LAPAROSCOPIC MANAGEMENT OF A LARGE OVARIAN CYST IN A NULLIGRAVIDA ADOLESCENT: A CASE-BASED REFLECTION ON PRESERVING FERTILITY

The management of large ovarian cysts in nulligravida adolescents poses a significant clinical challenge, necessitating careful balance between effective treatment and preservation of reproductive potential. This case-based analysis examines a 14-year-old nulligravida presenting with a symptomatic, large unilocular ovarian cyst. Laparoscopic surgery was selected over laparotomy to minimize invasiveness, optimize cosmetic outcomes, and reduce postoperative adhesion formation. Intraoperatively, advanced minimally invasive instrumentation—including atraumatic graspers, electrosurgical scissors, and endoscopic suturing devices—facilitated a cystectomy while meticulously preserving healthy ovarian tissue and vascular supply. Tissue extraction was performed via endoscopic retrieval bag to prevent cyst content spillage. The surgical strategy prioritized cystectomy over oophorectomy, supporting future fertility and hormonal function. Postoperative recovery was rapid, with minimal pain and no complications, and ovarian morphology was preserved on follow-up ultrasonography. The psychological well-being of the adolescent was also addressed through comprehensive pre- and postoperative counseling, underpinning holistic patient care. This case underscores the importance of specialized surgical approaches in pediatric gynecology, advocates for equitable access to fertility-preserving interventions, and demonstrates laparoscopic cystectomy as a benchmark for global best practices in adolescent reproductive health.