify the doctor. Before the intervention they must be canceled. Additionally, you should check with a specialist that you need to take to the hospital for laparoscopy of the ovaries - many institutions require disposable underwear, their own set of clothing and bedding.
Types of laparoscopy
There are several pathology removal techniques. They are determined by the type of education, the presence of a malignant process and damage to neighboring organs.
Surgical techniques of laparoscopy:
- Ovarian cystectomy. Enucleation, i.e. exfoliation of ovarian cyst while preserving the integrity of the latter. It is prescribed for small formations that do not damage the appendage capsule.
- Laparoscopic resection of ovarian cysts. It is necessary for the growth of an organ into the cavity of an organ, characterized by partial removal of the appendage.
- Ovariectomy. Complete removal of the pathology and the affected organ. It is used for suppurations, breaks, malignant processes.
In all these cases, the reproductive capacity of the woman is preserved, since conception is possible even with only one appendage.
With a full-fledged abdominal surgery of another type, it is possible to conduct a hysterectomy - complete removal of the female genitals. This is required if there is a cancer process or at high risk of its occurrence.
How to perform an operation to remove the formed ovarian cyst
Treatment is given on a specific day, before which the patient must go through all the stages of preparation. During laparoscopy, ovarian cysts require general anesthesia. Order of conduct:
- Introduction of sedatives and hypnotics, then - anesthesia.
- Installation of the operating table in a convenient position for the implementation of all manipulations.
- Puncture of the navel for filling the peritoneum with gas is necessary to create a space that facilitates the implementation of the intervention.
- Introducing a laparoscope into the opening is a special device with a camera and a light source.
- Two punctures for the introduction of medical instruments.
- A thorough examination of the genitals.
- Removal of the pathology and / or part of the appendage and / or the entire organ.
- Check for no bleeding.
- Suction gas.
- Extraction tools.
- Suture and sterile dressings.
- Check the patient's condition - breathing, heart rate, blood pressure.
- Transfer of the woman to the ward.
After inspecting with a laparoscope, it is possible to change the course of the operation — all instruments are removed and the peritoneum is cut.
On average, removal of an ovarian cyst by laparoscopy lasts from 20 minutes to one and a half hours, at the discretion of the doctor during the intervention, the time can be extended. The duration of the operation is determined by its complexity, the size of the formations and their number. The amount of anesthesia is determined depending on how long the laparoscopy of the ovarian cyst lasts. The required volume of the latter is also significantly influenced by the weight of the patient and her age.
The essence and advantages of laparoscopy in the treatment of ovarian cysts
Laparoscopy is a surgical procedure in which the manipulations on the internal organs are carried out through small incisions in the anterior abdominal wall. В них вводят медицинские инструменты и лапароскоп – тонкую трубку с системой линз, источником света и цифровыми матрицами, посредством которых изображение передается на экран.Thanks to this, the surgeon is able to visualize the state of the internal organs and clearly control all his actions: innovative equipment allows you to magnify the image 40 times and view it from different angles.
Laparoscopy is widely used in the treatment of gynecological diseases, including using it to diagnose and remove ovarian cysts. The main advantages of this method:
- low invasiveness
- short rehabilitation period,
- minimizing the likelihood of complications and pain after surgery,
- no scarring after the intervention.
Indications and Contraindications
The purpose of laparoscopy of the ovary can be both the specification of the diagnosis (determination of the type of neoplasm) and the direct removal of a cyst. The main indications for cystic cavity surgery:
- dermoid and endometrioid cysts of large sizes
- tendency to rapid growth of neoplasms
- the risk of rupture of the capsule or ovarian deformity,
- the presence of cyst legs (may cause its twisting),
- the risk of transformation into a malignant neoplasm.
Laparoscopic surgery to remove an ovarian cyst is estimated by specialists as relatively safe and gentle, but there are certain contraindications to it. The main ones are:
- viral or bacterial diseases (surgery is possible 30 days after recovery),
- exacerbation of chronic pathologies - asthma, cardiovascular diseases, arterial hypertension,
- bleeding disorder,
- depletion of the body
- the presence of abdominal hernia,
- severe obesity
- the malignant nature of tumors in the ovaries or other organs,
- adhesions in the abdominal cavity,
- purulent peritonitis,
- violation of cerebral circulation,
- hemorrhagic shock.
Pregnancy is not a contraindication to laparoscopy.
Laparoscopy for cystic tumors is carried out exclusively under sterile conditions in the operating room. The main stages of surgical intervention:
- A woman is placed on the operating table. She is given an intravenous catheter to deliver a solution for anesthesia and other medications, as well as a urinary catheter.
- The anterior abdominal wall is treated with a disinfectant solution.
- The surgeon makes three incisions 0.5-1.5 cm in size - one near the navel for the laparoscope, two below the abdomen for the instruments. All devices are introduced into the abdominal cavity through trocars - special conductors that protect the skin from injury and make it easy to change instruments.
- The abdominal cavity is filled with carbon dioxide. This is necessary to create operational space. The abdominal wall rises like a dome, and the intestines move. This makes access to the ovaries easier.
- Focusing on the image on the screen, the doctor conducts the removal of a cyst.
- Carbon dioxide from the abdominal cavity is removed. On notched fabrics stitches and sterile dressings. In some cases, install drainage.
The operation without the preparatory phase lasts 15-60 minutes.
Types of operations
Removal of an ovarian cyst during laparoscopy can be performed by cystectomy, oophorectomy or adnexectomy.
Cystectomy - "husking" ovarian cysts. This method involves dissecting the bark of the ovary, removing the tumor without damaging the capsule, placing it in a sealed container and removing it from the abdomen. At the moment of passage through the abdominal wall, the capsule is opened and emptied, due to which it freely leaves through a small opening. Small vessels in the damaged tissues of the ovary coagulate. Thanks to this technique, ovarian functions are fully preserved.
Ovariectomy - complete removal of the ovary with a cyst. If this involves resection of the corresponding fallopian tube, the operation is called adnexectomy. Such interventions are carried out only in case of a high risk of oncological degeneration of tumors, significant damage to the tissues of the ovary, as well as during menopause.
Condition after surgery
3-4 hours after ovarian laparoscopy, a woman is allowed to stand up, but she cannot move and eat much. The next day, it is recommended to gradually increase physical activity. It is necessary for the normalization of intestinal peristalsis. In addition, you should establish fractional meals in small portions. Basic dietary recommendations:
- restriction of fatty, spicy, indigestible food for 1 month,
- rejection of alcohol for 1.5 months,
- the prevalence in the diet of vegetables, fruits, cereals, dairy products, that is, light meals with a high content of fiber and vitamins,
- drinking enough liquid.
In the first days after surgery, the following unpleasant symptoms may occur:
- Pain in the area of incisions, the intensity of which may vary. Analgesics are prescribed for their relief. As a rule, they disappear within 3-5 days as the incisions heal.
- Discomfort in all muscles and pain in the shoulder. They are associated with the introduction of carbon dioxide into the abdominal cavity, the remnants of which are slowly absorbed into the blood, and also irritate the phrenic nerve. Normally, discomfort disappears in 2-3 days.
- Temperature increase up to 37 ºС. Minor hyperthermia indicates activation of the immune system. It can last 2-4 days.
- Vaginal discharge mucous character for several weeks. They occur due to hormonal changes.
Indicate the development of an infectious process after surgery:
- very severe pain for more than 3-5 days,
- suppuration in the area of cuts,
- yellowish-green or bloody vaginal discharge,
- significant temperature increase.
Discharge from the hospital after laparoscopy to remove an ovarian cyst takes 5-6 days. In the case of a simple operation, a woman can recover home for 2 days already. Return to work will turn out in 7-14 days.
The whole process of rehabilitation takes about a month. During this period it is recommended:
- process the seams with antiseptics prescribed by the doctor, dressing (7 days),
- do not take a bath, do not visit the bath, beach, solarium (1 month),
- observe sexual peace (1 month),
- refuse to do sports (1 month)
- Do not lift more than 3 kg (3 months).
If external sutures were applied using non-self-absorbable material, they are removed 7 days after surgery. After a few months, inconspicuous scars remain at the site of the cuts, which can be removed by laser-polishing the skin.
After surgery, a woman is usually given hormone therapy to normalize the background and prevent the recurrence of cyst formation. If cystectomy of the cyst was performed, the menstrual function is not impaired, but a minor failure in the cycle may occur. Pregnancy is recommended to plan in 3-6 months after the intervention. A follow-up visit to a doctor should be made a month after laparoscopy.
By itself, the cyst is a growth on a particular human organ. The content of such a bag is very diverse and is completely due to the appearance of the tumor. Also, the tactics of the chosen correction depend on the type of growth.
In this case, we will focus on ovarian cysts. They come in several forms.
This type of tumor occurs when a woman does not ovulate. There may be many different reasons for this. The follicle with an egg cell being prepared for release grows and increases in size, but does not burst and does not ovulate. Too large an enlarged ovary can be called a follicular cyst. Such cysts do not pose any threat to the life and health of the patient, of course, if this phenomenon does not recur regularly.
This kind of education does not usually require treatment and disappear on its own with the advent of a new cycle of women. In some cases, the doctor sees the need for the appointment of hormonal correction.
Another thing, if follicular cysts appear monthly. And one entity does not have time to completely dissolve, as another one already appears next to it. This phenomenon is called polycystic, it must be treated. Typically, this method is used laparoscopy. The doctor makes notches on the ovaries so that the egg can easily leave his place of residence. The prognosis of this treatment is very favorable. After him, a woman becomes easily pregnant and bears a healthy child.
This type of tumor appears when ovulation did take place, and the egg cell left its place of long stay. After that, in place of the co-follicular follicle, a new body is formed called “yellow”. That it secretes the hormone necessary for the development of pregnancy and its normal progression.
Often the size of such a bag exceeds the norm, especially often this happens during fertilization. Do not worry and panic. At about the third month of pregnancy, the corpus luteum itself shrinks and transfers its most important function to a new organ, the placenta.
The presence of luteal cyst does not necessarily indicate the occurrence of pregnancy. In cycles with failed fertilization, large sacs of the corpus luteum can also grow. They disappear with the onset of the new menstrual cycle and do not require medical intervention. Luteal cysts do not represent any threat to the life and health of the female body. Despite deviations from the norm in size, they can appear almost monthly, under the influence of a large production of progesterone by the female ovaries. There is nothing terrible in this; such a situation does not require any correction. The body itself copes with the appeared large growth and over time gets rid of it.
This type of tumor disease is much less common than functioning growths. It is also called ovarian endometrioma. This tumor occurs when a woman has a hormonal disease such as endometriosis.
The symptoms of this pathology are very blurred. The disease can progress for many years and develop in the body of a woman, but not to let itself be known. As a rule, endometriomas occur already in the later stages of the development of the pathological process. If you have found this cyst - know that it is not the first day that such an insidious disease as endometriosis lives in your body.
This type of tumor definitely requires medical correction. Surgical removal of an endometrioid ovarian cyst is usually necessary. Laparoscopy is appropriate in this case. Under general anesthesia, the doctor creates small incisions in the abdominal cavity and pulls out a pathological formation.
Quite often a controversial question arises: “Ovarian cyst: surgery or laparoscopy?” There is no definite answer to it. It is necessary to consider each situation separately. And then make the right decision.
Laparoscopy of an endometrioid ovarian cyst usually gives quite favorable prognosis. After treatment, a woman can get up in a few hours, and in a week she can return to her usual way of life.
This type of neoplasm is most often found in girls during the transitional age and puberty. This is explained by the fact that such sacs of dermoid cysts originate in the womb, when the little girl is still an embryo. Under the influence of certain factors, there are certain disturbances in the formation of genital organs, and stem cells settle in the ovaries. That is why in this kind of cysts you can find a variety of components. This is usually hair or nails, teeth or bone fragments.
Such a benign tumor until puberty almost does not grow. Whereas, under the action of hormones that have been played out, and in connection with the development of the genitals, it begins to increase. It is then that most dermoid cysts are found.
Such growths necessarily require medical correction. Laparoscopy of a dermoid ovarian cyst is performed under general anesthesia. During the operation, the woman sleeps and feels nothing. The surgeon with the help of special reduced instruments-manipulators removes the pathological formation. After the procedure, called ovarian cyst laparoscopy, the postoperative period is quite fast. A woman after a while can stand up.
By itself, laparoscopy of ovarian cysts has only positive feedback. The procedure for its implementation is quite low-impact and gentle.
This type of neoplasm appears like dermoid types of tumors. Similarly, in the womb, the rudiments of parovarial cysts can already be laid. As in the previous cases, this type of formation requires laparoscopy of an ovarian cyst. Hospital in this case is made in accordance with all the rules described in the Labor Code.
Preference for treatment of parovarial cysts is always given to such a method as laparoscopy of ovarian cysts. After the operation, quite a bit of time is required to restore the body.
Absolutely exactly this type of cyst is the most dangerous. Women are always afraid to hear a similar diagnosis from a doctor. If a similar pathology is found, urgent laparoscopy is necessary - removal of an ovarian cyst. The operation is performed under general anesthesia, so that the patient does not experience the slightest pain. After laparoscopy, ovarian cysts require courses of chemotherapy, as carcinoma is a malignant tumor.
The prognosis of the future state of health in this case completely depends on the stage of the disease development. In this regard, when making such a diagnosis, it is necessary to immediately begin treatment. In this case, there is every chance of a successful outcome of events.
So, what should be the general treatment when making such a diagnosis (ovarian cyst) treatment? Laparoscopy is not always selected. Depending on the type of education, location and size, methods of conservative treatment and the so-called “waiting tactics” can be chosen. With this method, the doctor conducts careful monitoring of the development and growth of the pathological sac. If he does not give his mistress interference to the maintenance of a normal lifestyle, then a decision can be made to cancel the operation.
There is a certain group of women who are most likely waiting for laparoscopy. The removal of an ovarian cyst has led scientists to conclude that certain groups of women are most at risk of developing tumors.
- Constant failures of the menstrual cycle.
- The early onset of sexual activity and the early arrival of the first menstrual periods.
- Various thyroid diseases and metabolic disorders.
- Hormonal diseases and malfunctions of the pituitary gland.
- Frequent abortion and diagnostic curettage of the muscular layer of the uterus.
- The presence of erosions or other diseases of the cervix.
- Infectious and inflammatory diseases of the female urogenital sphere.
- Wrong lifestyle, smoking or use of drugs.
How to determine if a woman has an ovarian cyst? Does she need laparoscopy or is sexual health normal? There are a number of symptoms that should alert any woman.
- In the presence in the female body of a variety of pathological formations can be menstrual disorders, increased menstruation, or, conversely, their long delay.
- Also, with rather large neoplasms, there may be a pulling or tearing pain in the lower abdomen.
- Unpleasant pressure on sexual intercourse.
- The increase in the volume of the abdominal cavity at the location of the cyst.
- Increased temperature in the absence of other signs of colds or infections.
These or other complications can be given by almost any ignored ovarian cyst. Laparoscopy in this case is often the only treatment.
The most frequent of these is torsion of the legs, on which the cyst grows. With this phenomenon, women experience severe paroxysmal pain, lowering blood pressure. Blanching of the skin or even fainting can be observed. Severe vomiting or diarrhea occurs. It is difficult not to attach importance to such a complication. When it occurs, you should immediately consult a doctor and hospitalization. Later laparoscopy is performed - removal of an ovarian cyst.
Another complication that occurs most often is the rupture of the tumor walls with the subsequent discharge of its contents into the abdominal cavity. At the same time, the woman's health deteriorates sharply, pressure drops, weakness and dizziness appear. Such a complication can be fatal if you do not take action in time. With it, an ovarian cyst must be removed. Laparoscopy is not a terrible operation, much worse than the consequences to which a ruptured cyst can lead. True, if it came to peritonitis, then in this case a full-fledged abdominal surgery is required.
Бесспорно, что только врач может назначить правильную терапию и выбрать дальнейшую тактику действий. Depending on the type of education and its size, a certain type of treatment is prescribed.
Functional cysts do not require any treatment, they pass by themselves. But, as well as for others, observation of such tumors is necessary. Usually, the doctor gives the patient about three months for the independent disappearance of the cyst. In some cases, hormonal correction may be prescribed.
Non-functional cysts themselves will never pass, they always require medical intervention. Such formations as carcinoma, dermoid cyst and endometrioma require mandatory surgical intervention, otherwise they can lead to irreparable consequences. After removal of such tumors, the patient is prescribed hormonal and antibacterial therapy, as well as drugs for general recovery of the body.
Benign tumors of the type parovarial cysts usually require observation for several months. And already on the basis of such a survey, a decision is made about the need for an operation.
For the surgical treatment of various types of cysts, two methods are used - laparotomy and laparoscopy. Of course, the abdominal type of surgery is more traumatic for the female body and causes many complications in the future. Laparoscopy of the ovarian cyst is much easier, the feedback on this operation can be found only positive.
During laparoscopy, the surgeon inserts a microscopic video camera into the patient's abdominal cavity. It is with its help that the image is displayed on the big screen, and the doctor sees all the internal organs of the woman. Next, create two cuts of minimum size, and then through them are introduced manipulators - tools for the operation. Thus, the patient does not cause traumatic incisions and does not damage the muscles of the abdominal cavity.
It should be said that for any complaints and suspicions about the presence of a particular type of cyst, it is necessary to consult a doctor for diagnosis and choice of treatment. You should not run such a state and bring it to complications, because its consequences can be completely unpredictable. Watch your health!
Ovarian laparoscopy preparation
In 2-3 days, the patient performs a number of preparatory procedures. It is necessary to follow a diet before performing laparoscopy of an ovarian cyst, it includes the rejection of products that increase gas formation in the intestine:
- sparkling water,
- legumes: peas, beans, chickpeas,
- rich products
- asparagus, cabbage, corn,
- grapes, apples, pears, figs,
- dried fruits: prunes, dried apricots.
Meals should include steamed food: cereals, potatoes, lean meats, as well as dairy products, lightly dried bread, and vegetables. The last use of food on the eve before 18: 00–19: 00. Allowed to receive mineral water without gas. To eliminate fecal masses from the intestine, a cleansing enema is performed.
List of laparoscopy tests
A prerequisite before any operation is testing and instrumental diagnostics. This is necessary to assess the patient's condition, calculate the likely complications in the postoperative period, select the date, taking into account the menstrual cycle.
- clinical blood test, biochemical, for sugar, for RW,
- installation of blood group and rhesus,
- general urine analysis,
- analysis of vaginal smear on the degree of purity.
After performing laboratory diagnostics and examination by an anesthesiologist, routine laparoscopy is prescribed, which is done in the first phase of the menstrual cycle at 6–7 days after menstruation.
Removal of the ovary during laparoscopy
Sometimes the exfoliation of a cyst is impossible due to the complete damage of the ovarian tissue, multiple cysts, and appendage dysfunction. Gynecologists make a choice in favor of oophorectomy.
Surgery may be partial or complete.
Organ-preserving (partial) is indicated for functional cysts in women of reproductive age. Total (complete) in cysts, especially if there is a risk of malignancy process. During the operation, the surgical instrumentation seizes the ovary, cut off its retention ligament, blood vessels and nerves. In the process of excision coagulate bleeding vessels.
With the involvement of the fallopian tubes in the inflammatory process, the presence of adhesions with the ovary, and difficult to control endometriosis, an operation to remove the appendage with the fallopian tube (adnexectomy) is shown.
Rehabilitation after laparoscopy of ovarian cysts
Recovery after laparoscopic intervention is much faster than after laparotomic surgery, therefore adherence to the inpatient treatment and the implementation of recommendations will help speed up the healing process.
After 6–8 hours, liquid warm food is allowed in small portions. Recommended sparing diet, including easily digestible foods:
- stewed vegetables are high in fiber, with the exception of legumes,
- Steamed porridges: buckwheat, oatmeal, millet, wheat,
- non-carbonated drinks: juice, fruit compote,
- vegetable soups,
- low-fat varieties of fish and meat: pelengas, lemonema, beef, turkey,
- fermented milk products: kefir, ryazhenka, cottage cheese.
Obligatory condition - compliance with the drinking regime, the amount of fluid consumed at the rate of 30 ml per kilogram of weight. Water contributes to the formation of fecal masses soft consistency.
With a positive dynamic, discharge from the hospital is provided for the 3-5th day. The sick-list after laparoscopy averages from 10 to 14 days.
Restoration of the house: After treating an ovarian cyst, a woman regularly undergoes examinations, when pain is found in the suprapubic area, hyperthermia, malaise, and abundant white discharge, it is necessary to go to the clinic.
End of the recovery period
The final recovery of the body after 2-6 weeks after surgery: the patient feels satisfactory, there is no complaint, according to the results of the ultrasound diagnosis there are no deviations.
After laparoscopy with exfoliating cysts, menstruation is usually not delayed, a slight delay is allowed, followed by scanty bleeding. The next 2-3 months, the cycle is restored.
Pregnancy after removal
The time interval after which you can get pregnant depends on the underlying disease, on the basis of which the operation was performed. If a woman has undergone enucleation, elimination of adhesions, then pregnancy is allowed after the removal of an ovarian cyst within 1–6 months.
If there has been an operation for a complicated cystoma, endometriosis, an extensive adhesions process, it is advisable for the couple to abstain from conception for 5-6 months. The female body needs to fully recover with the help of hormonal medicines.
Husking of an ovarian cyst is well tolerated by patients, has a number of features and benefits. After minimally invasive intervention, women of childbearing age get a chance to get pregnant and carry a healthy baby.
Important recommendations of experts
The patient must follow the recommendations of the gynecologist:
- sex after laparoscopy no earlier than 28–30 days, oral coitus options are allowed,
- You can play sports after an accident for 4–5 weeks, starting with light physical exertion,
- alcohol after laparoscopy is prohibited for 21-30 days,
- weight lifting (over 4 kg) is prohibited, namely by sudden movements and jerks,
- it is advisable to postpone trips over long distances
- visiting of public places is excluded: beach, pool, sauna, bath,
- the first 2 weeks bathing in the shower,
- patients prone to thrombosis wear special elastic underwear.
Laparoscopy is a progressive method of removing unwanted formations of the female internal genital organs. Gentle access leaves barely visible skin scars, and accurate work with surgical instruments does not lead to adhesions. Laparoscopic surgery can be performed on patients of any age.
Indications for minimally invasive surgery
The removal of an ovarian cyst by laparoscopic approach is performed in such situations:
- The lack of effect of the treatment of retention ovarian cysts (follicular or luteal). In 80% of cases, these formations spontaneously regress within 3 months. If the disease progresses, and for the specified period, the cyst has diminished less than twice, or has not been treated at all, its removal is indicated,
- Detection of a growing paraovarial or other ovarian cyst. These formations are not treated conservatively and do not disappear spontaneously. You can get rid of the disease only through surgery,
Paraovarian cyst of the ovary is not treated with drugs, to remove such a formation can be laparoscopic access.
- Detection of progressive dermoid ovarian cyst sizes from 3 cm. Such a formation can grow almost infinitely. Conservative treatment is not amenable, shows the mandatory removal,
- The lack of effect from the treatment of endometrioid cysts or the rapid growth of education,
- Infertility against the background of ovarian pathology,
- Suspicion of a malignant tumor
- The development of complications: torsion cyst legs, capsule rupture, infection,
- Primary detection of any ovarian formation in menopause.
Laparoscopic surgery is possible with an education size of up to 10-12 cm (in the presence of modern equipment - up to 15-17 cm). When a giant cyst is detected, the question of a laparotomy is raised.
If a woman has a large cyst, then laparoscopy in this situation is impossible, its removal is performed laparotomically.
Contraindications for laparoscopic intervention
A minimally invasive procedure is not carried out in such circumstances:
- Obesity III-IV degree. A large layer of subcutaneous fat does not allow to enter the instrument and perform the necessary manipulations,
- Pronounced adhesions after previous operations on the pelvic organs,
- Diffuse peritonitis (inflammation of the peritoneum) - a consequence of a rupture of a cyst or its suppuration,
- Pregnancy late terms.
In these situations, abdominal surgery with the opening of the abdominal cavity is shown.
There are relative contraindications to laparoscopy:
- Pathology of the heart and blood vessels in the stage of decompensation,
- Kidney and liver failure
- Disorders of blood clotting, not amenable to correction,
- State of shock
- Severe exhaustion (cachexia)
- Acute infectious diseases.
If such states are revealed, their correction is shown. The operation is delayed until the restoration of body functions.
One of the contraindications to laparoscopy surgery is a strong depletion of the body (cachexia).
Technique of laparoscopic removal of ovarian cysts
- Transfer of the patient to the Trendelenburg position. The head end of the table leans down. The intestine shifts to the diaphragm and gives access to the pelvic organs,
- Treatment of the surgical field with antiseptic solutions,
- Puncture the abdominal cavity and filling it with carbon dioxide. This tactic helps to increase the distance between the internal organs and make room for manipulations.
- Introduction to the puncture of a laparoscope - a tool with a camera and a light source. The laparoscope progresses to the ovaries,
- Creating punctures in the side of the abdomen and the introduction of manipulators. Performed under video control,
- In diagnostic laparoscopy, the doctor examines the organ and gives its conclusion. If an ovarian cyst is detected, the operation can be transferred to treatment, and the formation will be immediately removed. In the presence of adhesions, laparoscopic equipment is folded, and an abdominal opening is performed (laparotomy),
- Removal of a cyst or ovary
- Stopping bleeding,
- Removing tools and removing carbon dioxide
- Suturing and puncture dressing.
Thanks to the laparoscope, during surgery, damage to the abdominal organs is minimized, as the doctor sees everything on the screen.
You can see in detail how laparoscopic surgery is performed with an ovarian cyst, can be on the video. Removal of a ruptured follicular cyst (left) and dermoid (right) is shown:
The volume of surgical intervention is determined during the operation:
- Cystectomy - treating cysts. Conducted with intact ovarian tissue and no signs of malignancy. Recommended for women of reproductive age and adolescents. Average cost - 25 thousand rubles,
- Ovarian resection - removal of a small part of the organ along with a cyst. It is performed if a part of the ovary is functional and not affected by the pathological process. The price in the clinics of Moscow - 18-22 thousand rubles,
- Ovariectomy - removal of the ovary with a cyst. It is indicated for marked changes in the tissues of the organ (necrosis, replacement by connective tissue). Often held in menopause. Cost - from 20 thousand rubles,
- Adnexectomy - removal of a cyst, ovary and fallopian tube. It is performed in case of severe disease, the process is spread to neighboring organs, and cancer is detected. Price - from 18 thousand rubles.
Laparoscopy of the cyst of the right and left ovary is the same. There are no differences in the technique of execution, duration and volume of manipulations.
The photo below shows one of the stages of laparoscopy with an endometrioid ovarian cyst:
The following photo schematically shows the course of laparoscopic removal of an ovarian cyst:
Removal of one ovary does not affect the reproductive health of women. The second ovary completely copes with its task and can fully function until the onset of natural menopause. After ovariectomy, with preserved appendages on the opposite side, a woman can conceive, bear and give birth to a child.
Observation in the postoperative period
After completing laparoscopy, the woman comes out of the anesthesia and is transferred to the ward. In serious condition, the patient is transferred to the intensive care unit, but after minimally invasive intervention, the need for such an measure rarely arises.
In the first hours after the operation, the woman lies in the ward, after which she begins to sit down, get up and walk. The patient quickly begins to move, because there are no large cuts and pain. By the end of the first day it is allowed to take liquid food. When restoring the intestinal work, the woman is transferred to a sparing diet.
Principles of nutrition after laparoscopic surgery:
- It is recommended to refrain from foods that cause gas formation in the intestines. Some vegetables (cabbage) and fruits (grapes), legumes, fresh pastries, black bread,
After surgery, you can not eat foods that cause bloating.
- Food is steamed, in an oven or boiled. Should not eat fried foods,
- Practicing frequent split meals - 5-6 times a day,
- It is recommended to drink up to 1.5-2 liters of fluid per day. Berry fruit drinks, fruit compotes, herbal tea are allowed. Prohibited carbonated drinks, coffee, black tea.
Recovery after laparoscopic removal of an ovarian cyst takes about 5-7 days. On the 3-6th day the patient is discharged home. The length of stay in the hospital depends on the state of the woman and the course of the postoperative period.
A sick-list after laparoscopy is issued for 7-14 days. At the end of this period, a woman can return to the usual life with some restrictions.
In the first 2-4 weeks after surgery is prohibited:
- Lead a sex life
- Lift heavy objects (over 3 kg),
- Do sport,
- To visit the sauna and solarium,
- Practice any heat treatments
- Take a bath (you can use the shower),
- Visit the pool and the beach.
Within a month after surgery, a woman needs to abandon a different type of thermal procedures, sports and heavy physical exertion.
Care for postoperative sutures starts on the first day after surgery. Puncture sites are treated with antiseptics. A sterile gauze bandage is applied over the top. Stitches and dressings are changed daily. During the manipulation, the doctor carefully examines the wound. Normally, healing should take place without marked edema and signs of inflammation (appearance of pus, seam divergence).
The stitches are removed on the 5-7th day. If a non-removable suture material was used during the operation, the threads will dissolve on their own within a week. Stitches are removed in the antenatal clinic or in the gynecological hospital.
Postoperative monitoring also includes:
- Daily monitoring of body temperature. A slight increase in temperature to 37.5 degrees in the first three days after surgery is allowed,
- Blood pressure measurement
- Assessment of pulse and respiratory rate,
- Urination control. If the patient cannot empty the bladder by himself, his catheterization is performed,
- Control of the bowel. When constipation shows cleansing enema.
After discharge from the hospital, the patient falls under the supervision of the doctor's antenatal clinic. A follow-up ultrasound scan is performed after 1, 3 and 6 months, then every six months.
After discharge from the hospital, the woman should be monitored by her gynecologist, where she will undergo an ultrasound test.
- Физиолечение для стимуляции кровотока в органах таза,
- Прием рассасывающих препаратов для профилактики образования спаек,
- Защита от нежелательной беременности комбинированными оральными контрацептивами.
The menstrual cycle is restored a month after surgery. Possible delay of up to 1-2 weeks. You can plan a pregnancy 3-6 months after the removal of a cyst. Before conceiving a child, it is necessary to undergo a check-up at a gynecologist and make an ultrasound. With a successful postoperative period, women usually do not have problems with the onset of pregnancy.
Reviews of women on laparoscopic ovaries
Comments of women undergoing surgery, mostly positive. Most noted a quick recovery after the procedure and the opportunity to return to normal life after 2-3 weeks. Women who have undergone abdominal surgery in the past and have the opportunity to compare speak particularly well of laparoscopy. In contrast, all the advantages of minimally invasive intervention become apparent.
From the practice of a gynecologist
A 22-year-old woman was operated on for an endometrioid cyst of the left ovary. Pathology was found six months ago. Conservative therapy had no effect. A laparoscopic surgery was planned - cystectomy (excision of the cyst). The whole manipulation lasted 39 minutes. The patient says that she felt nothing during operations — it seemed to her that no more than a minute had passed. After laparoscopy, the woman was in an intensive care unit for some time, but on the same day she was transferred to the general ward. Discharged on the 7th day. The stitches were resolved and on the 10th day were almost imperceptible.
Anna, 28 years old. She underwent two laparoscopic operations for dermoid cyst on both ovaries. The operation itself does not remember, said that everything went smoothly. Discharged on the 6th day after surgery. Notes that everything went well, and only in place of a puncture there was a rough scar. Gynecologists comment that after laparoscopy such a phenomenon is rare, and more often the punctures heal practically without a trace.
Severe scar after laparoscopy is a rarity.
Frequently asked Questions
What worries women who decide on laparoscopic removal of an ovarian cyst.
On which day of the cycle is laparoscopy done?
The operation is planned on the 5-7th day of the cycle - after the completion of menstruation. Emergency laparoscopy is performed at any time.
Can I do laparoscopy during menstruation?
Not recommended. If the time of a planned operation coincides with menstruation, the doctor may prescribe drugs that delay the onset of bleeding. Monthly come after laparoscopy.
How long does the surgery take?
On average, laparoscopy lasts from 30 minutes to an hour. No surgeon will tell the exact time - it all depends on the extent of the intervention, the state of the internal organs, the presence of adhesions.
Where is it better to do laparoscopic surgery - in a public hospital or in a private center?
It all depends on the qualifications of the doctor and the equipment available, and not on the status of the clinic. A woman has the right to choose the place of operation independently
Is it possible to understand before a surgery whether it is a cyst or a cancer?
No, it will not work. An accurate diagnosis can be made only after a histological examination of a removed tumor.