Salpingo-oophorectomy is needed when the disease process
has invaded the Fallopian tube and ovary in such a manner that salvage
of the ovary is undesirable or technically impossible. This occurs
in both benign and malignant disease, particularly where the benefits
derived from leaving the uterus and other adnexa in place outweigh
the risks associated with the primary disease.
The purpose of the operation
is to remove the tube and ovary.
Physiologic Changes. Although removal of one ovary
may reduce the total hormone output, there is little clinical physiologic
Points of Caution. The indundibulopelvic
ligament must be dissected clear to the ureter if the ligament is to
be clamped in the area of the pelvic brim.
The infundibulopelvic ligament
should be doubly tied because the venous network within this ligament
tends to retract, producing hematomas that dissect up to the renal
vessels. Transecting the round ligament and thus opening the broad
ligament is not always necessary; however, it provides the most anatomic
approach to this procedure and often allows a clean dissection of a
tubo-ovarian mass without rupture.
A laparotomy is performed through a midline
or transverse incision. The round ligament on the affected side
is tied and transected. The posterior leaf of the broad ligament
is then opened. The anterior leaf of the broad ligament can be
seen through the opened posterior leaf, although in most cases
there is no reason to open the anterior leaf.
The infundibulopelvic ligament is undermined
with finger dissection. Care should be taken to identify the
ureter on that side. The infundibulopelvic ligament is triple-clamped
and incised between the first and second clamps.
The proximal side of the infundibulopelvic
ligament is tied with a 0 synthetic absorbable suture, then sutured
A defect is made in the mesosalpinx
of the Fallopian tube adjacent to the cornual area. A Kelly clamp
is placed across the suspensory ligament of the ovary and the
Fallopian tube. The mesosalpinx of the Fallopian tube is penetrated,
as shown previously under Salpingectomy and the mesosalpinx is
clamped between the open portions. The tubes, suspensory ligament,
and mesosalpinx are transected, and the tube and ovary are removed.
distal portion of the round ligament is reapproximated to the
cornu of the uterus with a 0 synthetic absorbable mattress
suture. The proximal stump of the round ligament is buried
within the broad ligament. The defect in the broad ligament
and the peritoneal lining of the mesosalpinx are reestablished
with a running 3-0 synthetic absorbable suture starting at
the cornu of the uterus and extending to the stump of the infundibulopelvic
The abdomen is closed in layers.