Laparoscopic Cystectomy: What Happens During Surgery?

Laparoscopic cystectomy is a well-established gynaecological procedure with a recognised safety profile. This guide explains what to expect before, during, and after surgery in Singapore.

What Is a Laparoscopic Cystectomy?

Laparoscopic cystectomy is a minimally invasive (keyhole) surgical procedure in which a gynaecologist removes a cyst from the ovary through small incisions in the abdomen, using a tiny camera and slender instruments, while preserving the ovary itself.

The two terms are sometimes confused:

• Cystectomy means removing the cyst while leaving the ovary intact.
• Oophorectomy means removing the entire ovary.

In many cases, the surgical goal is cystectomy: to take out the cyst and preserve as much healthy ovarian tissue as possible. Oophorectomy is considered only when the ovary is too damaged to be saved, or when other clinical factors make it necessary.

Types of Ovarian Cysts That May Require Surgery

Not every ovarian cyst requires an operation. Many small, simple cysts resolve on their own. Surgery is typically recommended when a cyst:

• Is large (generally above 5-6 cm)
• Is growing over time on repeat scans
• Causes persistent pain or pressure symptoms
• Has features on ultrasound that warrant further investigation
• Does not resolve after a period of watchful waiting

Common cyst types that may be surgically removed include endometriomas (chocolate cysts caused by endometriosis), dermoid cysts (which contain tissue such as hair or skin cells), and persistent simple or complex cysts.

Why Keyhole Surgery Is Often Used Instead of Open Surgery

In laparoscopic surgery, the gynaecologist works through three or four small incisions (each around 0.5-1 cm) rather than one large abdominal cut. This approach is associated with several clinical benefits:

• Smaller wounds and less post-operative pain
• Lower risk of infection at the incision sites
• Shorter hospital stay (often one night or less)
• Faster return to daily activities
• Minimal visible scarring

How Do You Prepare for Laparoscopic Cystectomy?

Pre-Surgery Consultations and Tests

Before your operation, your gynaecologist will arrange a pre-operative assessment. This typically includes:

• A review of your medical history and any current medications
• Blood tests (including a full blood count and clotting profile)
• An ultrasound or MRI scan to map the cyst’s size, location, and characteristics
• A tumour marker blood test (such as CA-125) if clinically indicated, to help characterise the cyst
• An anaesthetic review, particularly if you have any underlying health conditions

What to Do the Night Before and Morning of Surgery

Your surgical team will give you specific instructions tailored to your case. General guidance usually includes:

• Fasting: You will typically be asked to stop eating solid food from midnight the night before surgery. Clear fluids may be permitted up to a few hours before your scheduled time, but follow your team’s exact instructions.
• Medications: Inform your doctor of all medications, supplements, and herbal remedies you take. Some, such as blood thinners or certain supplements, may need to be paused before surgery.
• Skin preparation: You may be asked to shower with an antiseptic wash the morning of surgery.
• Practical arrangements: Arrange for a responsible adult to accompany you home after discharge, as you will not be able to drive. Plan for at least a few days of rest at home, so organise childcare, meal preparation, or other domestic help in advance if needed.

What Happens During Laparoscopic Cystectomy: Step by Step

Because you will be under general anaesthesia (fully asleep and feeling nothing), this section describes what happens so you can picture the process.

Anaesthesia and Positioning

An anaesthetist administers general anaesthesia through a cannula (a small needle in a vein in your hand or arm). You will fall asleep within seconds. Once you are fully anaesthetised, the team positions you on the operating table with a slight tilt. A catheter (a thin tube) is placed into your bladder to keep it empty and protected during surgery.

Making the Small Incisions

The surgeon makes a small incision at or just below the navel and inserts a thin needle to inflate the abdomen with carbon dioxide gas. This gas gently lifts the abdominal wall away from the organs, creating a clear working space. A laparoscope (a slim tube with a camera and light at its tip) is then inserted through this incision, projecting a magnified view of your pelvic organs onto a screen. Two or three additional small incisions are made in the lower abdomen to allow slender surgical instruments to be passed through.

Locating and Separating the Cyst from the Ovary

Using the camera as a guide, the surgeon carefully identifies the ovary and the cyst. The goal is to separate the cyst wall cleanly from the surrounding healthy ovarian tissue. The surgeon works methodically to peel the cyst away while minimising trauma to the ovary. If endometriosis is present, adhesions (bands of scar tissue that cause organs to stick together) may need to be released first, which requires additional care.

Removing the Cyst and Closing the Incisions

Once the cyst is fully separated, it is placed inside a sterile retrieval bag inside the abdomen. This bag is then drawn out through one of the small incisions, preventing any cyst contents from spilling into the abdominal cavity. The surgeon inspects the pelvis carefully, ensures there is no bleeding, and releases the carbon dioxide gas. The small incisions are closed with dissolvable sutures (stitches that absorb on their own) and covered with small dressings.

Surgical Steps at a Glance

How Long Does Laparoscopic Cystectomy Take?

Laparoscopic cystectomy typically takes between 30 and 90 minutes from the first incision to closure. The total time in the operating theatre, including anaesthetic preparation, is usually longer.

Several factors can extend the duration of surgery:

• Cyst size: Larger cysts require more careful dissection and a larger retrieval incision.
• Endometriosis: If endometriosis is present, adhesions may need to be treated before the cyst can be addressed, adding time to the procedure.
• Adhesions from previous surgery: Prior abdominal or pelvic operations can cause scar tissue that needs to be carefully released.
• Cyst type: Dermoid cysts, for example, require particular care to avoid spillage of their contents.

Your gynaecologist will give you a more specific estimate based on your imaging and clinical history.

What Happens to the Cyst After Removal?

Once the cyst is removed, it is sent to a pathology laboratory for histological analysis (examination of the tissue under a microscope). The pathologist analyses the cyst tissue to confirm its nature and rule out any atypical cells.

Most ovarian cysts removed in premenopausal women are benign (non-cancerous). Histology results are typically available within one to two weeks and are discussed at your post-operative follow-up appointment. Your gynaecologist will explain the findings and advise whether any further management is needed.

Recovery After Laparoscopic Cystectomy

Recovery from laparoscopic cystectomy is generally smoother and quicker than recovery from open abdominal surgery. Many women feel well enough to return to light daily activities within a week, though individual recovery timelines vary.

The First 24 Hours After Surgery

After surgery, you will be moved to a recovery area where nurses monitor your vital signs as the anaesthesia wears off. Most women spend one night in hospital, though some may go home the same day depending on how they feel and their surgeon’s assessment.

In the first 24 hours, you may experience:

• Shoulder or upper abdominal discomfort: This is caused by residual carbon dioxide gas irritating the diaphragm (the muscle beneath your lungs). It usually resolves within 24-48 hours.
• Mild to moderate abdominal soreness around the incision sites, managed with prescribed pain relief.
• Nausea: A common effect of general anaesthesia that typically settles quickly.
• Fatigue: Rest is important in the first day after surgery.

You will be encouraged to get up and walk gently as soon as you feel able, as movement helps reduce the risk of blood clots forming.

Returning to Daily Activities and Work

• Days 1-3: Rest at home. Avoid lifting, strenuous activity, and driving. Short, gentle walks around the house are encouraged.
• Days 4-7: Many women feel significantly better and can manage light household tasks. Discomfort at the incision sites should be easing.
• Week 2: Many women with desk-based jobs feel ready to return to work. Physical or manual jobs may require a longer period of rest.
• Weeks 3-4: Light exercise such as walking can typically resume. Always follow your surgeon’s specific guidance.
• Week 6 onwards: Return to exercise, swimming, and sexual activity is subject to your surgeon’s clearance at your follow-up appointment.

Signs That Recovery Is Progressing Well

• Pain is gradually decreasing each day
• You are able to eat and drink normally
• Your energy levels are slowly returning
• The incision sites look clean and dry, with no redness spreading outward
• You are passing urine and bowel movements normally

Does Laparoscopic Cystectomy Affect Fertility?

Laparoscopic cystectomy is specifically designed to preserve the ovary. By removing the cyst rather than the entire ovary, the procedure aims to maintain as much healthy ovarian tissue as possible. Many women go on to conceive naturally after the procedure, though outcomes vary by individual.

A few nuances are worth noting:

• Ovarian reserve (the number of eggs remaining in the ovary) can be affected by surgery, particularly when operating on endometriomas. The cyst wall in endometriomas can be closely fused with the ovarian cortex, making clean separation challenging.
• Pre-existing conditions such as endometriosis may themselves affect fertility independently of surgery.
• Cyst recurrence is possible in some cases, particularly with endometriomas, which may require further discussion about long-term management.

If fertility preservation is a priority for you, you may wish to discuss this with your gynaecologist before surgery. Your surgeon can tailor the approach and, if appropriate, refer you to a fertility specialist for pre- or post-operative assessment.

Taking an Active Role in Your Surgical Journey

Before your consultation, consider writing down questions such as:

• What type of cyst do I have, and why is surgery recommended now?
• Will you aim to preserve my ovary?
• What are the risks specific to my case?
• How will this affect my fertility?
• What are my options if I prefer to wait?

When to Seek Professional Help

After surgery, contact your surgical team promptly or go to the emergency department if you experience:

• Fever of 38°C or higher, or a fever that lasts more than a few days or is accompanied by unusual symptoms, (e.g., severe pain or swelling)
• Heavy vaginal bleeding
• Severe or worsening abdominal pain not relieved by prescribed medication
• Redness, swelling, or discharge at an incision site
• Difficulty passing urine
• Calf pain, swelling, or shortness of breath (which may indicate a blood clot)

Before surgery, you may wish to consult a gynaecologist if you have been told you have an ovarian cyst and are experiencing persistent pelvic pain, a sensation of pressure or fullness in the lower abdomen, or if a cyst has been identified on imaging and you have not yet had a specialist review.

Commonly Asked Questions

Is laparoscopic cystectomy painful?

General anaesthesia means you will feel nothing during the procedure itself. Afterwards, many women describe the discomfort as manageable soreness at the incision sites and shoulder discomfort from residual gas. Pain relief is prescribed to help keep you comfortable, and discomfort often reduces noticeably within the first few days, though individual experience varies.

How many days of medical leave will I need?

Many women require between five and fourteen days of medical leave, depending on the nature of their work and how their recovery progresses. Women with desk-based roles often return to work within a week; those with physically demanding jobs typically need longer. Your surgeon will advise you based on your individual circumstances.

Can ovarian cysts come back after surgery?

For some types of cysts, particularly endometriomas associated with endometriosis, recurrence is possible. Your gynaecologist may recommend hormonal management after surgery to help reduce this risk. For other cyst types, such as dermoid cysts, recurrence is less common. Your follow-up appointments are an important opportunity to monitor for any changes.

Will I have visible scars after keyhole surgery?

The incisions in laparoscopic surgery are small (typically 0.5-1 cm). Over time, these fade and may become less noticeable. One incision is usually placed at or just inside the navel, where it is naturally concealed. The others are positioned in the lower abdomen in areas that are generally covered by underwear or clothing.

Is laparoscopic cystectomy suitable for large cysts?

Laparoscopic cystectomy can be performed for many large cysts, though surgical complexity increases with size. For very large cysts, the retrieval incision may need to be slightly extended. In some cases, your gynaecologist may discuss whether a different surgical approach is more appropriate, based on the cyst’s size, type, and your overall clinical picture.

Next Steps

If you have been told you have an ovarian cyst, you may wish to arrange a consultation with a gynaecologist to review your imaging and discuss your options. Bring any ultrasound reports or blood test results you have, and prepare a list of questions. Understanding your cyst type, the recommended approach, and what recovery looks like can help you feel informed about your care.

Learn More About Minimally Invasive Gynaecological Surgery

Keyhole surgery is one approach available for women managing ovarian cysts, endometriosis, and other gynaecological conditions. If you would like to understand more about minimally invasive surgical approaches and how they may apply to your situation, speaking with a specialist in O&G in Singapore may be a helpful next step.