From the Research
Cystectomy, when performed properly, has a minimal impact on ovarian tissue reserve, and ovarian function typically recovers within 6 months after surgery. For women concerned about fertility preservation, laparoscopic cystectomy with careful dissection of the cyst wall from normal ovarian tissue is recommended 1. During this procedure, surgeons should use techniques that minimize trauma to healthy ovarian tissue, such as hydrodissection and precise stripping of the cyst capsule. Bipolar electrocautery should be used sparingly and at low power settings to control bleeding points. The procedure typically takes 60-90 minutes and requires 2-4 weeks of recovery.
Key Considerations
- Antimüllerian hormone (AMH) levels may temporarily decrease following surgery but often recover within 3-6 months 1.
- Factors that influence the impact on ovarian reserve include cyst size (larger cysts >5cm pose greater risk), cyst type (endometriomas carry higher risk than dermoid or simple cysts), surgical technique, and baseline ovarian reserve 2.
- Women with diminished ovarian reserve or advanced reproductive age should be counseled about potential fertility impacts before proceeding with surgery.
- For those with significant fertility concerns, egg or embryo freezing prior to surgery might be considered, especially if bilateral cysts require removal.
Surgical Approach
- Laparoscopic cystectomy is the preferred approach for benign ovarian cysts, as it is associated with better pain control and less recurrence than drainage or cyst ablation procedures 2.
- Single-port laparoscopic (SPL) ovarian cystectomy may be offered as a minimally invasive surgical alternative for patients who want to preserve their fertility, although it may be associated with higher blood loss and longer operative time 3.
- Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is a new approach that provides a less invasive approach for performing an ovarian cystectomy, with improved patient comfort and better cosmetic results 4.