Overview:
Massive ovarian cysts (MOCs) are rare tumours of the ovary presenting with diameters greater than 10 cm. Ovarian cysts are generally asymptomatic at early stages causing symptoms only after reaching enormous dimensions, and consequently they are often diagnosed late. The clinical symptoms of ovarian cysts are usually progressive abdominal distension, nonspecific diffuse abdominal pain, vaginal bleeding and symptoms related to organs compression such as constipation, early satiety, vomiting and frequent micturition. The actual incidence of MOCs in postmenopausal women is unknown since good imaging modalities now lead to early diagnosis and removal before they develop into huge intra-abdominal masses. Majority of MOCs are benign and are generally treated by surgical excision. In this article, we discuss Antai’s highly specialised surgery MOC removal during pregnancy, in which the cyst poses significant threat to foetal development.
Antai Hospital has the medical technology and expertise to surgically remove massive ovarian cysts found during a pregnancy. Generally, large ovarian cysts are teratomas (ovarian dermoid cysts), where they can grow up to several kilograms and larger than the fetus itself.
The surgery’s main goal is:
- To remove the cyst safely and completely, without damaging or removing the ovaries.
- Make sure the pregnancy can be maintained/saved.
Once the ovarian cysts are removed, there will be:
- More room for optimal fetal and uterine growth throughout the remainder of pregnancy.
- Relief of the massive pressure in the abdominal cavity.
If left untreated, your pregnancy will most likely result in a late miscarriage or preterm birth, as the massive cyst will grow even bigger overtime: take up more space in the uterine cavity and absorbing more nutrients, affecting the fetal growth.
Conventional treatment of these massive ovarian cysts is by either recommending artificial abortion first then undergoing treatment or by directly removing the affected ovary (Oophorectomy), which is detrimental for the reproductive and holistic health of the patient and carries several lifelong side effects such as premature menopause.
Indications
This treatment is specific for pregnant women who have massive ovarian cysts that is endangering the growth of the fetus, which may cause a potential late miscarriage or preterm birth.
Due to the complexity and high risk of the procedure, patient and spouse must have a strong intention to save the pregnancy ie: They are currently old age and this likely is their final pregnancy, couples who finally conceived after struggling with infertility for many years etc; and they must also be mentally prepared in case of adverse outcome.
Treatment Method (The Removal Process)
- Suction to empty liquid contents of the ovarian cysts.
- Antai Hospital uses 3D-Laparoscopy to surgically remove the teratoma or cysts growing on the ovaries, causing no scarring and minimal secondary damage to the organs.
- The abdomen cavity will not be filled with CO2 gas due to the already immense pressure in the cavity.
- Due to the presence of the fetus in proximity, surgery must be conducted carefully and precisely.
Notes:
- This surgery is an experimental procedure. Although Antai has had previous success with this treatment, we cannot provide any guarantee of success. Patients must provide full informed consent before undergoing treatment.
- Due to the technical and complex nature of the procedure, the surgeons involved must be highly skilled and mentally capable.
- A comprehensive pre-surgery meeting to discuss all possible outcomes, determine the nature of the cysts (benign or malignant), patient’s medical history, pathology, and surgical challenges must be conducted.
- Surgeons will administer uterine contraction inhibition medications (Atosiban, MgSO4 etc) to prevent any contractions during the surgery