Laparoscopic Ovarian Surgery

RANZCOG Laparoscopy Patient Information - RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists) is the college responsible for training and accreditation of gynaecologists in Aotearoa; they have released this information pack about laparoscopy, which includes an outline of what the keyhole surgery involves, the risks and information about recovery.

Ovarian Cysts

When planning what to do with ovarian cysts, we aim to get as much information around the cyst from ultrasound and blood tests (tumour markers) before planning surgery. Ovarian cysts are very common and are benign (not cancer) most of the time. The life time risk of ovarian cancer is around 1/70. Unlike tumours in other parts of the body, taking a biopsy from ovarian cysts is not recommended in most situations, as this can spread cancer.

There are different ways to work out the chance of an ovarian cyst being malignant (cancer). Some scoring systems look at blood tests, ultrasound findings and other factors (e.g. menopause), other scoring systems just use the ultrasound findings. If there is a high risk of cancer a CT scan may be required to look for any signs of spread, and the case may need to be discussed at a regional gynaecology oncology meeting. 

Remove the Cyst or the Ovary?

If there is a high risk that a cyst is malignant (cancer), we generally recommend removing the ovary. This can vary for your specific circumstances (for example if you are planning further children). For cysts in women after menopause, we generally recommend removing the ovary, as this is unlikely to cause any long term problems. For women before menopause, where a cyst is likely benign (not cancer) we usually recommend removing the cyst without removing the ovary. This can be a complex decision, and we encourage you to discuss this and make sure you are comfortable with what is being offered and understand the reasoning behind any recommendations. Removing both ovaries in a woman before menopause will cause a "surgical menopause", and medical hormone therapy may be recommended.

When a cyst is removed without removing the ovary (ovarian cystectomy), this involves making a small incision in the ovary. Cysts generally arise within the ovary, and the entire wall of the cyst should be removed to reduce the risk of the cyst growing back. Sometimes sutures (stitches) are placed in the ovary to close this incision. 

Fallopian Tubes

We always recommend removal of the Fallopian tubes if the ovaries are being removed, in line with international recommendations. This is because most ovarian cancer is thought to arise in the Fallopian tubes, and removing them further reduces your risk of ovarian cancer.

• You will be contacted by the hospital to let you know what time to arrive at the hospital

• You will need to be fasted, so can't have anything to eat for at least 6 hours before the operation; the hospital will give you instructions on what time to stop eating and when to stop drinking water

• You can usually continue any medications as usual, except for blood thinning medications (e.g. warfarin, dabigatran, rivaroxaban, clexane) the team will let you know in advance if any of your medications need to be changed

• Try to optimise your sleep and diet leading into surgery, this can help your recovery