Most ovarian cysts develop as a result of disturbances in the normal ovulation process in which the follicle (which is composed of aggregations of cells that harbor a single oocyte [immature ovum or egg[) fails to release the oocyte. The follicular cells continue to secrete fluid which causes the follicle to fill up and enlarge, which over time can become cystic. Ovarian cysts are quite common and involve all age groups; they can be with or without symptoms.
Absolute indications for ovarian cystectomy (removal; of an ovarian cyst) include the following: definitive diagnostic confirmation of an ovarian cyst, removal of symptomatic cysts, and exclusion of ovarian cancer. Additional indications include cyst size larger than 7.6 cm, cysts that do not resolve after 2-3 months of close monitoring, bilateral (on both sides) lesions, and ultrasound imaging findings that reveal a cyst that is not a simple one.
General anesthesia is indicated for laparoscopic technique (جراحة بالمنظار).
Laparoscopic cystectomy is the preferred approach to managing benign ovarian cysts in adolescents and adults. Puncture (entry) sites include a para-umbilical (around the navel) and 2 side incisions about 3 cm above the lower abdominal line. In general, 5-mm ports can be used at all 3 sites. The abdomen is insufflated with CO2 gas and the laparoscope is inserted. Examination of all inner surfaces of the abdomen, liver, and diaphragm is performed and, when normal, the ovaries are identified and similarly examined.
Open laparotomy is an alternative approach. Indications for laparotomy include large, complex cysts that cannot be removed through the laparoscope, cysts for which the benign nature is questionable, and for cysts in which spillage of contents would result in significant complications.
Ultrasound-guided cyst aspiration is often used in assisted reproductive technology (for women with trouble getting pregnant). The most common indication in this setting is oocyte retrieval after induction of ovulation with gonadotropins. Often these cysts reaccumulate fluid because the follicular cells continue their secretory function. Ultrasound-guided cyst aspiration is also used to reduce persistent cysts following controlled super-ovulation. In this technique the cyst wall is not destroyed, so fluid reaccumulation is expected to often occur. The cure rate for cysts arising in these setting ranges from 30-80%. This approach is not usually used for treating persistent cysts of unknown origin,
Absolute indications for ovarian cystectomy (removal; of an ovarian cyst) include the following: definitive diagnostic confirmation of an ovarian cyst, removal of symptomatic cysts, and exclusion of ovarian cancer. Additional indications include cyst size larger than 7.6 cm, cysts that do not resolve after 2-3 months of close monitoring, bilateral (on both sides) lesions, and ultrasound imaging findings that reveal a cyst that is not a simple one.
General anesthesia is indicated for laparoscopic technique (جراحة بالمنظار).
Laparoscopic cystectomy is the preferred approach to managing benign ovarian cysts in adolescents and adults. Puncture (entry) sites include a para-umbilical (around the navel) and 2 side incisions about 3 cm above the lower abdominal line. In general, 5-mm ports can be used at all 3 sites. The abdomen is insufflated with CO2 gas and the laparoscope is inserted. Examination of all inner surfaces of the abdomen, liver, and diaphragm is performed and, when normal, the ovaries are identified and similarly examined.
Open laparotomy is an alternative approach. Indications for laparotomy include large, complex cysts that cannot be removed through the laparoscope, cysts for which the benign nature is questionable, and for cysts in which spillage of contents would result in significant complications.
Ultrasound-guided cyst aspiration is often used in assisted reproductive technology (for women with trouble getting pregnant). The most common indication in this setting is oocyte retrieval after induction of ovulation with gonadotropins. Often these cysts reaccumulate fluid because the follicular cells continue their secretory function. Ultrasound-guided cyst aspiration is also used to reduce persistent cysts following controlled super-ovulation. In this technique the cyst wall is not destroyed, so fluid reaccumulation is expected to often occur. The cure rate for cysts arising in these setting ranges from 30-80%. This approach is not usually used for treating persistent cysts of unknown origin,
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