Ovarian cysts, endometrioma, hydrosalpinx. Minimally invasive laparoscopic surgery, preserving fertility as much as possible.
A few figures to situate ovarian and tubal surgery.
Ovarian cysts, endometriomas, adnexal torsion, hydrosalpinx — all these ovarian and tubal conditions do not necessarily require surgery. The surgical decision depends on symptoms, evolution over time, and your fertility plans. Each situation is assessed individually.
There are two main categories. Functional cysts (90% of cases) are linked to the menstrual cycle — follicular cyst or corpus luteum cyst. They disappear spontaneously within a few weeks, without any intervention. Organic cysts do not regress on their own: the serous cyst (thin wall, clear fluid); the mucinous cyst (multilocular, thick fluid); the dermoid cyst or teratoma (contains fat, teeth, hair — benign but requires surgery); the serous or mucinous cystadenoma (benign epithelial tumour, can become very large); the borderline tumour (atypical cells, requires oncological management); and more rarely ovarian cancer (thick wall, vegetations, abnormal vascularisation, elevated markers — indications for specialised oncologic management). Surgery is indicated when the cyst persists, grows, is symptomatic, or appears suspicious on imaging (O-RADS ≥ 3).
An endometrioma is an ovarian cyst filled with menstrual blood, linked to endometriosis. It can cause significant pelvic pain and weaken the ovary by reducing its egg reserve. For a long time, it was systematically operated on. Today we know that classical surgery (cystectomy) always removes a small amount of healthy ovarian tissue around the cyst — which can reduce the chances of pregnancy, especially if the operation is repeated. This is why specialised centres now offer techniques that spare the ovary: plasma energy vaporisation, which destroys the inner wall of the cyst without touching the surrounding tissue, and ultrasound-guided sclerotherapy (ethanol sclerotherapy), particularly useful when the cyst recurs after a first operation or when the ovarian reserve is already weakened. Cystectomy still has its place for very large cysts or when there is doubt about the nature of the cyst. A fertility assessment (AMH measurement) is offered before any decision, and the question of egg freezing is systematically addressed.
Adnexal torsion is a surgical emergency. The ovary and/or tube twist on themselves, interrupting blood supply. Without prompt intervention, the ovary may become necrotic. The main sign is sudden and intense pelvic pain, often accompanied by nausea and vomiting. The operation is performed urgently by laparoscopy — the aim is to untwist the adnexa and preserve the ovary if possible. In case of suspected adnexal torsion in Paris, Hartmann Clinic has an operating theatre available for emergencies.
Hydrosalpinx is a dilated and obstructed Fallopian tube, filled with serous fluid. It is often the consequence of an old pelvic infection or endometriosis. It can impair fertility — particularly in the case of in vitro fertilisation, where it reduces success rates. Treatment is surgical: salpingectomy (removal of the tube) or salpingostomy depending on the case.
PCOS (polycystic ovary syndrome) — PCOS is often confused with ovarian cysts. It is a hormonal disorder that causes the appearance of many small follicles on the ovaries — these are not true cysts. It manifests as irregular cycles, acne, and may cause difficulty conceiving. Its management is medical, not surgical in the vast majority of cases.
Would you like fast-track care or a second opinion on the results of your pelvic ultrasound and/or pelvic MRI?
The discovery of an ovarian cyst or mass on ultrasound does not mean that surgery is necessary. Diagnosis relies on a structured imaging assessment, now codified by the O-RADS classification.
Endovaginal ultrasound with Doppler is the first-line examination. It characterises the mass: fluid or solid content, septa, vegetations, vascularisation. Each mass is classified according to the O-RADS US score (1 to 5), which reflects the risk of malignancy and guides further management.
When ultrasound is not sufficient to decide — complex cyst, large mass, uncertain result — a pelvic MRI with contrast is requested. It better characterises the nature of the mass and assesses the risk of malignancy. Its result is expressed as an O-RADS MRI score, recommended by the French National Cancer Institute, which directly guides the decision: surveillance, surgery, or oncological care.
For an organic cyst (persistent > 3 months) or one that appears suspicious on imaging, a biological workup is requested. CA-125, HE4 and the ROMA score (combining both based on menopausal status) are the reference markers.
Important: these markers do not diagnose cancer. They can be elevated in benign situations (endometriosis, fibroid, pregnancy, menstruation, peritonitis) and normal in some early cancers. Their role is to guide the surgical decision (diagnostic laparoscopy vs oncological multidisciplinary management) and to provide a baseline for subsequent monitoring in case of confirmed cancer, where their evolution mirrors the disease.
→ When in doubt, the case is systematically presented at a multidisciplinary oncology board (MDT) before any surgical decision. Learn more about ovarian cancer →
Do you have an ultrasound or MRI report with an O-RADS score ≥ 3, a suspicious cyst or an ovarian mass? Bring your results — we analyse them together in consultation to decide on the most appropriate management.
Some symptoms warrant a prompt consultation. A pelvic ultrasound can often clarify the situation within minutes. If your report mentions an O-RADS 3, 4 or 5 score, or a suspicious adnexal mass, a surgical opinion is recommended.
Almost all these operations are performed by laparoscopy — 3 to 4 small incisions on the abdomen, without opening the abdominal wall. Quick recovery, short hospital stay, discreet scars.
What it is. Cystectomy consists in removing the cyst by separating it from healthy ovarian tissue. The ovary is preserved. It is the reference operation for benign cysts in women of childbearing age.
For an endometrioma. Classical surgery (cystectomy) is increasingly avoided because it always removes a small amount of healthy ovarian tissue, which can reduce the chances of pregnancy — especially if the operation is repeated or if both ovaries are affected. In specialised centres, techniques that spare the ovary are preferred: plasma energy vaporisation, which destroys the inner wall of the cyst without touching the surrounding tissue, and ultrasound-guided sclerotherapy (ethanol sclerotherapy), particularly useful when the cyst recurs after a first operation or when the egg reserve is already weakened. Cystectomy still has its place for very large cysts or when there is doubt about the nature of the cyst. A fertility assessment is offered before any decision, and the question of egg freezing is systematically addressed.
When is the ovary removed? Adnexectomy (removal of the ovary and tube) is reserved for specific situations: suspicious cyst, ovary that cannot be preserved, or post-menopausal woman. It is not the default decision.
The recovery. Return home the next day or the same day depending on the case. Resumption of light activity within 1 week, sport after 3 to 4 weeks.
An absolute emergency. In case of adnexal torsion, every hour counts. The faster the intervention, the higher the chances of preserving the ovary. Emergency laparoscopy allows the adnexa to be untwisted and blood supply restored.
Is the ovary always preserved? The aim is to preserve it, even if the ovary appears necrotic to the eye — it often recovers after detorsion. Adnexectomy is performed only if the ovary is definitively non-viable.
And afterwards? If a cyst was at the origin of the torsion, it will be treated during the same operation or in a secondary intervention depending on the situation.
Why operate? A hydrosalpinx reduces IVF success rates — the fluid from the tube refluxes into the uterus and impairs embryo implantation. Salpingectomy (removal of the tube) significantly improves IVF success rates.
The contralateral tube. Removal of one tube does not prevent a natural pregnancy if the other tube is healthy. In case of an IVF plan in Paris, salpingectomy is discussed with your ART team before stimulation. In case of bilateral hydrosalpinx, IVF becomes the route to conception.
The recovery. Short procedure, often performed as day-case surgery. Resumption of normal activity within 5 to 7 days.
A question about the procedure that concerns you? Let's discuss it in consultation.
Laparoscopy allows rapid recovery. Timelines vary according to the extent of the surgical procedure.
A word on fertility. Any ovarian surgery can affect ovarian reserve, especially in case of endometrioma or repeated surgery. If you have a pregnancy plan, this point is discussed before the operation at Hartmann Clinic (Neuilly-sur-Seine) or at the Paris 8th practice — and an ovarian reserve assessment may be offered beforehand.
If your ultrasound shows a cyst with unusual features, or if your blood tests come back elevated, your doctor may be concerned about cancer. Don't panic: it's not a certainty, but it should be taken seriously.
Dr Zeitoun, surgical oncologist, manages these situations from start to finish — from diagnosis to surgery, working with a specialised oncology team.
Overview of the 3 main procedures on the ovary and tube.
| Criterion | Cystectomy | Adnexectomy | Salpingectomy |
|---|---|---|---|
| Procedure | Cyst removal only | Ovary + tube removal | Tube alone |
| Main indication | Benign cyst, young woman | Complex cyst, post-menopause | Hydrosalpinx, EP, prophylactic |
| Fertility | Preserved | Reduced (1 ovary) | Preserved (ovaries intact) |
| Surgical approach | Laparoscopy | Laparoscopy | Laparoscopy |
| Hospital stay | Day surgery | 1-2 nights | Day surgery |
| Return to activities | 7-10 days | 10-14 days | 7-10 days |
Bring your ultrasound results and your questions. We take the time to discuss them together.
Dr Zeitoun practises in French sector 2 (non-OPTAM) and applies fee supplements for all consultations and procedures. The French national health insurance (Assurance Maladie) reimburses on the basis of the Social Security tariff — this reimbursement is improved in case of cancer (ALD 30 long-term illness), but does not cover fee supplements. Your private health insurance (mutuelle) may cover all or part of these fee supplements according to your contract.