Ovarian Cyst Surgery: Everything You Need to Know

Ovarian cysts are fluid-filled sacs that can develop in women in their reproductive years or, rarely, after menopause. The first line of treatment for ovarian cysts is diagnosing the specific type of cyst using ultrasound and blood work. The most common treatment is watchful waiting, unless the cyst is found to be large or is causing symptoms. Ovarian cysts generally go away over a few weeks without intervention.

Your doctor will determine how often to monitor the cysts. For women with chronic, painful cysts, hormonal birth control may be recommended in addition to pain medicine.

What Is Ovarian Cyst Surgery?

Patients with large cysts, painful symptoms, or suspicious imaging may be recommended for ovarian cyst surgery. Ovarian cyst surgery is the removal of cysts from the ovaries either through small incisions (laparoscopically) or through one larger incision (laparotomy) in the abdomen. About 8% of women with ovarian cysts develop cysts large enough to require treatment.

Potential Risks

As with any surgery, there are risks with ovarian cyst removal surgery, including:

• Ovarian cysts may return after surgery
• Pain may not be controlled
• Scar tissue (adhesions) may form at the surgical site, on the ovaries or fallopian tubes, or in the pelvis
• Infection
• Damage to the bowel or bladder

Purpose of Ovarian Cyst Surgery

The purpose of ovarian cyst surgery is to remove the cysts that are either causing symptoms or are cancerous. Removing the cysts does not mean they will not return over time. It’s important to discuss fertility with your doctor prior to surgery because removing the ovaries or damaging the ovaries during surgery can affect your ability to get pregnant naturally. However, even if both ovaries are removed due to cysts, it’s still possible to carry a baby using in vitro fertilization. 

For women who are diagnosed with ovarian cancer, typically the uterus, ovaries, and fallopian tubes are removed, which would make pregnancy impossible. The risk of ovarian cancer increases with age, especially for women with ovarian cysts after menopause or with a family history of breast or ovarian cancer.

Cysts naturally occur throughout a woman’s menstrual cycle during her reproductive years. Many women do not even know they have a cyst until it causes pain or symptoms, or it is found with a diagnostic test.

Cysts can also be associated with endometriosis, in which the tissue lining the inside of the uterus grows outside of it, or polycystic ovarian syndrome (PCOS), a hormonal disorder that causes enlarged ovaries with small cysts. When the cysts are caused by either condition, it can lead to fertility issues.

How to Prepare

This surgery may be considered an elective procedure and will be scheduled through your doctor’s office in advance. For ruptured ovarian cysts, there may be blood and fluid loss, necessitating an emergency surgery for cyst removal. You should expect to take a few days off from work for the procedure and for the recovery period after the surgery.

Location

Ovarian cyst removal takes place in a hospital operating room or outpatient surgical center. 

Food and Drink

The surgeon will direct patients not to eat or drink anything after midnight the night before the surgery. Alcohol and smoking should be avoided at least one day before surgery, if not longer.

Medications

Patients should provide a thorough list of current medications, including any prescription medications, over-the-counter medications, supplements, vitamins, or recreational drugs that they are using. The surgeon will determine if medications that cause increased bleeding, such as blood thinners, should be continued or stopped depending on the medical situation of each patient.

What to Bring

You will need to schedule a ride home from the hospital with a support person. The anesthesia given during the procedure will make it dangerous for you to drive. 

What to Expect on the Day of Surgery

On the day of surgery, check in at the predetermined arrival time to give the presurgical teams ample time to prepare you for surgery. 

Before the Surgery

In the preoperative area on the day of surgery, a nurse will assess your vital signs, weight, pregnancy status and blood sugar level, if applicable. Patients will remove their clothes and jewelry and change into a surgical gown. Documents such as surgical and anesthesia consents will be reviewed and signed. 

The anesthesia team will complete another thorough assessment to determine any risks of undergoing general anesthesia. An intravenous (IV, through a vein) catheter will be placed to provide any necessary medications during the surgery. 

The operating room will be very cold and already set up with a special surgical bed, medical equipment and monitors, and numerous instruments needed for the surgery. The surgical team will position you on your back during surgery, and you will go to sleep once the medication the anesthesiologist gives you begins to work. The anesthesiologist will also insert a breathing tube (endotracheal tube) that is hooked up to the ventilator to help you breathe.

The surgical team will rub an antiseptic solution on the surgical site. Sterile drapes will be placed over your body, exposing just the area to be operated on.

During the Surgery

Laparoscopic surgery, a minimally invasive surgery, entails the following steps:

• A small incision is made in the abdomen to place a tiny camera and a separate small incision is made for the surgeon to insert an instrument with which to perform the procedure.
• The cyst is dissected off of the ovary, if possible (or the entire ovary may need to be removed).
• The cyst tissue is removed from the body.
• The surgeon removes the camera and instruments and then closes the tiny incisions with small sutures.
• Dressings will be applied to keep the incisions clean, dry, and intact. 

Laparotomy surgery may be performed for large cysts that cannot be easily removed from tiny incisions or for cysts that are suspected to be cancerous. An incision is made in the abdomen to access the cyst. The layers of muscle and skin are sewn back together and dressings are placed after the procedure is done.

Researchers are studying another, different method that is not currently a widely accepted approach to surgery. Instead of entering the abdomen to remove the ovarian cysts, it entails having the surgeon access the ovaries through a small incision in the vagina. It’s not well studied at this time, and laparoscopy or laparotomy are still considered the gold standard treatments when surgery is required.

After the Surgery

After surgery, you will be wheeled to the postanesthesia recovery unit, where you will recover for about two to four hours. As with any surgery, there will be pain afterward. Most patients will be discharged to home following laparoscopic surgery, and patients who had a laparotomy procedure will stay in the hospital for two to four days.

Recovery

Most people return to normal activities and routines within a week. Laparotomy procedures will take longer to recover from, with most people returning to normal activities at 12 weeks. Postoperative symptoms for laparoscopy recovery can include:

• Dizziness
• Nausea
• Shoulder pain
• Abdominal cramps
• Gassy or bloated feeling
• Sore throat if a breathing tube was placed for the procedure

Healing

The dressings should remain in place as long as directed by your doctor. If the incisions begin to bleed or leak pus, it’s important to get in touch with your surgeon right away because they may be infected. 

Summary

Ovarian cyst surgery is a procedure through which ovarian cysts, fluid-filled sacs that develop on the ovaries, are removed. Women develop cysts naturally as they age, but cysts can also be associated with ovarian cancer, endometriosis, and polycystic ovarian syndrome (PCOS).

Your doctor may recommend surgery if your cysts are particularly large, are causing problems, or are cancerous. The surgery can be done by laparoscopy, which is performed with small incisions and a camera, or by laparotomy, in which an incision is made in the abdomen to access the cysts.

A Word From Verywell

Ovarian cysts typically go away without treatment, but they usually require monitoring by your doctor. If the cysts rupture, are causing symptoms, or are suspected to be cancerous (although rare), ovarian cyst removal surgery is the next stage of treatment. Fertility is an important factor to discuss with your doctor prior to this surgery.

Frequently Asked Questions 

Do ovarian cysts have to be a certain size for surgery?

Medical professionals agree that large ovarian cysts should be removed typically when cysts are at least two to four inches in diameter. Ovarian cyst removal is easier and has fewer surgical risks when the cysts are smaller, compared with waiting until they are much larger (such as 20 inches). Cysts that are suspected to be ovarian cancer are removed regardless of size.

How long is recovery from ovarian cyst surgery?

For minimally invasive (laparoscopic) surgery, patients usually are sent home the same day. There are minimal restrictions and most people return to normal activities within a week. For larger incisions, such as those made in a laparotomy, a hospital stay is required for a couple of days. It takes about 12 weeks to recover completely.

How are ovarian cysts removed?

Ovarian cyst removal occurs through small incisions (laparoscopic) or, if the cysts are large, through a bigger incision made in the abdomen (laparotomy).

Does ovarian cyst surgery cause infertility?

Some ovarian cysts can cause infertility, such as those resulting from endometriosis or PCOS. Functional cysts, cystadenomas, and dermoid cysts are not associated with infertility. Surgical removal of cysts does not affect fertility unless the ovaries themselves are removed (oophorectomy) because the ovaries secrete hormones associated with reproduction and pregnancy.

How much does ovarian cyst surgery cost?

Medicare estimates that for ovarian cyst surgery, patients who undergo the procedure at an ambulatory (walk-in) surgery center pay about $529 out of pocket and $1,059 for hospital outpatient surgery. This estimate includes facility fees in addition to the surgeon's fees, but does not indicate whether it is with or without insurance.