Surgical Removal Of Ovary / Oophorectomy

Oophorectomy - Overview
Synonyms: Surgical Removal of Ovary, Oophorectomy, Ovarian Surgery, Ovariectomy, Ovarian Ablation

Surgical removal of one or both ovaries is called Oophorectomy. It accelerates menopause by a few years in a menstruating women.


The ovaries are a part of a woman's reproductive system that store and release eggs (ova) for fertilization and produce the female sex hormones called estrogen and progesterone. There are two ovaries that lie by the side of the uterus. If one of the two ovaries is removed, a woman may continue to menstruate and have children. If both ovaries are removed, menstruation stops and a woman will lose the ability to have children.

Anatomy Of The Female Reproductive System
Normal Anatomy of the Female Reproductive System

In an Oophorectomy, one or a portion of one ovary may be removed or both ovaries may be removed. When Oophorectomy is done to treat ovarian cancer or other spreading cancers, both ovaries are always removed. This is called a Bilateral Oophorectomy.

oophorectomy

In younger women with early-stage ovarian tumors who have not yet completed their families, the surgeon may perform removal of ovaries from only one side (called Unilateral Oophorectomy). This approach is called fertility saving or fertility-sparing surgery as it allows the women to reproduce.

Occasionally uterus removal (hysterectomy) is performed in women above the age of 40 along with the ovaries and fallopian tubes. The surgery is then called "Total Abdominal Hysterectomy with Bilateral Salpingo- Oophorectomy", abbreviated as TAH-BSO.

Oophorectomy is sometimes recommended when the hormones produced by the ovaries are making a disease, such as breast cancer or endometriosis, worse.

In rare instances where there is a strong family history of ovarian tumors, the ovaries are removed in an attempt to reduce the possibility of developing a future disease, such as ovarian cancer. This is called a Prophylactic Oophorectomy.



Oophorectomy - Indications
When surgery is indicated for benign ovarian disease, preservation of ovarian tissue by partial removal of ovaries or ovarian cystectomy is preferred over its complete removal or oophorectomy.

Oophorectomy indications include:

 Benign ovarian neoplasms

 Prophylactic oophorectomy with hysterectomy

 Torsion of the ovary, which is rotation of the ovary on its axis thereby obstructing its blood supply.

 Ovarian malignancy

 Tubo-ovarian abscess, which is unresponsive to antibiotics.

 The ovaries may have deposits of endometriosis advocating their removal.

 Gastrointestinal or other metastatic cancer deposits on the ovaries.



Oophorectomy - Hospital Admission
Certain hospital formalities maybe required before hospitalization especially if you have private health insurance. Clarify the issue with the doctor or with the administrator. Sometimes authorization maybe required from your insurance service provider for the procedure.

You may require to pack your usual toiletries and a few clothes including undergarments, night wear for hospital stay. If the operation is done using Laparoscopy the stay in hospital may only be for a day or two whereas an open surgical procedure may require a 5 to 7 days stay.

You are advised to discuss the type of anesthesia with the doctor. It is best to clarify all the doubts about the procedure. In some patients these procedures are done using general anesthesia and in others the preferred anesthesia is using a spinal or epidural anesthesia.



Oophorectomy-Pre-operative Preparations
Before surgery, the doctor may order blood and urine tests, and any additional tests such as ultrasound or x rays to help the surgeon visualize the woman's condition. The woman may also meet with the anesthesiologist to evaluate any special conditions that might affect the administration of anesthesia. A colon preparation may be done, if extensive surgery is anticipated.

It is recommended that the patient take nothing by mouth (food, water, etc.) for at least 6 hours before the scheduled operation or after midnight, if the operation is planned for the morning.

 Painkillers and antibiotics may be prescribed before the procedure.

 A sedative maybe useful to relieve the anxiety of surgery.

 The pubic and genital area may be shaved and prepared for the surgery.

 Before surgery or during the previous night a bath maybe advisable. While bathing thorough cleaning of the abdominal and genital area with soap and water a few times can help in lowering the bacterial count and lessen the chances of any infection from surgery.

 An enema maybe administered to the patient prior to performing the surgery. Sometimes a laxative maybe given to clear the bowels prior to the surgery.

On the evening before the operation a light easily digestible meal is advised.



Oophorectomy - Surgical Procedures
There are two main ways in which the ovaries can be removed from the body:

 Open Surgical Procedure

 Laparoscopically assisted Vaginal Procedure

Open Surgical Procedure involves removal of the ovaries using an incision in the abdomen, or incision in the upper section of the vagina.

Laparoscopy or keyhole surgery involves smaller incisions to remove the ovaries.

The type of surgery usually depends on physical limitations as well as the surgeon's choice and expertise. For example, if the vaginal canal is very restricted and small, performing a vaginal oophorectomy may not be possible.

Oophorectomy can be done under General Anesthesia or Spinal Anesthesia depending on the patient's physical fitness and preference.



Oophorectomy - Procedures
A. Open Abdominal Surgical Procedure

1. After administering anesthesia the abdomen and vagina are prepared with an antibacterial solution.

2. A surgical incision about 5 to 6 inches long or 12 to 15 cms is made either vertically, running from the navel to the pubic bone, or horizontally, running along the top of the pubic hairline. Horizontal incisions leave a less noticeable scar, but vertical incisions give the surgeon a better view of the abdominal cavity.

oophorectomy


3. After the incision is made, the abdominal muscles are pulled apart, not cut, so that the surgeon can visualize the ovaries.

4. The ovarian ligaments are identified, which are cut and ligated

5. The ovaries are separated from the surrounding tissues and vessels and are removed. The blood vessels are tied off to prevent bleeding.

6. The fallopian tubes are often removed with the ovaries.

7. Similarly the ovary on the other side is identified and removed, if bilateral oophorectomy is indicated.

8. After ensuring that all the bleeding points have been checked, the abdomen is closed in layers.

The advantage of an abdominal incision are that the ovaries can be removed even if a woman has many adhesions from previous surgery. The surgeon gets a good view of the abdominal cavity and can check the surrounding tissue for disease. A vertical abdominal incision is mandatory if cancer of ovary is suspected.

The disadvantage is that it is more painful in comparison to the laparoscopy procedure and has the usual associated complications of open surgical procedures like bleeding, and infections and longer post surgery recovery period.



Oophorectomy - Procedures
B. Laparoscopically-Assisted Vaginal Oophorectomy

A laparoscope is a thin telescope tube (from 5 to 10 mm diameter) with a magnifying glass-like eye piece at one end to which a video camera is attached. Through the camera the view inside the abdomen can be seen on a television monitor.

1. After administering anesthesia the abdomen and vagina are prepared with an antibacterial solution.

2. In order for the surgeon to observe the inside of the body clearly, the peritoneal cavity is inflated with gas (usually carbon dioxide).

3. The surgery begins with small abdominal incisions below to the belly button in the skin crease, which allows the insertion of the laparoscope. Another two or three small incisions may be necessary to insert the laparoscopic instruments to dissect and remove the ovaries.

4. Using the laparoscopic surgical tools, the tissues and vessels surrounding the ovaries are cut and tied.

5. When the ovaries are detached, they are removed though a small incision at the top of the vagina. The ovaries can also be reduced in size by cutting into smaller sections before being removed through the small incision.

6. The top of the vaginal cuff is sutured. The abdominal cuts are all closed with stitches, which are likely to leave small scars.

The removed organ(s) are sent to a lab to be analyzed.

The fallopian tubes also may be removed during this surgical procedure.



Oophorectomy - Complications
Complications may arise during the procedure or due to removal of the ovaries. Oophorectomy is a relatively safe operation, although, like all major surgery, it does carry some risks. These may be related to the procedure itself or due to anesthesia.

 Reaction to anesthesia

 Internal bleeding

 Blood clots, particularly in the veins of the legs

 Accidental damage to other pelvic and abdominal organs

 Infection

Risk Factors likely to increase the Complications during the Procedure are:

 Presence of scar tissue and/or abscesses in the abdomen

 Obesity

 Smoking

Long-term Complications of Removing both the Ovaries include:

 Changes in sex drive

 Hot flashes and other symptoms of menopause, if both ovaries are removed

 Removing both ovaries increases the risk of heart disease and osteoporosis; taking hormone replacement therapy can help reduce this risk

 Depression and other forms of psychological distress

Women with a history of psychological and emotional problems before an oophorectomy are more likely to experience psychological difficulties after the operation.



Oophorectomy - Post- operative Care
Women report less pain after a laparoscopic procedure than the abdominal incision procedure.

After surgery a woman may feel some discomfort. The degree of discomfort varies and is generally greatest with abdominal incisions, because the abdominal muscles must be stretched out of the way so that the surgeon can reach the ovaries.

Post-operative Care: Some of the post operative measures include-

 Antibiotics are sometimes given to reduce the risk of post-surgical infection.

 If both ovaries are removed, the woman immediately goes into menopause. If there is no evidence of breast cancer, the doctor will prescribe hormone replacement therapy (HRT), either estrogen alone or with progesterone, to help manage the symptoms of menopause.

 Return to normal activities, such as driving and working, takes from 2-6 weeks, depending on the type of surgery you had.

 Some women experience emotional distress following the removal of their ovaries and benefit from counseling and may need some sort of hormone replacement therapy.

Average hospital stay for the abdominal Oophorectomy is three to five days and for the laparoscopic procedure one to two days. A woman will need three to six weeks to return to normal activities after an Abdominal Oophorectomy.

Contact Your Doctor If Any of the Following symptoms occur after you are discharged home -

 Signs of infection, including fever and chills

 Persistent or increased vaginal bleeding or discharge

 Severe pain

 Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision sites

 Difficulty urinating

 Cough, shortness of breath, chest pain, severe nausea or vomiting



Beyond Ovaries Removal
The outcome of an oophorectomy depends on the indication for surgery, the medical condition of the patient and the operating surgeon.

Oophorectomy is indicated for ovarian disease conditions and other systemic diseases like breast cancer. Removing the ovaries will not eliminate the cancer if it has already spread to other organs. Patients with ovarian cancer, therefore, routinely receive other forms of treatment like chemotherapy and/or radiation in addition to Oophorectomy.

Oophorectomy when performed for early ovarian cancers improves the prognosis and survival rates.

Endometriosis can be successfully treated with an Oophorectomy, although it often requires identification and treatment of other endometrial areas outside of the ovaries at the time of surgery. If both of the ovaries are removed, the women will no longer menstruate and will no longer be able to become pregnant. If one ovary or even just a portion of an ovary remains, she may still menstruate and may be able to become pregnant.



Oophorectomy - FAQ's
1. Who performs a Oophorectomy ?
A gynecologist performs Oophorectomy.

2. Why are the ovaries removed in women above 40 years who are under going hysterectomy operation?
Some physicians until the 1980's reasoned that a woman over 40 was approaching menopause would soon stop secreting estrogen and releasing eggs from the ovaries. Removing the ovaries would accelerate menopause by a few years however it would give them the advantage of reducing risks of cancers.

3. What are the affects of ovaries removal on the Body?
The current thinking towards preserving ovaries is increasing as the risks of ovarian cancer in women who have no family history of the disease is less than 1%.
Removing the ovaries increases the risk of cardiovascular disease and accelerates osteoporosis unless a woman takes prescribed hormone replacements. Hence there is no place for subjecting women to unnecessary removal of ovaries unless there is a surgical indication for the same

4. When is a prophylactic or preventive Oophorectomy done?
Genetic mutation of the two genes called BRCA1 or BRCA2 genes - are linked to breast cancer, ovarian cancer and some other cancers. In woman with strong family history of ovarian or breast cancers, preventive oophorectomy is sometimes recommended for those who are over 35 to 40 years and who have a completed their families.
The lifetime risk for developing ovarian cancer in women who have mutations in (genes) BRCA1 is 30% by age 60.

5. Can a woman conceive if one ovary is removed?
Yes she can conceive. As she will continue to produce eggs from the other ovary



Oophorectomy - Glossary
Cyst- An abnormal sac containing fluid or semi-solid material.

Endometriosis- A benign condition that occurs when cells from the lining of the uterus begin growing outside the uterus.

Fallopian tubes- Slender tubes that carry ova from the ovaries to the uterus.

Hysterectomy-Surgical removal of the uterus.

Osteoporosis- The excessive loss of calcium from the bones, causing the bones to become fragile and break easily.

Tuboovarian abscess- Infection of the ovary and tubes.

Haemostasis- The process whereby bleeding is halted.

Menopause- The natural cessation of menstruation occurring usually between the age of 45 and 55 years.

Ovaries- A pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus and are the size of an almond.

Salpingo-oophorectomy- Surgical removal of the fallopian tubes and ovaries.



Oophorectomy - References
http://www.healthatoz.com/healthatoz/
Atoz/common/standard/transform.jsp?request
URI=/healthatoz/Atoz/ency/oophorectomy.jsp

http://women.webmd.com/tc/Oophorectomy-
Topic-Overview

http://patients.uptodate.com/topic.asp?file=gyn_surg/5065

http://www.beliefnet.com/healthandhealing/get
content.aspx?cid=14848

Compiled by: Dr. Paderla Anitha
Edited by: Dr. Sunil Shroff



    

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