Most cysts can be removed using laparoscopy. The surgeon then removes the cyst through the small cuts in your skin. A laparoscopy is preferred because it causes less pain and has a quicker recovery time. Most women are able to go home on the same day or the following day.
In experienced hands, laparoscopic stripping of endometriomas appears to be a technique that does not significantly damage the ovarian tissue. But studies demonstrated that there are some risks regarding ovarian laparoscopy.
A study showed that in the group with cyst diameters of ≥4 cm and group with cyst diameters of <4 cm, the antral follicle counts (AFC), number of dominant follicles, and number of oocytes retrieved were decreased in the operated ovaries when compared with those in intact ovaries; in the former group, a statistically significant reduction was observed. The differences of AFC, number of dominant follicles, and number of oocytes retrieved from both ovaries were further compared among the two groups: the decrease in the group with cyst diameters of ≥4 cm was higher than in the group with cyst diameters of <4 cm.
Rupture of an ovarian mass is possible with either laparoscopic or open surgical procedures. According to the medical literature, rupture rates are higher in laparoscopy than open procedures. Ovarian cyst rupture during laparoscopy surgery is believed to have unfavorable clinical impact to the patient. Laparoscopic management of ovarian cysts with suspicious features for malignancy remains controversial due to potential spillage of ovarian cyst contents, delayed staging and the possibility of accelerating the spread of malignant cells if the cyst ruptured during laparoscopic operation, either intentionally or not. Larger ovarian cyst is particularly of concern because of the higher incidence of rupture during laparoscopy and because larger ovarian cyst also has the tendency to be more malignant in nature.
Laparoscopy field has evolved dramatically in the recent years. Most of ovarian masses can be operated by laparoscopy. While benign ovarian pathology remains the most common indication for laparoscopy treatment, borderline ovarian tumor still left some uncertainty whether it is better be handled by open laparotomy or laparoscopy can still be justified.