Dermoid Cyst: Understanding Diagnosis and Laparoscopic Removal

Question
I am 25 years old and I have been having a very consistnat dull ache in my left ovary so I went to see my obgyn. My Dr. told me that I have a dermoid cyst that is approx. 4cm on my left ovary. He would like to remove the cyst by laprotomy. His concern is that if he removes it laproscopy that the cyst could burst. I would prefer to have the surgery done laproscopy since I have heard the recovery time is quicker. However, my main concern is to keep my ovary and surrounding areas clean and safe. Do you think that removing my cyst laproscopy is something to be concerned about? Is my doctor just being conservative or should I trust he knows best. My husband and I had been trying for a baby for the last 3 months and have put that on hold until the cyst has been removed and recovery has taken place. If you have any input I would greatly appreciate it. Thank you, Stephanie

Answer
Dear Stephanie,

Dermoid cysts can cause the ovary to twist (torsion) and imperil its blood supply. The larger the dermoid cyst, the greater the risk of rupture with spillage of the greasy contents which can create problems with adhesions, pain etc. Although the large majority (about 98%) of these tumors are benign, the remaining fraction (about 2%) becomes cancerous (malignant). Torsion (twisting) of the ovary by the cyst is an emergency and calls for urgent surgery.

Removal of the dermoid cyst is usually the treatment of choice. This can be done by laparotomy (open surgery) or laparoscopy (with a scope). In some patients, surgery should be performed even more carefully than usual because the fatty content of the cyst may spread to the surrounding tissues, especially if the cyst is infected with bacteria. The spread of these contents can cause foreign body reactions and severe complications. Ovarian dermoid cysts can be difficult to treat, and sophisticated gynecologic surgical techniques are often needed to remove the lesion and prevent possible complications.

If it were me, I'd opt for the laparotomy. Yes, the recovery time is a bit longer, but a 4 cm cyst is right on the edge of being small enough to bring through a laparotomy incision anyway. So, if it were to burst and cause an infection, you might end up with a longer recovery time anyway. I'd simply want to try to avoid any complication if at all possible. And, with the laparotomy, your doctor can look things over, make sure there are no other cysts or other issues going on which would affect your fertility.

I hope this has helped you and answered your question. I apologize for the delay in the answer - I was on a rare vacation for the 4th and for some reason this system didn't schedule it as it should have.

Brenda