Salpingo-oophorectomy

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Salpingo-oophorectomy

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 change.

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.

Technique

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 again.

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.

The 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 ligament.

The abdomen is closed in layers.