Minimally Invasive Laparoscopic Management of a Huge Ovarian Cyst: A Clinical Case and Literature Review

Introduction: Pelvic masses affect up to 20% of women during their lifetime and encompass a spectrum of gynecologic and nongynecologic conditions.Adnexal masses-located in the fallopian tubes, ovaries, and adjacent adnexal structures-are predominantly benign.Ovarian cysts represent one of the most common gynecologic pathologies across all age groups and may be either benign or malignant.The most frequently encountered benign entities include simple serous (functional) cysts and endometriotic cysts, approximately 60% of cases are benign serous cysts, 25% are malignant, and 15% exhibit borderline malignant potential. Case presentation:We present a 25-year-old nulliparous patient.For one month she had experienced a sensation of heaviness and discomfort in the lower abdomen (below the umbilicus).On inspection of the abdomen there was visible distension, with the abdominal contour rising above the level of the umbilicus.Ultrasonography showed a right ovarian cyst with hypoechoic contents, without a solid component and without intracystic papillary projections.The sonographic features suggested a benign lesion.The cyst measured 20 × 17 × 13 cm on ultrasound.Based on the ultrasound images and the normal tumor marker level, a minimally invasive approach was considered most appropriate for this patient.Insufflation with carbon dioxide and creation of the pneumoperitoneum were performed via Palmer's point, the camera trocar was introduced through the Lee Huang point.The cyst contents were aspirated using a puncture needle, which allowed improved visualization of the pelvic anatomy.Following decompression of the cyst and reduction of its volume, visualization of the peritoneal cavity is markedly improved.Approximately 6 liters of clear serous fluid were drained from the cyst cavity.Following decompression, and considering the patient's nulliparity and desire to preserve fertility, the cyst was carefully dissected with its capsule, maximizing preservation of healthy ovarian tissue.Discussion: Surgical management is recommended for ovarian cysts exceeding 5 cm in diameter because of the increased risk of complications.Open-entry laparoscopy access to the peritoneal cavity is commonly achieved via a minilaparotomy.This open-entry approach enhances safety by obviating blind needle or sharp trocar insertions (e.g., Veress needle), thereby reducing the risk of major vascular or bowel injury.This technique is particularly advantageous in patients with suspected intra-abdominal adhesions or a history of prior laparotomy, where blind entry is associated with elevated risk.In our case, a screw-type trocar was inserted under direct laparoscopic (camera) visualization.Conclusion: Laparoscopic management of huge benign ovarian cysts is a safe and effective alternative to laparotomy when appropriate patient selection is applied.Compared with the open approach, laparoscopy does not appear to increase perioperative complication rates and offers clear advantages including shorter hospital stay, faster postoperative recovery, and the potential for ovarian-sparing surgery -a critical benefit for reproductive age patients desiring future fertility.