Laparoscopic ovarian cystectomy

Summary

A laparoscopic ovarian cystectomy is a keyhole operation to remove a cyst from an ovary while leaving the healthy ovarian tissue in place. It is important to know that most ovarian cysts need no treatment at all — simple, single-chambered (unilocular) cysts under about 4 cm mostly shrink and disappear on their own, so finding a cyst on a scan is not in itself a reason for surgery.

• Surgery is advised when a cyst is unlikely to resolve, is growing, is causing symptoms, or carries a risk of complications or of being cancerous.
• The operation is done under general anaesthetic through three small cuts — a 1 cm cut at the navel and two of just 5 mm.
• Because only the cyst is removed and the normal ovary is preserved, fertility is generally not reduced — though for endometriosis cysts (endometriomas) some loss of ovarian reserve can occur.
• The operation usually takes 45 minutes to an hour, and you go home the same day or the following day; most women resume normal activities within a few days.
• There is no size limit: even a very large cyst can be removed safely by keyhole. Open surgery is chosen only when cancer is suspected.

This information supports discussion with your healthcare team. Reading, saving or printing it does not constitute consent to surgery.

About the operation

An ovarian cyst is a fluid-filled space on or in an ovary. In a cystectomy the cyst wall is carefully peeled away from the ovary and removed, and the ovary is left to heal — as distinct from removing the whole ovary (oophorectomy), which is only done when the ovary itself cannot be preserved or when that is the safer option.

In the laparoscopic approach a thin camera (laparoscope) is passed through a small cut at the navel, giving a magnified live view on a screen, and the surgeon works with fine instruments through two further cuts of just 5 mm. The cyst is placed inside a retrieval bag and removed from the abdomen; larger cysts are drained within the bag first so that the fluid does not spill.

Why it is performed

Most cysts are simply monitored with a repeat scan. Surgery is considered when:

• The cyst is not resolving on its own, or is becoming large — it persists or grows in size over successive scans
• It causes symptoms — persistent pelvic pain, pressure, bloating, or pain during intercourse
• Suspicious features are seen on the scan, so the cyst needs removing to be examined under the microscope
• There is a risk of complications — a large cyst can twist the ovary (torsion), bleed or rupture, all of which cause sudden severe pain
• It is affecting fertility — for example an endometriosis cyst (endometrioma) on the ovary

Your scan findings, your age, your symptoms and blood tests together decide whether an operation is the right step, and what kind.

Benefits

• The cyst is removed and examined — symptoms are relieved, the risk of torsion or rupture is removed, and the tissue is sent for microscopic examination so its nature is known for certain.
• The ovary is protected and rebuilt. Only the cyst is taken, and the ovary is then reconstructed with laparoscopic stitches so it keeps its normal shape — so your hormones and fertility are generally unaffected. For an endometriosis cyst (endometrioma) the cyst wall is bound to the ovary more firmly, so some loss of ovarian reserve is unavoidable — this is discussed with you if it applies.
• Compared with open surgery: one 1 cm cut and two of 5 mm, much less pain, less injury to the body, a shorter stay and full recovery in days rather than weeks.

Alternatives

• No surgery for now — the right choice for most cysts: a repeat scan after some weeks, since the majority resolve without any treatment.
• Medicines — the combined pill and other hormonal treatments do not shrink an existing cyst but can reduce the chance of new functional cysts forming; painkillers manage discomfort meanwhile.
• Removing the whole ovary (oophorectomy) — advised in some situations, for example when the ovary cannot be saved, or after the menopause where preserving it brings no benefit.
• Open surgery — chosen only where a risk such as cancer is suspected and a complex operation may be needed; cyst size alone is not a reason for it.

Preparing for surgery

Before the operation you will have a pre-operative assessment: blood tests (including tumour markers where your individual case calls for them), blood pressure, a scan review, and a review of your medicines and general health. Tell the team about all medicines you take — blood thinners may need adjusting — and any previous surgery or anaesthetic problems.

• Smoking: stopping even a few weeks before surgery reduces chest and wound complications.
• Fasting: exact instructions are given; typically no food from 6 hours before, water up to 2 hours before.
• At home: arrange for someone to take you home, and plan a few easy days afterwards.

The day of surgery

You are usually admitted on the day of surgery. The team confirms your identity and the planned operation, and you meet the anaesthetist and the surgeon. This is the time for last questions — nothing is too small to ask.

You will be asked to sign the consent form. For this operation, be clear in advance about what should happen if the ovary cannot be preserved, or if the cyst looks suspicious at surgery — for example whether you agree to the ovary being removed in that situation. Recording your wishes now avoids difficult decisions being made without you. You can still change your mind at this point. Compression stockings are usually fitted to reduce the risk of blood clots.

During the operation

The operation is done under general anaesthetic — you are fully asleep and feel nothing. The abdomen is gently inflated with carbon dioxide gas to create space to operate, and the laparoscope and instruments are introduced through the three small cuts. The operation usually takes 45 minutes to an hour.

The surgeon inspects both ovaries, the tubes, the womb and the lining of the pelvis, then separates the ovary over the cyst and carefully peels the cyst wall away, preserving as much normal ovary as possible. The cyst is placed in a retrieval bag and taken out through one of the small cuts; a large cyst is drained inside the bag so nothing spills into the abdomen. The removed tissue is sent to the laboratory for examination.

The ovary is then reconstructed by laparoscopic suturing — the opened part of the ovary is stitched back together through the keyhole ports, restoring its normal shape rather than leaving it open to heal on its own. This protects the ovary’s blood supply and function and reduces the chance of adhesions forming around it afterwards. The carbon dioxide gas is then let out and the cuts are closed with dissolvable stitches.

Occasionally, if keyhole surgery proves unsafe to continue, or if the findings make it necessary, the surgeon completes the operation as an open operation for your safety. This is rare.

After the operation

By the time you wake, the operation is complete. Some shoulder-tip pain is common for a day or two — it comes from the gas used during surgery and settles on its own; walking about helps.

• Pain relief: regular simple painkillers control most discomfort; stronger medication is available if needed.
• Eating and drinking: usually the same day, starting with fluids.
• Moving: you can usually be up and about the same day — early walking speeds recovery and protects against clots.
• Going home: once you have eaten and passed urine — the same day or the following day.
• Results: the laboratory report on the cyst usually takes one to two weeks and is explained at your follow-up appointment.

Recovery at home

• First few days: mild pain, tiredness and bruising around the small cuts are normal; most women return to normal activities within a few days.
• Work: commonly within about a week, depending on your job and how you feel.
• Driving: once you can brake hard without hesitation — usually within a few days to two weeks.
• Strenuous exercise and heavy physical work: build up over the following two to three weeks, guided by comfort.
• Periods and fertility: your cycle usually continues as before, and the healthy ovary has been preserved. For an endometriosis cyst, ask your consultant what the operation means for your ovarian reserve.
• Follow-up: keep the appointment where the wounds are checked and the laboratory result is explained, even if you feel completely well.

This guidance covers what is usual after keyhole surgery; the advice given to you personally takes precedence.

Risks and complications

Every operation carries risk. The figures below are averages from published UK guidance; your individual risk depends on the size and nature of the cyst, your health and any previous surgery, and will be discussed with you.

Expected, temporary effects

• Pain and tiredness in the first days; shoulder-tip pain from the gas for a day or two
• Light vaginal bleeding or spotting
• Bruising around the small cuts

Complications

• Bleeding from the ovary during or after surgery; bleeding heavy enough to need a transfusion is uncommon.
• Infection — of the urine, chest or wounds; most cases minor and settled with antibiotics (uncommon).
• Injury to the bladder, bowel, ureters or a blood vessel — recognised injuries are repaired (rare).
• Blood clots in the leg or lung (VTE) — preventive measures are routine (uncommon).
• Loss of some ovarian tissue — removing the cyst wall inevitably takes a small amount of ovary with it; with careful technique the effect on ovarian reserve is small, but it is greater for endometriosis cysts and for repeat operations.
• Removal of the ovary — uncommonly the ovary cannot be preserved, or a suspicious appearance makes removal the safer option; this is why your wishes are agreed before surgery.
• Cyst recurrence — a new cyst can form later, on either ovary; this is not a failure of the operation.
• An unexpected laboratory result — rarely the cyst proves to be cancerous, and further treatment is then discussed with you.
• Conversion to open surgery during the operation, for safety (uncommon).
• Anaesthetic risks — serious anaesthetic complications are rare in otherwise healthy women.

When to seek help

After you go home, seek medical advice the same day if you notice:

• Worsening abdominal pain not controlled by your painkillers
• Fever (38 °C or higher) or feeling increasingly unwell
• Heavy vaginal bleeding, or foul-smelling discharge
• A wound that becomes red, swollen, hot or leaks fluid
• Burning on passing urine, or being unable to pass urine
• Persistent vomiting, or a swollen, tense abdomen
• A painful, swollen or red leg

Preparing for your consent discussion

Consent is a conversation, not a signature. Before agreeing to surgery you should feel you understand why an operation is recommended rather than watching and waiting, and what you want done if the ovary cannot be preserved. The checklist below is a starting point — print it and bring it to your consultation.

Sources and review

This page was drafted against the published guidance below. Each reference was live when checked; dates will be confirmed at clinical review.

1. Royal College of Obstetricians and Gynaecologists. Management of suspected ovarian masses in premenopausal women. Green-top Guideline No. 62. Available from: https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/ [last checked 28 July 2026].
2. National Health Service (UK). Ovarian cyst. Available from: https://www.nhs.uk/conditions/ovarian-cyst/ [last checked 28 July 2026].
3. Royal College of Obstetricians and Gynaecologists. Diagnostic laparoscopy — consent advice. London: RCOG. Available from: https://www.rcog.org.uk/guidance/browse-all-guidance/consent-advice/ [last checked 28 July 2026].

Patient information from our own clinics

1. Sugabi Clinic Ragama. Ovarian cysts: what they are and when they need treatment. Available from: https://sugabi.lk/blog/744/…
2. vog.lk — ඩිම්බ කෝෂ වල ගෙඩි සඳහා සිදු කරන ලැපරොස්කොපි ශල්‍ය කර්ම (Sinhala, by Dr Chaminda Mathota). Available from: https://vog.lk/1015-laparoscopic-ovarian-cystectomy.php
3. vog.lk — ඩිම්බ කෝෂ වල ඇති වෙන ගෙඩි (Sinhala). Available from: https://vog.lk/41-ovarian-cysts.php
4. vog.lk — ලැපරොස්කොපි සැත්කම් සිදු කරන හැටි (Sinhala). Available from: https://vog.lk/735-laparoscopic_surgery.php