Having performed laparoscopic surgery for over 20 years, Mr. Trehan is one of the most experienced laparoscopic surgeons in the country. Mr. Trehan has demonstrated that all ovarian cysts can be successfully removed via laparoscopic (keyhole) surgery no matter how large they are, even if the patient is pregnant. Further, he has demonstrated that the cyst can always be separated from the ovaries, and hence there is no need to remove the ovaries themselves; just the cyst must be removed. Mr. Trehan’s complication rates are amongst the lowest reported in the medical literature, and patients frequently travel from across the world in order to have ovarian cyst removal surgery with Mr. Trehan.
Ovarian cysts are swellings which present on the ovary. There a wide variety of different types of ovarian cysts, each with different causes, the most common of which are described below:
- Follicular cysts. Usually, follicles within the ovary rupture, thereby releasing an egg (ovum). However, in some instances, the follicle may fail to rupture and continues growing, thereby forming a follicular cyst.
- Corpus luteum cysts. After the follicle ruptures and releases the egg (ovum), a corpus luteum forms which releases hormones. In some instances, fluid may abnormally accumulate within the corpus luteum, forming a cyst.
- Dermoid cysts are formed from eggs which despite not being fertilized by sperm, begin to pathologically divide and develop into masses which may possess characteristic human tissues such as fat, bone and hair.
- Cystadenomas which are formed from abnormal growth of the cell layer covering the ovaries. They may be either “serous” (containing a clear water like fluid) or “mucinous” (containing a thick, viscous fluid). Mucinous cystadenomas are potentially most severe as they can grow extremely large.
- Endometriomas (chocolate cysts) which may be present in endometriosis (see endometriosis page)
- Polycystic ovaries (see polycystic ovary syndrome page)
Most ovarian cysts are asymptomatic, however they may cause pain and other symptoms if they are particularly large, rupture, undergo torsion or become infected and hence may need surgical removal. Endometriomas and polycystic ovaries significantly reduce fertility, however most other types of ovarian cysts do not effect fertility.
Removal of an ovarian cyst is known as a cystectomy. During this procedure, the cyst is specifically separated from the ovary and then removed from the pelvic cavity. During the removal of a dermoid cyst, particular care must be taken in order to prevent material leaking into the pelvic cavity and they are hence placed into a bag prior to removal from the pelvic cavity.
Mr. Trehan has demonstrated that no matter how large the ovarian cyst, the ovarian cyst itself can always be removed whilst leaving the ovaries themselves in tact. This is particularly important in patients with bilateral ovarian cysts (ie. cysts on both ovaries), as removal of both ovaries (bilateral oophorectomy) is associated with a variety of adverse irreversible and long term effects:
- Since the ovaries are responsible for producing the ovum (egg), by removing the ovaries, permanent infertility occurs and patients will never be able to conceive.
- The ovaries are responsible for producing the sex hormones oestrogen and progesterone. Further, even after natural menopause, the ovaries produce significant quantities of the male hormones androstenedione and testosterone which are converted to oestrogen in the female body, and these hormones are important for a woman’s health. Since a bilateral oophorectomy results in a loss of these hormones, it causes:
- Early menopause resulting in menopausal symptoms (hot flashes, night sweats, lack of sleep, vaginal dryness resulting in painful sex, depressed mood, lethargy/irritability, impaired body self image). Unlike natural menopause, these changes caused by a bilateral oophorectomy are abrupt and dramatic due to the sudden loss in ovarian hormones.
- A variety of deleterious effects on a woman’s long term health including an increased risk of: premature death, cardiovascular disease, cognitive impairment or dementia, Parkinson’s disease, osteoporosis and bone fractures, a decline in psychological well-being and a decline in sexual function.
- In order to try and mitigate some of these deleterious effects of a bilateral oophorectomy, Hormone Replacement Therapy (HRT) is usually prescribed, especially in young patients. However, studies have shown that long term HRT use significantly increases the risk of cardiovascular disease, strokes, deep vein thrombosis (DVT – clots in the legs) resulting in pulmonary embolism (potentially fatal clots which migrate to the lungs) and breast cancer.
For these reasons, in Mr. Trehan’s opinion, under no circumstances should a woman’s ovaries be removed in order to treat ovarian cysts; even if a cyst is present only on one ovary, future problems with the remaining ovary can result in the above problems. By completely separating the cyst from the ovarian tissue and reconstructing the ovarian tissue, the cyst can be completely removed whilst normal ovarian hormone and egg production can be retained.
Thirteen photographs taken by Mr. Trehan during the laparoscopic removal of a large dermoid cyst are shown below:
In addition, twelve photographs taken by Mr. Trehan during the laparoscopic removal of large (greater than 10cm in diameter) dermoid cysts on both ovaries in the same patient (ie. bilateral dermoid cysts) are shown below:
A peer-reviewed journal paper published by Mr. Trehan which described a case in which he removed of a large ovarian cyst during pregnancy can also be viewed by clicking here.
Mr. Trehan performs all benign gynaecological procedures, including cystectomies via laparoscopic (keyhole) surgery as it is associated with less post-operative pain and complications, a quicker recovery and a far superior cosmetic appearance when compared to laparotomy (open surgery). Mr. Trehan’s patients can be confident that their operation will be completed by keyhole means as Mr. Trehan’s conversion to laparotomy rate is amongst the lowest in the medical literature, as are his major complication rates, reoperation rates and readmission rates. Further, over 90% of Mr Trehan’s patients are able to leave the hospital after just an overnight stay in hospital.
For information on making an appointment with Mr. Trehan, please click here.