Cyst removal
Cyst removal refers to the surgical procedure undertaken to eliminate fluid-filled sacs, known as cysts, from various parts of the body. While most cysts are benign, some may harbor cancerous cells, necessitating their removal based on specific indications such as type, location, and symptoms. Common types of cysts include Baker's cysts, Bartholin's gland cysts, ovarian cysts, sebaceous cysts, thyroglossal cysts, and breast cysts, each having distinct characteristics and treatment protocols.
For example, Baker's cysts, often linked to knee arthritis, may require surgical excision if conservative measures fail. Bartholin's cysts can be treated with antibiotics or catheter drainage, but may need to be surgically incised if they persist. Ovarian cysts are generally monitored unless they cause complications, such as twisting, where laparoscopic removal may be necessary. Sebaceous cysts, resulting from blocked glands, are usually removed in a physician’s office, while thyroglossal cysts necessitate surgery to prevent infection.
Breast cysts can often be managed through drainage if they are persistent. The objectives of cyst removal include alleviating discomfort, preventing infection, and ensuring the surrounding organ functions remain intact. However, potential complications such as bleeding, damage to nearby structures, and recurrence can occur, alongside specific risks associated with the type of cyst being removed.
Subject Terms
Cyst removal
Anatomy or system affected: Breasts, genitals, glands, joints, reproductive system, skin
Definition: A surgical procedure to remove a fluid-filled nodule, performed in a physician’s office or a hospital, depending on the type and location of the cyst
Indications and Procedures
Many types of cysts can develop in the body. Most of them are noncancerous, although in rare cases, small areas of cancerous tissue may be found within a cyst. The indications and procedures for removing cysts depend on the type of cyst, its location, and whether it is causing symptoms. Examples of common types of cysts are Baker’s, Bartholin’s, ovarian, sebaceous, thyroglossal, and breast cysts.
Baker’s cysts are small lumps that form behind the knee. Fluid-filled sacs found around joints, known as "bursas," normally protect the moving joint from causing damage to overlying skin, tendons, and muscles. When the bursas behind the knee accumulate excess fluid, they can expand and form a Baker’s cyst. This fluid accumulation often occurs if the knee is arthritic. Physicians usually apply pressure bandages to reduce the bursal swelling. If this does not work, the cyst must be excised surgically.
Bartholin’s gland cysts are formed when the Bartholin’s glands found in the external female genitalia (specifically the vulva) become occluded and swollen with fluid. Infections can occur in the ducts of these glands, causing pain and scarring. Bartholin’s cysts are treated with conservative measures, such as warm water soaks, antibiotics, and placement of a catheter, which continuously drains the cyst. If these methods fail, the cyst may be incised in the operating room and then marsupialized, a procedure that sutures the inner cyst wall to the vulval skin and keeps the cyst open and draining.
Ovarian cysts do not usually need to be removed, and many of them are physiologic and come and go with the menstrual cycle. When an ovarian cyst becomes large (greater than 6 centimeters in diameter), it may cause the ovary to twist, a condition called "ovarian torsion." A twisted ovary is at risk for necrosis since its blood supply is cut off. In this case, the ovarian cyst needs to be removed. Other reasons for removing an ovarian cyst include a cyst that is persistent and growing with time and a cyst with characteristics upon ultrasound examination that suggest malignancy.
If an ovarian cyst is thought to be noncancerous, it can usually be removed through the abdomen using a laparoscope. The laparoscope enables visualization of the cyst, while manipulation of the ovary and cyst is accomplished through incisions and tools placed on the sides of the abdomen. The cyst is usually shelled out from the remainder of the ovary using blunt dissection, and the remaining ovary is inspected for areas of bleeding, which may be cauterized. Many patients do not need to be hospitalized if the surgery is straightforward. If there is a concern about cancer within an ovarian cyst, open abdominal surgery is indicated. In this case, the abdomen is opened surgically, and the cyst is removed, along with any other abnormal-appearing tissue surrounding the cyst.
A sebaceous cyst may develop when a duct from a sebaceous gland in the skin becomes blocked, and the oily fluid is unable to escape. These glands, which are associated with hair follicles, secrete sebum to lubricate the hair and skin. If the sebaceous cyst is very large or infected with bacteria, surgical removal is usually indicated. This operation can be done in a physician’s office under local anesthesia. A small incision is made in the skin, and the entire cyst is removed or drained. The complete wall of the cyst is removed to prevent recurrence. A few sutures are usually placed to close the wound.
Thyroglossal cysts usually arise because of a congenital defect in which the duct that connects the base of the tongue to the thyroid gland fails to disappear. If a cyst develops in this area, a noticeable swelling will occur above the thyroid cartilage (Adam’s apple). This cyst nearly always becomes infected and thus should be removed surgically. This procedure involves an incision just above the thyroid cartilage and gland. The surgeon separates surrounding tissue up to the base of the tongue to gain access to the cyst. The cyst can be removed, and the skin sutured.
Breast cysts are common and can come and go with the menstrual cycle. They are usually detected as a breast lump on physical examination. If they are persistent, they can be visualized on ultrasound (or mammogram) to confirm that they are fluid-filled (rather than solid, which could be indicative of cancer). Breast cysts can be drained using a needle and the fluid sent for pathological analysis. If the fluid is benign, no further procedures are indicated.
Uses and Complications
The uses of cyst removal, in general, are to relieve pain and discomfort, minimize the chance of infection, and preserve the normal anatomy and function of surrounding organs. The cyst can be sent for pathological analysis after it is removed to determine if any portions suggest cancer.
Complications common to all cyst removal procedures include bleeding at the removal site, damage to surrounding organ structures during the excision process, and risk of infection as foreign instruments are introduced into the field. Another potential complication is the recurrence of cysts, necessitating further intervention. Additionally, each type of cyst removal has its own specific risks. For instance, thyroglossal cyst removal surgery may inadvertently remove thyroid tissue, which can lead to thyroid hormone deficiency and the need for thyroid medication for hormone replacement.
Bibliography
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Kasper, Dennis L., et al., eds. Harrison’s Principles of Internal Medicine. 21st ed., 2 vols. McGraw-Hill, 2022.
McPhee, Stephen J. et al. Current Medical Diagnosis & Treatment 2023. 62nd ed., McGraw-Hill Medical, 2023.
Moynihan, Timothy J. "Tumor vs. Cyst: What's the Difference?" Mayo Foundation for Medical Education and Research, 22 July 2023, www.mayoclinic.org/diseases-conditions/cancer/expert-answers/tumor/faq-20057829. Accessed 25 July 2023.