Oophorectomy and ovarian cystectomy
- Fidel A Valea, MD
Fidel A Valea, MD
- Associate Professor
- Division of Gynecologic Oncology
- Duke University Medical Center
- William J Mann, Jr, MD
William J Mann, Jr, MD
- Section Editor — Gynecologic Surgery
- Clinical Professor
- Department of Obstetrics and Gynecology
- Virginia Commonwealth University School of Medicine
Ovarian pathology can occur at any time from fetal life to menopause. The most common surgical procedures for benign ovarian disease will be reviewed here.
General principles of the evaluation and management of an adnexal mass, elective oophorectomy at the time of hysterectomy, and surgical treatment of ovarian cancer are discussed separately. (See "Approach to the patient with an adnexal mass" and "Management of an adnexal mass" and "Elective oophorectomy or ovarian conservation at the time of hysterectomy" and "Cancer of the ovary, fallopian tube, and peritoneum: Staging and initial surgical management".)
OOPHORECTOMY VERSUS CYSTECTOMY
The indications for ovarian surgery versus expectant management of an ovarian cyst depend upon the patient's age, findings on pelvic examination and ultrasound, and laboratory results. These issues are discussed in depth separately. (See "Approach to the patient with an adnexal mass" and "Differential diagnosis of the adnexal mass".)
When surgery is indicated for benign ovarian disease, preservation of ovarian tissue via cystectomy or enucleation of a solid tumor from the ovary is generally preferable to complete oophorectomy. When the ovary cannot be salvaged or insufficient viable tissue remains after attempts at conservation, oophorectomy is performed. In postmenopausal patients, no effort is made to preserve the ovary.
Indications for oophorectomy include:
- Barber HR. Ovarian cancer. CA Cancer J Clin 1986; 36:149.
- SCULLY RE. Gonadoblastoma; a gonadal tumor related to the dysgerminoma (seminoma) and capable of sex-hormone production. Cancer 1953; 6:455.
- Teter J, Boczkowski K. Occurrence of tumors in dysgenetic gonads. Cancer 1967; 20:1301.
- Andrews J. Streak gonads and the Y chromosome. J Obstet Gynaecol Br Commonw 1971; 78:448.
- Dewhurst CJ, Ferreira HP, Gillett PG. Gonadal malignancy in XY females. J Obstet Gynaecol Br Commonw 1971; 78:1077.
- Simpson JL, Christakos AC, Horwith M, Silverman FS. Gonadal dysgenesis in individuals with apparently normal chromosomal complements: tabulation of cases and compilation of genetic data. Birth Defects Orig Artic Ser 1971; 7:215.
- Barr ML, Carr DH, Plunkett ER, et al. Male pseudohermaphroditism and pure gonadal dysgenesis in sisters. Am J Obstet Gynecol 1967; 99:1047.
- Mesogitis S, Daskalakis G, Pilalis A, et al. Management of ovarian cysts with aspiration and methotrexate injection. Radiology 2005; 235:668.
- Zanetta G, Lissoni A, Torri V, et al. Role of puncture and aspiration in expectant management of simple ovarian cysts: a randomised study. BMJ 1996; 313:1110.
- Kafali H, Yurtseven S, Atmaca F, Ozardali I. Management of non-neoplastic ovarian cysts with sclerotherapy. Int J Gynaecol Obstet 2003; 81:41.
- Fisch JD, Sher G. Sclerotherapy with 5% tetracycline is a simple alternative to potentially complex surgical treatment of ovarian endometriomas before in vitro fertilization. Fertil Steril 2004; 82:437.
- AbdRabbo S, Atta A. Aspiration and tetracycline sclerotherapy for management of simple ovarian cysts. Int J Gynaecol Obstet 1995; 50:171.
- Bret PM, Atri M, Guibaud L, et al. Ovarian cysts in postmenopausal women: preliminary results with transvaginal alcohol sclerosis. Work in progress. Radiology 1992; 184:661.
- Hidlebaugh DA, Vulgaropulos S, Orr RK. Treating adnexal masses. Operative laparoscopy vs. laparotomy. J Reprod Med 1997; 42:551.
- Bisharah M, Tulandi T. Laparoscopic preservation of ovarian function: an underused procedure. Am J Obstet Gynecol 2003; 188:367.
- Medeiros LR, Fachel JM, Garry R, et al. Laparoscopy versus laparotomy for benign ovarian tumours. Cochrane Database Syst Rev 2005; :CD004751.
- Hulka JF, Parker WH, Surrey MW, Phillips JM. Management of ovarian masses. AAGL 1990 survey. J Reprod Med 1992; 37:599.
- Herrmann UJ. Sonographic patterns of ovarian tumors. Clin Obstet Gynecol 1993; 36:375.
- Granberg S. Relationship of macroscopic appearance to the histologic diagnosis of ovarian tumors. Clin Obstet Gynecol 1993; 36:363.
- Ekerhovd E, Wienerroith H, Staudach A, Granberg S. Preoperative assessment of unilocular adnexal cysts by transvaginal ultrasonography: a comparison between ultrasonographic morphologic imaging and histopathologic diagnosis. Am J Obstet Gynecol 2001; 184:48.
- Tozzi R, Köhler C, Ferrara A, Schneider A. Laparoscopic treatment of early ovarian cancer: surgical and survival outcomes. Gynecol Oncol 2004; 93:199.
- Fanfani F, Fagotti A, Ercoli A, et al. A prospective randomized study of laparoscopy and minilaparotomy in the management of benign adnexal masses. Hum Reprod 2004; 19:2367.
- Benedetti-Panici P, Maneschi F, Cutillo G, et al. Surgery by minilaparotomy in benign gynecologic disease. Obstet Gynecol 1996; 87:456.
- Magrina JF, Espada M, Munoz R, et al. Robotic adnexectomy compared with laparoscopy for adnexal mass. Obstet Gynecol 2009; 114:581.
- Lee YY, Kim TJ, Kim CJ, et al. Single port access laparoscopic adnexal surgery versus conventional laparoscopic adnexal surgery: a comparison of peri-operative outcomes. Eur J Obstet Gynecol Reprod Biol 2010; 151:181.
- Fagotti A, Fanfani F, Rossitto C, et al. Laparoendoscopic single-site surgery for the treatment of benign adnexal disease: a prospective trial. Diagn Ther Endosc 2010; 2010:108258.
- Escobar PF, Bedaiwy MA, Fader AN, Falcone T. Laparoendoscopic single-site (LESS) surgery in patients with benign adnexal disease. Fertil Steril 2010; 93:2074.e7.
- Kim WC, Lee JE, Kwon YS, et al. Laparoendoscopic single-site surgery (LESS) for adnexal tumors: one surgeon's initial experience over a one-year period. Eur J Obstet Gynecol Reprod Biol 2011; 158:265.
- Fagotti A, Bottoni C, Vizzielli G, et al. Postoperative pain after conventional laparoscopy and laparoendoscopic single site surgery (LESS) for benign adnexal disease: a randomized trial. Fertil Steril 2011; 96:255.
- Prevention of postsurgical adhesions by INTERCEED(TC7), an absorbable adhesion barrier: a prospective randomized multicenter clinical study. INTERCEED(TC7) Adhesion Barrier Study Group. Fertil Steril 1989; 51:933.
- Hart RJ, Hickey M, Maouris P, et al. Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev 2005; :CD004992.
- Diamond, MP, Cunningham, T, Linsky, CB, et al. Laparoscopic application of Interceed (TC7) in the pig. J Gynecol Surg 1989; 5:145.
- Nagele F, Magos AL. Combined ultrasonographically guided drainage and laparoscopic excision of a large ovarian cyst. Am J Obstet Gynecol 1996; 175:1377.
- Eltabbakh GH, Kaiser JR. Laparoscopic management of a large ovarian cyst in an adolescent. A case report. J Reprod Med 2000; 45:231.
- Ghezzi F, Cromi A, Bergamini V, et al. Should adnexal mass size influence surgical approach? A series of 186 laparoscopically managed large adnexal masses. BJOG 2008; 115:1020.
- Sagiv R, Golan A, Glezerman M. Laparoscopic management of extremely large ovarian cysts. Obstet Gynecol 2005; 105:1319.
- Eltabbakh GH, Charboneau AM, Eltabbakh NG. Laparoscopic surgery for large benign ovarian cysts. Gynecol Oncol 2008; 108:72.
- Panici PB, Palaia I, Bellati F, et al. Laparoscopy compared with laparoscopically guided minilaparotomy for large adnexal masses: a randomized controlled trial. Obstet Gynecol 2007; 110:241.
- Symmonds RE, Pettit PD. Ovarian remnant syndrome. Obstet Gynecol 1979; 54:174.
- Magtibay PM, Nyholm JL, Hernandez JL, Podratz KC. Ovarian remnant syndrome. Am J Obstet Gynecol 2005; 193:2062.
- Kaminski PF, Sorosky JI, Mandell MJ, et al. Clomiphene citrate stimulation as an adjunct in locating ovarian tissue in ovarian remnant syndrome. Obstet Gynecol 1990; 76:924.
- Nezhat C, Kearney S, Malik S, et al. Laparoscopic management of ovarian remnant. Fertil Steril 2005; 83:973.
- Abu-Rafeh B, Vilos GA, Misra M. Frequency and laparoscopic management of ovarian remnant syndrome. J Am Assoc Gynecol Laparosc 2003; 10:33.
- El-Minawi AM, Howard FM. Operative laparoscopic treatment of ovarian retention syndrome. J Am Assoc Gynecol Laparosc 1999; 6:297.
- Kho RM, Magrina JF, Magtibay PM. Pathologic findings and outcomes of a minimally invasive approach to ovarian remnant syndrome. Fertil Steril 2007; 87:1005.
- Ayhan A, Celik H, Taskiran C, et al. Oncologic and reproductive outcome after fertility-saving surgery in ovarian cancer. Eur J Gynaecol Oncol 2003; 24:223.
- Swanton A, Bankhead CR, Kehoe S. Pregnancy rates after conservative treatment for borderline ovarian tumours: a systematic review. Eur J Obstet Gynecol Reprod Biol 2007; 135:3.
- Lass A. The fertility potential of women with a single ovary. Hum Reprod Update 1999; 5:546.
- OOPHORECTOMY VERSUS CYSTECTOMY
- ASPIRATION AND FENESTRATION VERSUS CYSTECTOMY
- SURGICAL APPROACH
- Open laparotomy versus laparoscopy
- - Use of robotic or single port laparoscopy
- - Open or laparoscopic approach
- - Laparoscopic instruments
- - Open cystectomy
- - Laparoscopic cystectomy
- POSTOPERATIVE ISSUES
- Spillage of malignant cells
- Ovarian remnant syndrome
- Fertility following unilateral oophorectomy
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS