Key-Hole Surgery for Fibroids and Ovarian Cysts

What is keyhole surgery?

Keyhole surgery, also known as laparoscopic surgery, is a minimally invasive surgical technique.

Rather than making one large incision across the abdomen, the surgeon makes several small incisions. A narrow camera called a laparoscope is inserted through one of these openings, allowing the surgeon to see the pelvic organs on a high-definition screen.

Specialist surgical instruments can then be introduced through the other small incisions to carry out the procedure.

Laparoscopy is performed under a general anaesthetic, so you will be asleep and will not feel the operation.

For suitable patients, laparoscopic surgery can result in smaller scars, less postoperative discomfort and a faster recovery than traditional open surgery.

What is the difference between a fibroid and an ovarian cyst?

Although both can appear as growths or masses on scans, fibroids and ovarian cysts are very different conditions.

Fibroids

Fibroids are non-cancerous growths of muscle tissue arising from the womb (uterus).

They can vary considerably in size, number and location. Some women have no symptoms at all, while others experience:

• Heavy or prolonged periods
• Bleeding between periods
• Pelvic pain or pressure
• Abdominal swelling or bloating
• Lower back pain
• Frequent urination or pressure on the bladder
• Pain during sex
• Difficulties becoming pregnant

Treatment depends on the size, number and position of the fibroids, the severity of symptoms and whether you wish to become pregnant in the future.

Ovarian cysts

An ovarian cyst is a fluid-filled sac that develops on or within an ovary.

Many ovarian cysts are related to the normal menstrual cycle and disappear without treatment. Others can persist, become large or cause symptoms.

Symptoms may include:

• Pelvic or abdominal pain
• Bloating or abdominal swelling
• Pain during sex
• Changes to your periods
• Pressure on the bladder or bowel
• Difficulty becoming pregnant

Surgery may be recommended when a cyst is large, persistent, symptomatic or has features that require further investigation.

When might keyhole surgery be recommended?

Not every fibroid or ovarian cyst requires surgery.

Your specialist will first consider whether monitoring, medication or another treatment is more appropriate.

Surgery may be considered when:

• Symptoms are persistent or significantly affecting your quality of life
• A fibroid is large or causing pressure symptoms
• Fibroids are contributing to heavy menstrual bleeding
• A fibroid may be affecting fertility
• An ovarian cyst is large or persistent
• An ovarian cyst is causing significant pain or other symptoms
• The appearance of a cyst or fibroid requires surgical assessment
• Previous treatment has not provided sufficient relief

The decision is individualised. The fact that a fibroid or cyst has been identified does not automatically mean that it needs to be removed.

Keyhole surgery for fibroids

The surgical procedure used to remove fibroids while preserving the womb is called a myomectomy.

A laparoscopic myomectomy involves removing suitable fibroids through small abdominal incisions while leaving the womb in place.

This can be an important option for women who wish to preserve their fertility or retain their uterus.

However, laparoscopic myomectomy is not suitable for every fibroid. The number, size and position of the fibroids are important considerations when deciding whether they can safely be removed using a keyhole approach.

For some patients, an open abdominal myomectomy may be more appropriate.

Your consultant will explain which approach is safest and most likely to achieve the desired outcome.

Keyhole surgery for ovarian cysts

The surgical removal of an ovarian cyst is known as an ovarian cystectomy.

Where appropriate, this can be performed laparoscopically.

The aim is often to remove the cyst while preserving as much healthy ovarian tissue as possible.

Whether this is achievable depends on the size and type of cyst and how much normal ovarian tissue remains.

In some circumstances, it may be necessary to remove part or all of an ovary. Your surgeon will discuss this possibility with you before surgery, particularly where there is concern that the cyst may not be benign.

Can keyhole surgery preserve my fertility?

For many women, preserving fertility is an important part of deciding whether and how to have surgery.

Where medically appropriate, the surgical plan can be designed with fertility preservation in mind.

With fibroids

A myomectomy removes the fibroid while leaving the womb in place.

This may be considered for women who wish to become pregnant in the future, although the effect of fibroid removal on fertility depends on the individual circumstances and location of the fibroids.

With ovarian cysts

Where an ovarian cyst needs to be removed, the surgeon will generally aim to preserve healthy ovarian tissue where possible.

However, some cysts can involve or replace a significant proportion of an ovary. In these circumstances, removing the entire ovary may sometimes be necessary.

If one ovary is removed, the remaining ovary will usually continue to function.

If fertility is important to you, make sure this is discussed before surgery so that it can form part of the treatment planning process.

What happens before keyhole surgery?

Before recommending surgery, Mr Abu will assess your symptoms and review your previous investigations.

Depending on the problem, this may include:

• A detailed medical and gynaecological history
• Pelvic examination
• Transvaginal or abdominal ultrasound
• MRI in selected cases
• Blood tests
• Review of previous scans or treatment
• Assessment of your fertility plans

For ovarian cysts, the size and appearance of the cyst and whether you have been through the menopause are particularly important when deciding whether surgery is appropriate.

For fibroids, their size, number and location, together with your symptoms and fertility plans, help determine the most appropriate treatment.

Your consultant will explain the options available and why a particular approach is being recommended.

What happens during keyhole surgery?

Laparoscopic surgery is performed under general anaesthetic.

Once you are asleep:

• A small incision is usually made near the belly button.
• The abdomen is gently inflated with carbon dioxide gas to create space for the surgeon to work.
• A laparoscope is inserted so the surgeon can see the pelvic organs.
• Additional small incisions are made for the surgical instruments.
• The fibroid or ovarian cyst is carefully removed.
• The surgical area is checked before the instruments are removed.
• The gas is released and the small incisions are closed.

The exact procedure will depend on what is being treated and what your surgeon finds during the operation.

What if the fibroid or cyst is too large for keyhole surgery?

Keyhole surgery is not always the safest or most appropriate option.

A larger fibroid or ovarian cyst may require an open operation, known as a laparotomy, which involves a larger abdominal incision.

With ovarian cysts, open surgery may be recommended when a cyst is particularly large or when there is concern that it could be cancerous.

Similarly, the size and position of fibroids can make an open myomectomy more appropriate than a laparoscopic procedure.

Choosing open surgery does not mean that treatment has been unsuccessful. The priority is always to use the safest approach that provides appropriate treatment.

What if there is a concern about cancer?

Most fibroids are benign and most ovarian cysts are not cancerous.

However, some ovarian cysts or pelvic masses can have features that require further investigation.

If there is a significant concern about cancer, a standard laparoscopic cyst-removal procedure may not be appropriate. Your specialist may recommend a different surgical approach that allows the mass to be removed safely without compromising cancer treatment.

This is particularly important because some techniques used to remove tissue during laparoscopic fibroid surgery, such as power morcellation, have specific safety considerations where an undiagnosed cancer could potentially be present. NICE recommends specific precautions and patient selection for laparoscopic fibroid removal involving power morcellation.

Your surgeon will discuss the risks and alternatives with you before surgery.

What are the benefits of keyhole surgery?

Where laparoscopic surgery is appropriate, potential benefits compared with open surgery can include:

• Smaller abdominal incisions
• Less visible scarring
• Less postoperative pain
• Reduced impact on the abdominal wall
• Shorter hospital stay
• Earlier return to normal activities
• Faster recovery

Most people undergoing straightforward laparoscopy can go home on the same day or the following day, although this varies depending on the operation and individual recovery.

It is important to remember that these benefits only apply when keyhole surgery is clinically appropriate.

What are the risks of keyhole surgery?

Laparoscopic surgery is generally safe, but every operation carries risks.

Potential complications include:

• Bleeding
• Infection
• Blood clots
• Injury to the bowel, bladder, ureters or blood vessels
• Damage to surrounding organs
• Anaesthetic complications
• Wound problems
• Formation of adhesions
• The need to convert to open surgery

With ovarian cyst surgery, there may also be a risk of damaging healthy ovarian tissue or needing to remove the ovary.

With fibroid surgery, there can be significant bleeding and, rarely, a need to remove the womb if serious bleeding or another unexpected complication occurs. Fibroids can also recur following myomectomy.

Your individual risks will depend on the size and location of the fibroid or cyst, your previous surgery and your general health.

Does previous abdominal surgery affect whether I can have keyhole surgery?

Previous surgery does not automatically prevent you from having laparoscopic surgery.

However, previous operations can result in adhesions, areas of internal scar tissue that can cause organs to stick together.

Extensive adhesions can make laparoscopic surgery more technically difficult and may increase the risk of injury to surrounding structures.

Your previous surgical history will therefore be considered when deciding whether keyhole surgery is appropriate for you.

What is recovery like?

One of the major advantages of keyhole surgery is the potential for a quicker recovery compared with open abdominal surgery.

Immediately after your operation, you may experience:

• Abdominal discomfort
• Bloating or cramping
• Tiredness
• Mild nausea
• Bruising around the small incisions
• Shoulder-tip pain caused by the carbon dioxide gas used during surgery

These symptoms generally improve as you recover.

You will usually be encouraged to get up and move around soon after surgery to help reduce the risk of blood clots and support your recovery.

The time needed before returning to work and normal activities depends on the procedure you have had. Although some women recover relatively quickly, more extensive laparoscopic surgery can take several weeks to fully recover from.

Your surgeon will provide individual advice about driving, exercise, work, lifting and sexual activity.

When should I seek medical advice after surgery?

Most women recover without significant problems.

However, you should seek medical advice if you develop:

• Severe or worsening abdominal pain
• Heavy vaginal bleeding
• A high temperature or fever
• Increasing redness, swelling or discharge around an incision
• Persistent vomiting
• Difficulty passing urine
• Shortness of breath or chest pain
• A painful or swollen leg

These symptoms can indicate an infection, bleeding, blood clot or another complication and should be assessed promptly.

Will removing my fibroids or ovarian cyst improve my symptoms?

The purpose of surgery is to treat the specific problem identified and, where appropriate, improve symptoms.

For women with symptomatic fibroids, removal may improve problems such as heavy bleeding, pelvic pressure or pain.

For ovarian cysts, removing a symptomatic cyst may relieve pain or pressure caused by the cyst.

However, the outcome depends on the underlying condition. If your symptoms are caused by more than one condition, removing a fibroid or cyst may not resolve every symptom.

Your consultant will discuss what you can reasonably expect from surgery before you make a decision.

Are there alternatives to keyhole surgery?

Yes.

Surgery is not always necessary, and keyhole surgery is not the only surgical approach.

Depending on your diagnosis, alternatives may include:

• Monitoring and follow-up scans
• Medication
• Hormonal treatments
• Uterine artery embolisation for selected fibroids
• Hysteroscopic treatment for fibroids within the womb cavity
• Open abdominal surgery
• Hysterectomy in appropriate circumstances
• Observation of ovarian cysts that are likely to resolve naturally

For fibroids measuring 3cm or more, NICE recommends specialist assessment to discuss treatment options, taking into account the size, location, number of fibroids, symptoms and reproductive plans.

For ovarian cysts, treatment depends particularly on the cyst's size and appearance, symptoms and whether you have been through the menopause. Many cysts do not require surgery.

Specialist keyhole surgery at Gynae Solution

Choosing surgery can feel daunting, particularly when you are worried about pain, recovery, fertility or the possibility of needing a larger operation.

At Gynae Solution, the aim is to provide clear, individualised advice so that you understand both the benefits and limitations of each treatment option.

Mr Jafaru Abu has a specialist interest in minimally invasive gynaecological surgery, including laparoscopic treatment for fibroids and ovarian cysts. Gynae Solution also highlights his experience in advanced laparoscopic procedures and single-incision laparoscopic surgery for selected patients.

Where keyhole surgery is appropriate, the goal is to treat the underlying condition while minimising surgical trauma and supporting your recovery.

Most importantly, the operation will be planned around you: your symptoms, your health, your fertility wishes and the nature of your fibroid or ovarian cyst.

Discuss your options

If you have been diagnosed with fibroids or an ovarian cyst and have been told that you may need surgery, a specialist consultation can help you understand your options.

Book a consultation with Mr Abu to discuss whether keyhole surgery could be an appropriate treatment for your fibroids or ovarian cyst.

Patient leaflets

Written for patients, relatives and hospital personnel, to read before your operation and to keep afterwards.

See all patient leaflets

Related services

• Fibroids
• Ovarian cysts
• Endometriosis
• Menstrual disorders
• Hysteroscopy
• Pelvic pain
• Total laparoscopic hysterectomy

See all conditions and treatments

Common questions