OT notes · Gynaecology

Ovarian cystectomy (laparoscopic / open)

Usual anaesthesia
General anaesthesia (laparoscopic); regional or general for open cystectomy
Position
Low lithotomy with arms tucked for laparoscopy; supine for laparotomy
Setting
elective

Operative note template for laparoscopic or open ovarian cystectomy, with a filled example for a laparoscopic right dermoid cystectomy in a young woman.

Download printable PDFFree. Just log in with your Google (Gmail) account.

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

  • removal of the ovary (oophorectomy) if it cannot be saved or cancer is suspected
  • cyst rupture and spill of contents
  • unexpected cancer, which may need a second staging operation
  • reduced ovarian reserve after surgery
  • cyst coming back
  • adhesions around the ovary and tube
  • bleeding
  • bowel, bladder, ureter or blood vessel injury
  • conversion to open surgery

Pre-operative details for this operation

  1. Indicationsymptoms (pain, torsion, rupture) or persistent / enlarging cyst; side
  2. ImagingUSG / MRI: side, size, simple or complex, solid parts, Doppler flow, ascites, other ovary
  3. Assessment of cancer riskfeatures for and against malignancy; tumour markers if done; oncologist involved or not
  4. Pregnancy testNegative
  5. Consent for oophorectomy if neededTakenRefused (record)
  6. Fertility wishrelevant to how much ovary is conserved and energy use

Anaesthesia and position

  1. AnaesthesiaGeneral with ETTSpinal (open)
  2. PositionLow lithotomy, arms tuckedSupine
  3. Foley catheter and uterine manipulatormanipulator used or not, and why

Operative findings

  1. Cystside, size, surface (smooth / excrescences), intact or ruptured, adhesions
  2. Cyst contentsserous / mucinous / chocolate / sebaceous material with hair / blood
  3. Opposite ovary
  4. Tubes and uterus
  5. Peritoneum, omentum, liver surface, ascitesany deposits
  6. Endometriosissites and stage if present
  7. TorsionNonePresent: number of twists, colour before and after detorsion

Procedure (steps)

  1. AccessVeress at umbilicusOpen (Hasson) umbilicalPalmer's pointPfannenstiel laparotomyMidline laparotomy
  2. Portsnumber, size, site
  3. Peritoneal washingsTaken (volume) and sent for cytologyNot taken
  4. Survey of abdomen and pelvis, ureters identified
  5. AdhesiolysisNot neededDone (blunt / sharp)
  6. Containment bag under the ovaryUsedNot used
  7. Vasopressin into ovaryNot usedUsed (dilution, volume)
  8. Ovarian incisionsite, direction (along long axis), instrument (cold scissors / needle cautery)
  9. Cyst enucleationIntactRuptured, contained drainagePlanned drainage then strippingtraction and counter-traction, aqua-dissection
  10. Whole cyst wall removedYesNo: reason
  11. Haemostasis of ovarian bedNot neededMinimal bipolarSuture (material, size)Topical haemostat
  12. Specimen retrievalin bag through which port / extended incision / colpotomy
  13. Irrigation and low-pressure checkvolume; gutters checked for spilled contents
  14. Adhesion barrierNot usedUsed (type)

Closure, drains and dressing

  1. Fascia at ports 10 mm or more / laparotomy sheathsuture and technique
  2. Skin
  3. DrainNonePlaced (size, site)

Specimens and implants

  1. Cyst wall sent for HPEside labelled; intact or ruptured
  2. Peritoneal washings / cyst fluid for cytologySentNot sent
  3. Frozen sectionNot doneDone: result

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. Vitalsevery 15 min in recovery, then hourly till stable
  2. Dietliquids when awake, normal diet the same day
  3. Catheterremove before discharge from recovery / ward
  4. Mobilisationwalk the same day
  5. Analgesiadrug, dose, frequency
  6. Dischargeusually day care or next day after laparoscopy
  7. Follow-upwith HPE report; repeat scan only if new symptoms or the cyst was not removed completely

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: Ms. A.R., 24 years, unmarried, with vague right lower abdominal pain. TVS/TAS: right ovarian complex cyst 6 cm with an echogenic nodule and fat-fluid level, normal ovarian tissue at one pole, no ascites. Left ovary normal. Diagnosis: right mature cystic teratoma (dermoid).

Case details

Date: 03/07/2026. Elective laparoscopic right ovarian cystectomy. OT 4.

In OT 10:00. Induction 10:08. Entry 10:20. Last port closed 11:25.

Surgeon: Dr A. (Assistant Professor, OBGY). Assistant: Dr B. (1st-year resident). Anaesthetist: Dr C. Scrub nurse: Sr D.

Indication and pre-op

Indication: symptomatic right dermoid cyst, 6 cm. No features of malignancy on USG. Urine pregnancy test negative. Hb 12.1 g/dl.

Consent in Marathi from patient, mother as witness, for laparoscopic right ovarian cystectomy, with right oophorectomy only if the ovary cannot be saved, and conversion to laparotomy.

WHO checklist sign in and time out done. Antibiotic prophylaxis not given: laparoscopic procedure without planned entry into bowel or vagina, as per unit protocol.

Anaesthesia and position

General anaesthesia with ETT. Low lithotomy, arms tucked. Parts painted with povidone-iodine and draped. Foley catheter inserted. No uterine manipulator (unmarried).

Procedure

Open (Hasson) entry at umbilicus, 10 mm port. CO2 to 15 mm Hg. Two 5 mm ports in right and left lower quadrants lateral to the inferior epigastric vessels, under vision.

Findings: right ovary enlarged by a 6 cm smooth cyst, surface intact, no excrescences. Left ovary, both tubes and uterus normal. No ascites. Peritoneum, omentum and liver surface normal. Both ureters seen.

Peritoneal washings taken with 200 ml NS and sent for cytology.

Retrieval bag placed under the right ovary. Ovarian cortex incised along the long axis over the thinnest part of the cyst with cold scissors.

Cyst wall enucleated by traction and counter-traction with atraumatic graspers and aqua-dissection. Small rent near the end of dissection with spill of sebaceous material and hair into the bag, sucked out. Cyst removed complete with wall.

Ovarian bed oozing controlled with two short bursts of bipolar. Ovary not sutured.

Cyst placed in the bag and brought out through the umbilical port; fascial opening extended to 2.5 cm.

Pelvis and both paracolic gutters irrigated with 3 L warm NS till clear. Insufflation pressure lowered to 8 mm Hg: no bleeding.

Closure

Ports removed under vision. Gas let out. Umbilical fascia closed with polyglactin 910 (Vicryl) 0, two interrupted sutures. Skin closed with Monocryl 4-0 subcuticular. No drain.

Specimens

Right ovarian cyst wall with contents (sebaceous material, hair), labelled right, sent for HPE in formalin. Peritoneal washings sent for cytology.

End of procedure

Estimated blood loss 30 ml. No transfusion.

Mop, needle and instrument count correct. Retrieval bag removed intact.

Intra-operative event: minor spill of dermoid contents, cleared by irrigation.

Shifted to recovery in stable condition. Pulse 78/min, BP 112/70 mmHg, SpO2 99%.

Post-op orders

Pulse, BP every 15 min for 1 hour, then hourly for 4 hours.

Oral liquids after 2 hours, normal diet in the evening. Walk in the evening.

Catheter out in recovery.

Analgesia as charted by the anaesthetist: IV then oral paracetamol, and an NSAID if no contraindication.

Discharge next morning if afebrile and comfortable. Review in OPD with HPE report.

Signature

Dr B., JR-1, OBGY, for Dr A. Reg. no. ________. 03/07/2026, 11:40.

Must document for this operation

  • Side of the cyst and that the ovary was conserved (or why it was removed). Side errors and unplanned oophorectomy are common complaints, and the next surgeon needs to know how much ovary is left.
  • Whether the cyst ruptured, and what was done about the spill. If HPE shows a borderline or malignant tumour, rupture changes the stage and the need for further surgery.
  • Surface of the cyst, washings and the survey of peritoneum, omentum and liver. These findings are the baseline for staging if HPE is unexpectedly malignant.
  • Whether the whole cyst wall was removed. A cyst wall left behind is the usual reason for the cyst coming back.
  • How haemostasis was achieved and how much energy was used on the ovary. Heavy bipolar use on the ovarian bed reduces ovarian reserve, which matters for a woman who wants children.
  • Appearance of the opposite ovary. The note is the reference for later scans and for any future surgery on the other side.

Common mistakes in these notes

  • Not writing the side, or writing the side only in the heading.
  • Writing 'cyst removed' without saying whether it ruptured.
  • No record of washings or of the upper abdomen survey.
  • Not describing the cyst contents (chocolate, sebaceous, serous), which helps the pathologist.
  • Not documenting the opposite ovary.

Indian practice and paperwork

  • NABH standard COP.14(e) (5th edition) requires the operative note to be written before the patient is transferred out of recovery. (NABH Hospital Accreditation Standards 5th ed. (April 2020), COP.14 OE e)
  • In NQAS-assessed public hospitals, the OT checkpoint 'Operative Notes are Recorded' looks for the people present, pre- and post-op diagnosis, procedure, length of procedure, estimated blood loss, fluids given, specimen removed and complications. (NQAS Assessor's Guidebook for District Hospitals 2020, Vol I, ME E8.4)
  • Tissue not sent for HPE is Yellow category (a) human anatomical waste under the Bio-Medical Waste Management Rules 2016; record where the specimen went. (CPCB/DGHS Guidelines under BMW Management Rules 2016)

Sources

  • Handa VL, Van Le L, eds. Te Linde's Operative Gynecology. 13th ed. Wolters Kluwer; 2024, Ch 19, Surgery of the ovary and fallopian tube (Cohen Rassier SL, Gargiulo AR): treatment of benign ovarian masses, ovarian cystectomy; Ch 2, Table 2.4 antimicrobial prophylaxis, e-book PDF pp. 963-975; 164.
  • Te Linde's Atlas of Gynecologic Surgery. Wolters Kluwer; 2014, Ch 7, Laparoscopic ovarian cystectomy for benign ovarian tumors (Solnik MJ), pp. 57-63.
  • Te Linde's Operative Gynecology 13e, Ch 2, Table 2.4 (reprinted from ACOG Practice Bulletin 195, 2018): laparoscopic procedures without entry into bowel or vagina, prophylaxis not recommended; laparotomy without entry into bowel or vagina, consider cefazolin 2 g IV (3 g if over 120 kg).
  • Te Linde's Operative Gynecology 13e, Ch 19 (pdf 966): dilute vasopressin, no more than 10 units total, into the plane between cyst wall and cortex; low-pressure test at 5 to 10 mm Hg (pdf 967).

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.

Videos of this operation

Teaching videos and pages for this operation, listed under the curriculum item that asks for it.

This page cannot be printed from the browser. Use the Download printable PDF button on the page.