Uncomplicated cysts
Procedure before the onset of menopause:
- Diameter of the cyst is <5 cm:
- Postmenstrual control (after menstruation) of the cyst by sonography (ultrasound).
- In case of persistence (persistence): sonography every 4 weeks.
- After three months of persistence: surgery with histological clarification.
- Postmenstrual control (after menstruation) of the cyst by sonography (ultrasound).
- Diameter of the cyst is > 5 cm:
- Postmenstrual control of the cyst by sonography.
- In case of persistence or increase in size of the cyst: surgery with histological clarification.
Procedure after the onset of menopause:
- Diameter of the cyst is < 5 cm:
- Control of the cyst by sonography every 4 weeks.
- After three months of persistence: surgery with histological clarification (carcinoma!).
- Diameter of the cyst is > 5 cm:
- Surgery with histological clarification (carcinoma!).
As a rule, an ovarectomy (removal of one ovary / ovary) is performed. Depending on the histological findings and age of the patient, the other ovary may also be removed.
Complicated cysts
Procedure before the onset of menopause:
- Caveat: The cyst may be a corpus luteum cyst. This changes its appearance daily and must therefore be monitored very closely.
Procedure after the onset of menopause:
- If the cyst has a suspicious internal structure, it should be removed immediately.
1st order
- Laparoscopy (laparoscopy)/pelviscopy (pelviscopy)Indications: It is the, preferred procedure over laparotomy (abdominal incision) in the vast majority of all benign (benign) ovarian tumors.Advantages are: Usually shorter operation time, lower postoperative morbidity (incidence of disease), less scarring, shorter convalescence time. Even in the case of cystic tumors, complete removal without opening is desirable for safety reasons, in order to prevent tumor spread to the abdomen in the rare case of malignancy (malignancy) that can only be diagnosed microscopically. Today, fenestration is obsolete. Safe removal is possible by means of a salvage bag. For safety reasons, secretions should also be obtained from the Douglas space (pocket-shaped protrusion of the peritoneum (abdominal membrane) between the rectum (rectum) at the back and the uterus (uterus) at the front) or a lavage (diagnostic procedure for obtaining cell material) of the pelvis should be performed to allow cytological evaluation. Contraindications:
- Ascites (abdominal fluid)
- Abnormal/suspicious Doppler sonography
- Elevated tumor marker(s)
- Tumor
- Larger than 10 cm
- With papillary and/or solid structures
- Polycystic and/or septate
2nd order
- Laporotomy (abdominal incision): a primary laparotomy is often performed for tumors whose dignity (biological behavior of tumors; i.e., whether they are benign (benign) or malignant (malignant)) cannot be assessed with certainty preoperatively (before surgery), e.g., in the case of
- Contraindications see above.
- Cysts unicameral, echoleer > 6 cm,
In all other respects, the identical safety measures apply as in laparoscopy concerning the integrity of the specimen and cytological diagnosis.