- Stabilise and incise cyst wall
- Elevate the ovary with atraumatic graspers
- Make a small incision on the ovarian surface over the cyst bulge using monopolar hook or scissors
- Identify the correct plane between the cyst wall and ovarian cortex
- Dissect and enucleate the cyst
- Use traction and counter-traction to gently peel the cyst wall away from ovarian tissue
- Proceed carefully to avoid tearing the ovarian stroma
- Use suction to keep the field clear, especially if the cyst ruptures
- Remove the cyst intact if possible; if it ruptures, irrigate thoroughly
- Achieve haemostasis
- Use bipolar energy to cauterise small bleeding vessels on the ovarian bed
- Avoid excessive coagulation to preserve ovarian reserve
- Ovarian reconstruction
- Reapproximate ovarian edges with fine absorbable sutures (e.g. 4-0 Vicryl) if needed
- In small defects, approximation may not be required