Emergency removal of an ovarian cyst is usually necessitated because of either severe pain or hemorrhage. In either case, the cyst can often be “shelled out” from the ovary allowing ovarian conservation. With most cysts, there is a very nice dissection plane between the cyst and the ovary that will allow you to quickly and easily separate the cyst from the ovary.
After removal of the cyst, close the ovary in two layers – a deeper layer to assure hemostasis, and a second superficial layer to approximate the edges of the ovarian capsule.
In the case of endometriosis, surgical dissection planes are less clear and removal of just the cyst is more difficult. Usually, the chocolate cyst ruptures while you are trying to remove it. Just do the best you can and remember:
- You will probably not cure the endometriosis surgically, no matter how much you remove.
- Take care of the problem you came to fix (hemorrhage, torsion, etc.) and leave the rest to medical therapy.
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