Appropriate Preoperative Planning Leads to Successful Removal of the Small Volume Ovarian Remnant

Abstract

<h3>Study Objective</h3> To review the ovarian remnant syndrome characteristics and risk factors. To describe the correct surgical technique to prevent this condition. To demonstrate the appropriate preoperative evaluation and surgical resolution of the small volume ovarian remnant. <h3>Design</h3> Educational video. <h3>Setting</h3> Robotic assisted laparoscopic procedure. Patient in dorsal lithotomy position. Bilateral double ended tiger tail prophylactic ureteral stents used. <h3>Patients or Participants</h3> We describe a case of a 40-year-old patient who presented with a pelvic cystic mass and pelvic pain. She had a history of multiple laparotomies including an abdominal hysterectomy and bilateral salpingo-oophorectomy. She had a known BRCA 1 mutation and a strong family history of ovarian cancer. Her estradiol and follicle-stimulating hormone (FSH) levels were in the premenopausal range. Ovarian remnant syndrome was suspected. <h3>Interventions</h3> Robotic assisted removal of bilateral small volume ovarian remnants. <h3>Measurements and Main Results</h3> An overview of the preoperative evaluation and management of small volume ovarian remnant syndrome is described. The surgical technique to prevent ovarian remnant syndrome is discussed. The preoperative evaluation including hormone levels, ovarian stimulation, and imaging studies are discussed. Surgical planning including discussion with radiology and pathology are reviewed. Relying on anatomical landmarks, ureterolysis, proximal ligation of the infundibulopelvic ligament, and other surgical tips for the successful removal of the small volume ovarian remnant are presented. <h3>Conclusion</h3> Appropriate surgical technique prevents ovarian remnant syndrome. Serial MRIs may help identify cyclic changes of the ovarian remnant. Ovarian stimulation and hormone levels may assist with diagnosis and treatment planning. Preoperative discussion with Radiology to look for anatomical landmarks is important to successfully excise small volume lesions.