Dermoid Cysts

You never knows the exact type of ovarian cyst 100% before surgery, but on ultrasound one can often diagnose a dermoid with a high probability. Best bet for two 5-6 cm. dermoids is surgery SOON. There is probably viable ovarian tissue left on one or both ovaries. If you wait too long and the cyst grows, the cyst can destroy the remaining viable ovarian tissue so that there is no alternative to removing the ovaries. If the dermoids are benign, removing the cyst and leaving the ovary is a good option. You should seek out a good reproductive surgeon (ob-gyn) —and make it clear that the very highest priority is preservation of the ovaries. Unless a surgeon is VERY adept at laparascopic suturing (often necessary to make a good closure of the ovary with laparoscopy to prevent adhesions- and many gyn surgeons do not know how to do this), a mini-laparotomy (a small incision opening the abdomen) in most surgeon’s hands will produce a better result. Totally removing the ovary via laparoscopy is not nearly as difficult – even though that isn’t what you want! Removing the cyst with a laparoscope is also an option, leaving it gaping open, but this is not as good as a good closure of the ovary! The outer layer of the ovaries (after the cystectomy) should be closed with a non-resorbable inactive suture such as proline. This is not a difficult operation to do well via mini-laparotomy. I would have a frank discussion with your potential surgeon about surgical technique and find someone who is not arrogant or insulted by this discussion. You may actually be better off with a more “ordinary” gyn who will listen to you rather than a reproductive surgeon who may try to convince you that not suturing their ovary closed after resecting the cyst is OK. (It isn’t as good for future reproduction). There is a very good chapter on closing the ovary in a new textbook by Dr.Thomas Hilgers. Someone could probably make this chapter accessible to you so that you and your surgeon could see it. Again, the technique is not difficult for an ordinary gynecologist.

M. Davenport, M.D.