Laparoscopic Surgery for Chocolate Cyst Ovary (Ovarian Endometriomas)
Yes, laparoscopic (keyhole) surgery is available and is the preferred surgical approach for treating ovarian endometriomas (chocolate cysts). Laparoscopic surgery offers significant advantages over traditional open surgery including less blood loss, shorter hospital stays, reduced post-surgical pain, and faster recovery 1, 2.
Surgical Options for Ovarian Endometriomas
- Laparoscopic cystectomy (removal of the cyst while preserving the ovary) is the primary surgical option for women with symptomatic endometriomas, especially for those desiring future fertility 3
- Surgical treatment should be considered for endometriomas larger than 4 cm due to the risk of rupture or torsion 3
- The most efficient surgical approach involves adhesiolysis, removal of the cyst along with its capsule, and excision of any remaining endometriotic foci 3
- For recurrent endometriomas in women who have completed childbearing, unilateral oophorectomy with preservation of the contralateral ovary may be considered 3
Indications for Surgical Treatment
- Symptomatic endometriomas causing pain 3
- Large cysts (>4 cm) due to risk of rupture or torsion 3
- Infertility cases where patients have failed to conceive after 1-1.5 years of trying 3
- Cases where malignancy cannot be excluded 4
Laparoscopic Technique
- The procedure typically involves cyst fenestration followed by capsule ablation or excision 5
- Techniques include using laser (such as KTP laser) or bipolar diathermy for ablation 5
- An impermeable bag should be used for cyst removal to prevent spillage of contents 6
- The "closed technique" is recommended to minimize risks of chemical peritonitis or implantation 6
Outcomes and Recurrence
- Laparoscopic surgery has been shown to be successful in up to 93.9% of cases, even for large ovarian cysts (≥10 cm) 1
- Recurrence rates after laparoscopic ablation range from 12.5-16.4% within 12 months 5
- Bilateral cysts have a higher recurrence rate (58.3%) compared to unilateral cysts (26.2%) 5
- Reoperation rates of approximately 24.6% have been reported 5
Special Considerations
- Small asymptomatic cysts (<4 cm) should not be treated surgically, especially in women older than 35 years 3
- For women with infertility who are older than 35 years or who have failed to conceive after surgery, in vitro fertilization should be considered as the treatment of choice 3
- Pharmacotherapy has a limited role but may be considered for diffuse endometriosis associated with pain 3
Surgical Expertise Requirements
- Surgery for ovarian endometriomas should be performed by surgeons with extensive experience in gynecological endoscopy 7
- The surgeon should be capable of performing comprehensive assessment of the entire abdominal cavity 7
Laparoscopic surgery provides significant benefits over laparotomy for treating ovarian endometriomas, including reduced blood loss, shorter hospital stays (3.18 vs 6.32 days), and significantly less post-surgical pain 2. This minimally invasive approach should be considered the standard of care for most women with symptomatic chocolate cysts.