OT notes · Gynaecology

Marsupialisation of Bartholin cyst / abscess

Usual anaesthesia
Local infiltration with sedation, spinal, or short general anaesthesia
Position
Lithotomy
Setting
elective

Operative note template for marsupialisation of a Bartholin cyst, with a filled example for a recurrent symptomatic left Bartholin cyst under spinal anaesthesia.

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Blank template

Follow this order in the case sheet. Tick the options that apply and fill the blanks.

Patient and case

  1. Name / Age / Sex
  2. UHID / IP no. / Ward-Bed
  3. Date of surgery / OT no.
  4. CaseElectiveEmergency (non-elective)if emergency, state urgency and reason
  5. Timesin OT ___ anaesthesia start ___ incision ___ closure ___ out of OT ___

Team

  1. Operating surgeonname, designation
  2. Assistant(s)
  3. Supervising consultantpresent in OT / available / not applicable
  4. Steps done by the residentwhole procedure / named steps, under whose supervision
  5. Anaesthetist
  6. Scrub nurse / circulating nurse

Diagnosis and procedure

  1. Pre-operative diagnosis
  2. Post-operative diagnosis
  3. Procedure planned
  4. Procedure performedif different from plan, state why
  5. Extra procedure done and reason'none' if none. Only to save life or health if not consented

Consent and safety checks

  1. Informed consentGeneralProcedure-specificHigh-riskAnaesthesiain a language the patient understands: language ___ witness ___
  2. Site / side markedYesNot applicable
  3. WHO Surgical Safety ChecklistSign inTime outSign out
  4. Antibiotic prophylaxisdrug, dose, route, time given before incision
  5. VTE prophylaxisMechanicalPharmacologicalNot indicated

Risks to explain in the consent for this operation

  • recurrence of the cyst (up to 10 to 15%)
  • bleeding and haematoma
  • wound infection
  • pain and tenderness for a few days
  • scarring
  • need for excision of the gland later if it recurs
  • no intercourse for 3 to 4 weeks

Pre-operative details for this operation

  1. Side and sizeRightLeftsize in cm on examination
  2. Cyst or abscessChronic cyst, not inflamedAbscess / inflamedboth Te Linde books advise against marsupialisation in the acute infected phase. If done for an abscess, write why
  3. Previous episodes and treatmentnumber of recurrences, earlier I&D, Word catheter or marsupialisation
  4. Confirmed to be Bartholin glandposterolateral introitus at 4 or 8 o'clock, not labial or other vaginal cyst
  5. Age / menopausal statuspostmenopausal or over 40 with a recurrent or solid swelling: plan biopsy of the cyst wall
  6. Anticoagulantsstopped / not on any

Anaesthesia and position

  1. AnaesthesiaLocal + sedationSpinalGeneral (LMA)
  2. Local infiltrationdrug, strength, volume, site (medial labium minus / around the cyst)
  3. PositionLithotomy
  4. BladderEmptied with plain catheterVoided before

Operative findings

  1. Cystside, size in cm, fluctuant, any solid or hard area
  2. ContentsClear mucoid fluidTurbidPusBlood-stainedapproximate volume
  3. LoculationsNonePresent, broken down
  4. Cyst wallthin and smooth, or thickened / irregular (send biopsy)

Procedure (steps)

  1. Vulva and vagina prepared and drapedantiseptic used
  2. Examination under anaesthesiare-check size, side and extent
  3. Incisionsite (vaginal side of the hymenal ring, over the cyst), shape (vertical / elliptical), length. Aim about 2 to 3 cm so it does not close
  4. Vaginal mucosa separated from cyst wallinstrument used, e.g. mosquito forceps
  5. Cyst wall openedgrasped with toothed forceps and incised
  6. Contents drained, loculations broken, cavity irrigatedswab for culture if pus
  7. Cyst wall everted and sutured to vaginal mucosa / skinnumber of interrupted sutures, material and size, e.g. polyglactin 910 (Vicryl) 2-0, tied without tension
  8. Cyst wall biopsyNot neededTakentake in postmenopausal women or if the wall looks abnormal
  9. HaemostasisDry after suturingDiathermyAdditional suture

Closure, drains and dressing

  1. Size of opening leftin cm
  2. Pack / drain in cavityNoneGauze wickWord catheter
  3. DressingSterile perineal pad

Specimens and implants

  1. Pus / fluid for cultureSentNot sent
  2. Cyst wall for HPESentNot sentreason if sent

End of procedure

  1. Estimated blood lossml
  2. IV fluids and blood / products givenfluids (ml); blood: type, units, bag nos.
  3. Swab, needle and instrument countCorrectIncorrect: action taken
  4. Intra-operative complications / difficultieswhat happened and what was done; 'none' if none
  5. Implant stickersNo implantAffixed in case sheet, OT register and for discharge summary
  6. Condition at end of surgery / shifted toPACUWardICU/HDU

Post-operative orders

  1. Vitals and local bleedingpad check
  2. Voidingcheck the patient passes urine after spinal
  3. AnalgesiaNSAID and / or paracetamol: drug, dose, frequency
  4. Sitz bathswarm sitz baths, start after the first day or two
  5. Perineal hygienewash with lukewarm water after voiding and pat dry
  6. Pelvic restno intercourse for 3 to 4 weeks
  7. Antibioticsnot routine. Give only if pregnant, immunosuppressed, MRSA, recurrent abscess, or gonorrhoea / chlamydia
  8. Follow-upreview at 1 week to check the opening and healing. Culture / HPE report

Signature

  1. Name and designation of person writing note
  2. Medical Council registration no.
  3. Signature / date / time of writingwrite before the patient leaves recovery

Worked example

Fictional case: Mrs. P.D., 29 years, P1L1, with a 4 cm left Bartholin cyst causing pain on walking and dyspareunia, second recurrence after incision and drainage 8 months ago. No signs of acute infection.

Case details

Date: 14/05/2026. Elective marsupialisation of left Bartholin cyst. Minor OT.

In OT 11:30. Spinal given 11:36. Incision 11:48. Procedure ended 12:08.

Surgeon: Dr A. (2nd-year resident, OBGY). Assistant: Dr B. (1st-year resident). Consultant: Dr C.

Anaesthetist: Dr D. Scrub nurse: Sr E.

Indication and pre-op

Indication: recurrent symptomatic left Bartholin cyst, 4 cm, second episode after I&D. Non-tender, no redness, no fever.

Swelling at the 4 o'clock position of the introitus, posterior part of the left labium majus, typical of Bartholin gland. No solid component.

Not on anticoagulants. Hb 11.8 g/dl.

Consent: general, procedure-specific and anaesthesia consent taken in Hindi from the patient. Recurrence risk of 10 to 15% explained.

WHO checklist sign in and time out done.

Anaesthesia and position

Spinal anaesthesia. Lithotomy. Vulva and vagina painted with povidone-iodine and draped. Bladder emptied with a plain catheter.

Procedure

EUA: left Bartholin cyst 4 x 3 cm, cystic, no hard area. Right side normal.

2 ml of 1% lignocaine with adrenaline infiltrated at the medial side of the left labium minus.

2.5 cm vertical elliptical incision on the vaginal side of the hymenal ring over the cyst.

Vaginal mucosa separated from the cyst wall with mosquito forceps. Cyst wall held with toothed forceps and opened with a No. 15 blade.

About 15 ml of clear mucoid fluid drained. No loculations. Cavity irrigated with normal saline.

Cyst wall edges everted and sutured to the vaginal mucosa with 6 interrupted polyglactin 910 (Vicryl) 2-0 sutures, tied without tension.

Opening about 1.5 cm. Haemostasis secure, no diathermy needed.

Closure

No pack, no drain. Sterile perineal pad applied.

End of procedure

Estimated blood loss 20 ml. No transfusion.

Mop, needle and instrument count correct, confirmed by scrub nurse.

No intra-operative complications.

Specimens: none. Fluid clear, not sent for culture. Cyst wall normal, biopsy not taken (premenopausal, no solid area).

Shifted to post-operative ward in stable condition. Pulse 78/min, BP 112/70 mmHg.

Post-op orders

Pulse, BP and pad check every 30 min for 2 hours.

Oral fluids after 2 hours, normal diet by evening. Check that she voids after the spinal wears off.

Oral analgesic as charted. No antibiotics.

Warm sitz baths twice daily from day 2. Wash the area with lukewarm water after passing urine.

No intercourse for 4 weeks.

Discharge next morning. Review in OPD after 1 week.

Signature

Dr A., JR-2, OBGY. Reg. no. ________. 14/05/2026, 12:20.

Must document for this operation

  • Side, size and whether it was a cyst or an abscess. Marsupialisation is meant for a chronic cyst. If it was done on an inflamed gland, the note must say why, because early closure and recurrence are more likely.
  • Site and length of the incision (inside the hymenal ring). A small opening tends to close as it heals, and an incision outside the ring leaves a scar on the labium.
  • Number, size and material of the everting sutures. This shows a true marsupialisation was done and not a simple incision and drainage, which has a higher recurrence rate.
  • Nature of the contents and whether culture was sent. Pus with gonorrhoea or chlamydia risk needs treatment of the patient and partner.
  • Whether the cyst wall looked normal and whether a biopsy was taken. Bartholin gland carcinoma is rare but occurs in older women, and a missed solid area delays diagnosis.
  • Number of earlier episodes and treatments. Further recurrence after marsupialisation is an indication for excision, and the next surgeon needs this history.

Common mistakes in these notes

  • Writing 'I&D done' when sutures were placed, or 'marsupialisation done' when they were not.
  • Not recording the side.
  • Not documenting why no biopsy was taken in a woman over 40.
  • Leaving out the advice on sitz baths and pelvic rest.
  • Prescribing routine antibiotics without a listed indication.

Sources

  • Handa VL, Van Le L, eds. Te Linde's Operative Gynecology. 13th ed. Wolters Kluwer; 2024, Ch 17, Surgery for benign vulvar conditions (Sankey HZ, Burkman RT): Bartholin gland abscess and cyst (Word catheter, marsupialization, excision), e-book PDF pp. 878-890.
  • Cundiff GW, Azziz R, Bristow RE. Te Linde's Atlas of Gynecologic Surgery. Lippincott Williams & Wilkins; 2014, Ch 9, Marsupialization of Bartholin gland cyst (Solnik MJ), pp. 73-77.

Educational template for residents. Adapt it to your institution's case-sheet format and your consultant's instructions. Patient details in the example are fictional.

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