Robotic-Assisted Resection of Ovarian Remnant Causing Pelvic Pain

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Study Objective To demonstrate the safe and effective excision of an ovarian remnant in the face of extensive pelvic adhesion. Design Surgical video presentation. Setting Academic tertiary care center. Patients or Participants This is a 46 year old patient G7P5025 patient with a history of chronic pelvic pain. Her past surgical history is significant for a total abdominal hysterectomy followed by a right salpingo-oophorectomy 8 years later for an ovarian cyst. Her right salpingo-oophorectomy surgery was complicated by an enterotomy with injury to the sigmoid colon due extensive pelvic adhesive disease. Interventions Preoperative pelvic ultrasound and MRI revealed a large left sided cystic pelvic mass as well as aright adnexal mass suspicious for an ovarian remnant. Intraoperatively, extensive pelvic adhesions were noted as well as the large cytic pelvic mass and an ovarian remnant attached to the right pelvic side wall. A left oophorectomy was performed and the right ovarian remnant was excised after extensive ureterolysis. Measurements and Main Results After the above interventions normal anatomy was restored to the pelvis. Pathologic evaluation confirmed right ovarian cortical tissue. At her 6 months follow up visit the patient had significant resolution of her pelvic pain. Conclusion Surgical removal of an ovarian remnant can be quite challenging and has risks of injury to the ureters, bladder and bowel. With good surgical technique using the laparoscopic/robotic platform, safe and effective excision of ovarian remnant can be achieved; affording a favorable outcome for patients.