Doctors Hospital surgeons remove record size cyst

Doctors Hospital surgeons remove record size cyst

By Lindsey Turnbull

In early March, two Cayman doctors removed an ovarian cyst measuring 36cm x 28cm from a 42-year-old patient at Doctors Hospital which they believe was one of the largest ovarian cysts to be removed using laparoscopic surgery. This type of surgery, also known as keyhole surgery, allows surgeons to access the inside of the abdomen via small tubes without the need to make large incisions.

Obstetrician and Gynaecologist Surgeon Dr Sarath de Alwis led the surgery and was assisted by Dr Darley Solomon.

Dr Solomon gave some background: “This was a 42-year-old mother of two who presented with a gradually enlarging abdomen over about a year. She had difficulty breathing and was most uncomfortable. She had severe abdominal pains associated with heavy irregular bleeding, due to fibroids. Clinically the physical examination was unremarkable, except the enormous mass, extending from the pubic symphysis to the Xiphisternum (ribcage). She could not afford a CT scan. The ultrasound revealed an enormous mass which was compressing the ureters. The liver was normal and her cancer markers were negative.”

Dr de Alwis added: “The patient had almost four litres of fluid in the endometriotic cyst,” Dr de Alwis advised.

Dr de Alwis said the patient was also embarrassed about the size of the mass, which made her look as if she was about nine months’ pregnant. The patient was therefore in desperate need of surgery and, even though she was without the funds needed to pay for this type of surgery, the doctors agreed to perform the operation free of charge.

In the end, the patient required a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy performed by the doctors, with Dr Johannes Wejbora the anaesthetist.

“This was one of the biggest ovarian cysts ever removed in this way,” Dr de Alwis confirmed. “Such large cysts are generally also associated with multiple fibroids, as was the case with this patient, so the uterus was also removed laparoscopically as well. This was the first enormous ovarian cyst to be removed, with the added complication of multiple fibroids, making it more difficult.”

The cyst was bigger than one removed via laparoscopy that was recorded in the American Journal of Obstetrics and Gynaecology, which, at the time (1996), set a record at 24cm x 10cm x 20cm.

Dr de Alwis said he was pleased to report that the operation was fully successful and the patient was able to go home in less than 24 hours.

“I am delighted to say that the patient visited me at the surgery just a short time later and she arrived unaided and looked in great health,” he confirmed. “We are very pleased that we were able to conduct such an important surgery using laparoscopic surgery which meant minimum invasion for the patient and therefore a quicker recouperation.”