A Stepwise Strategy to Minimally Invasive Salpingo-Oophorectomy in the Post-Hysterectomy Patient

Abstract

Study Objective Demonstrate a five-step strategy for effective, safe completion of a minimally invasive salpingo-oophorectomy in patients with prior hysterectomy. Design Step-by-step demonstration and explanation of technique using a surgical video Setting Tertiary-care operating room using standard equipment for laparoscopic surgery and three 5 mm trocars, a 30 degree laparoscope, and bipolar sealing device. Patients or Participants A 56 year-old female patient presents with pelvic pain and persistent adenxal mass and requesting definitive surgical management. Interventions Five steps were utilized to perform a laparoscopic bilateral sapling-oophorectomy in a patient with prior open total abdominal hysterectomy. The stepwise procedure was highlighted on one side without significant adhesions and then repeated on the opposite side with a more challenging adnexal mass Measurements and Main Results Post-hysterectomy sapling-oophorectomy can pose significant surgical complexity. With increasing data on the benefits of ovarian conservation during hysterectomy especially in pre-menopausal women such as cardiovascular health, bone and sexual health, more patients elect to preserve their ovaries. Up to 9% of these women who preserved their ovaries at the time of hysterectomy require future adnexal surgery. Some of the common indications for post hysterectomy sapling-oophorectomy are persistent adnexal masses, chronic pelvic pain, suspicious adnexal masses concerning for malignancy, and risk-reducing surgery. This video presents a five step strategy to facilitate this procedure to include pelvic and abdominal exploration, restoring normal anatomy, identification of the ureter, isolation, coagulation, and transection of the infundibulopelvic ligament and hemostasis and re-evaluation of ureter. Conclusion In this video we described a five step strategy to ensure safe, efficient and reproducible salpingo-oophorectomy in the post hysterectomy patient using a minimally invasive approach. Although this surgery can be challenging to perform in post hysterectomy given anatomical variance and adhesive disease, by following these five simple principles we aim to simplify this potentially difficult procedure.