Extension of ovarian tissue into the infundibulopelvic ligament beyond visual margins

Abstract

Objective The purpose of our study was to identify microscopic margins of the ovary and possible extension of the ovarian tissue beyond visual margins into the infundibulopelvic (IP) tissue to formulate recommendations for adequate salpingo-oophorectomy. Methods An observational study was conducted with thirty female patients who underwent bilateral salpingo-oophorectomy (BSO) as part of their procedure at Bethesda North Hospital between September 2007 and May 2008. Results Thirty patients underwent BSO as part of their primary procedure. Two ovaries were excluded from the study because of multiple adhesions to the pelvic wall and distortion of the IP ligaments resulting in fifty-eight ovaries accepted for study. Microscopic extension of the ovarian stroma into IP ligament beyond gross visual margins was found in eight ovaries (13.8%), five left ovaries and three right ovaries. The range of the extension was from 0.2 cm to 1.4 cm (four ovaries 0.2 cm, one 0.4 cm, two 0.8 cm and one 1.4 cm). Conclusion Our study demonstrates that ovarian stroma can extend beyond grossly visual margins. To prevent residual ovarian tissue following oophorectomy surgeons need to ligate the IP ligament at or more than 2 cm proximal to the visual ovarian margins. Similar surgical principals need to be applied during oophorectomy by abdominal, laparoscopic and vaginal approach.