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Most ovarian cysts are benign, even in postmenopausal women. Laparoscopy is the procedure of choice in the opinion of AWHI. Even oncologist are using laparoscopy for early stage ovarian cancer.
Ovarian cysts are classified as simple and complex on ultrasound. Ultrasound is considered the appropriate initial imaging technology for pelvic problems. CT scans and MRI are not generally recommended by the American College of Obstetricians and Gynecologists. There are ultrasound findings that suggest an increased risk the cyst will be cancer. However no assessment can guarantee perfect results.
Simple cysts appear on ultrasound as round, black circles inside the ovary. Most of the time they go away on their own and are not present on follow up. A persistent simple cyst in a premenopausal woman is highly likely to be benign. If the cyst is causing problems or grows over time then it should be removed.
We treat almost every simple cyst with advanced laparoscopic surgery.
We suture and use cost effective instruments. Using a robotic platform for an ovarian cyst
would be more painful, more costly and unnecessary. A simple cyst in a postmenopausal
woman is also most probably benign. We draw a Ca 125. If it is negative
we do not need to do surgery unless there are symptoms.
Complex cysts have internal structures within the cyst
or the color of the fluid on ultrasound is grey instead of black.
In premenopausal women an elevated Ca 125 is not as concerning as it would be in a postmenopausal woman. Other ultrasound indicators of ovarian cancer are ascites and thick internal walls with increased blood flow.
At AWHI most postmenopausal women with either a simple or complex cyst are candidates for laparoscopic surgery. Almost all premenopausal women are treated laparoscopically.