Special Surgical Procedures II
LESSON 2: Procedures in Gynecological and Obstetrical Surgery
2-40
2-40. OOPHORECTOMY AND OOPHOROCYSTECTOMY
a. General. Oophorectomy is the removal of an ovary. Oophorocystectomy is the removal of an ovarian cyst. A wide variety of tumors, both benign and malignant, are found in ovaries. Functional cysts comprise the majority of the ovarian enlargements, follicle cysts being the most common. The choice of operation depends on the patient's age and symptoms, findings on physical examination, and direct examination of the adnexa during exploration. If the ovarian tumor is recognized as benign, only the visibly diseased portions of the adnexa are removed. In the presence of dermoid, follicle, and corpus luteum cysts, the cyst is usually enucleated, and most of the ovarian parenchyma is preserved. In tubal pregnancy, the pregnant tube is removed and, in some cases, the ovary also.
b. Operative Procedure. The abdominal peritoneal cavity is opened, the cyst is removed.
(1) For removal of a large ovarian cyst, a purse-string silk suture is placed in the cyst wall, and a trocar is introduced in its center; the suture is tightened around the trocar as the fluid is aspirated. The trocar is removed, and the purse-string suture is tied. All normal ovarian tissue is preserved.
(2) For removal of dermoid cyst, the field is protected with laparotomy packs, since the contents of such cysts produce irritation if they are spilled into the peritoneal cavity. An incision is made along the base of the cyst between the wall and the normal ovarian tissue. The cyst is dissected free and removed intact. The ovary is closed with interrupted fine chromic gut sutures.
(3) For decortication of the enlarged ovary and bridge resection, a large segment of the ovarian cortex opposite the hilum is removed. The cysts are punctured with a needle point and collapsed. A wedge of ovarian stroma, extending deep in the hilum, is resected with a small knife; the cortex of the ovary is closed with interrupted chromic gut number 3-0 suture.
(4) To prevent prolapse of the tube into the cul-de-sac, it may be sutured to the posterior sheath of the broad ligament.
(5) The abdominal wound is closed as for laparotomy.
