Lap.Ovarian cystectomy
Laparoscopic ovarian cystectomy is a surgery where ovarian cysts are removed using an instrument called the laparoscope. Laparoscopic surgery for ovarian cysts give the following advantages;
1.Faster recovery, after the procedure, as the patient can go home faster.
2.More meticulous surgery, as magnification offered by the laparoscope makes the organs clearer to the surgeon.
3. Very few scars on the abdomen, so the stigma of having undergone surgery is less, specially for unmarried girls.
Indications: 1.Benign ovarian cysts. These are noncancerous tumours of the ovary, which are harmless at present, as diagnosed by ultrasonography and other investigative modalities. Usually, if the cyst diagnosed on ultrasonography does not disappear in 3 months and the size is more than 6cm, a benign ovarian cyst is diagnosed
2.Twisted ovarian cyst. Some cysts are not tumours, but they make the ovary undergo torsion and multiple twists will jeopardise the blood supply of the ovary. This causes severe abdominal pain and sometimes vomiting. This necessitates immediate surgery to untwist the ovarian cyst and do a cystectomy.
3. Definite tumours diagnosed, like endometrioma, dermoid etc.
Ovarian cystectomy under Dr.Shobhana: What can be expected:
Preoperative:
The patient has to undergo many blood tests , X-ray chest,and ECG to make sure she is medically fit.
In case of twisted ovarian cysts, surgery has to be done on an emergency basis. In all other cases, the protocol below will be followed.
If there are any deficiencies, like high blood sugar, high blood pressure, or changes in ECG, then these deficiencies have to be corrected.
On the day prior to surgery, She has to take only oral fluids after 4PM. She will be given 2 litres of a special fluid , which will make her empty her bowel completely. This is to ensure that the bowels do not come too much near the area of surgery near the uterus.
She should not take food or any fluids after 10PM the previous day.
She will be admitted in the morning of surgery and surgery will be done in the afternoon.
She will be given enough fluids intravenously in the morning so that she does not feel hungry or thirsty.
Operative time.
For compartively simple ovarian cysts, operative time can be expected to be half an hour to one hour. But in complicated cases like patients with previous surgery, severe adhesions, or advanced endometriosis,surgery can be prolonged.
Post operative period:
After surgery, the patient will be shown to the relatives and wheeled back to the post operative care room where she will be observed for complications for about 2 hours. After that she will be taken to the room.
Following surgery, women may feel nauseous as a side effect of the general anaesthetic and experience some abdominal pain and discomfort. These are relieved with medications.There may also be some vaginal bleeding which should reduce after a few days. Women are encouraged to get up and walk around on the first day following surgery to avoid constipation and gaseous bloating of abdomen and decrease the risk of blood clots and lung infections
She can start oral sips 6 hours after surgery.She can start food next day morning. Since the patient is well hydrated and enough glucose has gone into her system, she may not feel hungry or thirsty and bystanders should not force her to eat or drink, because they feel scared.
If she is very fit, she can be discharged next day. Usually, patients take 1 or 2 days to recuperate from surgery.
Some patients, requiring difficult surgery , with bowel adhesions, will take longer to recuperate. This is because, the bowel takes longer to get back to normal.
How much rest is need after Cystectomy: She can start small tasks after she is discharged. She can travel by bus, bend, climb stairs, lift objects from the kitchen platform to the cooking gas, and so on. She can start work within a week.
For a video on ovarian cystectomy for endometrioma by Dr.Shobhana Mohandas, click on:
http://keralagynaecology.com/video/endometrioma/
Video on gangrenous ovarian cyst: http://keralagynaecology.com/video/gangrenous-ovarian-cyst/
Ovarian cyst in this patient had undergone gangrene in this patient because of delay in treatment. But fortunately becuase of the minimal amout of ovary that could be left behind in the patient, she could undergo two spontaneous pregnancies a few years after her marriage.