Minimally Invasive Approach to Ovarian Cyst Torsion: Laparoscopic Management and Outcomes

Introduction
Ovarian cyst torsion is a gynecological emergency that requires prompt diagnosis and intervention to preserve ovarian function. Traditionally, open surgery (laparotomy) was the standard approach, but advances in minimally invasive techniques have revolutionized management. Laparoscopic surgery now offers a safer, more effective, and faster recovery option for patients with ovarian torsion. This article explores the benefits, surgical techniques, and outcomes of laparoscopic management of ovarian cyst torsion.

Understanding Ovarian Cyst Torsion
Ovarian torsion occurs when an ovary twists around its supporting ligaments, compromising blood supply. This often results from an underlying ovarian cyst, which increases the ovary’s mobility. Symptoms include:
- Sudden, severe pelvic pain
- Nausea and vomiting
- Adnexal tenderness on examination
- Possible intermittent pain due to partial torsion

Early diagnosis through ultrasound with Doppler imaging is crucial to prevent ischemic damage and potential ovarian necrosis.

Laparoscopic Management
Laparoscopy has emerged as the preferred method for ovarian cyst torsion due to its minimally invasive nature. The procedure involves:

1. Diagnostic Confirmation: A laparoscopic camera is inserted to visualize the twisted ovary and assess viability.
2. Detorsion: The ovary is gently untwisted to restore blood flow. Contrary to previous beliefs, studies show that even ischemic-appearing ovaries can recover.
3. Cystectomy or Oophoropexy: If necessary, the cyst is removed while preserving ovarian tissue. In recurrent cases, oophoropexy (ovarian fixation) may be considered.
4. Oophorectomy (if nonviable): In cases where the ovary is necrotic, removal may be required, though efforts are made to preserve ovarian function whenever possible.

Outcomes and Benefits of Laparoscopy
Laparoscopic management offers several advantages over open surgery:
- Reduced postoperative pain
- Shorter hospital stays
- Faster recovery and return to daily activities
- Lower risk of infection and complications
- Higher ovarian preservation rates

Recent studies indicate that laparoscopic detorsion leads to ovarian function recovery in most cases, even when initial ischemic changes are observed. Fertility preservation is a key benefit, especially for younger patients.

Conclusion
Laparoscopic surgery has transformed the management of ovarian cyst torsion, offering a minimally invasive, effective, and fertility-preserving alternative to traditional open surgery. Early intervention and conservative management, whenever feasible, improve patient outcomes and quality of life. As surgical techniques continue to advance, laparoscopy remains the gold standard for treating ovarian torsion while prioritizing reproductive health.