In recent years, laparoscopic oophorectomy has become one of the most widely used techniques in ovarian surgery due to its precision, lower complication rates, and faster recovery time. It is now considered a preferred surgical option for many gynecologic surgeons.
This technique originally began as a diagnostic procedure using a laparoscope to examine internal organs, but it later evolved into an advanced surgical method capable of performing complex operations through small skin incisions. During laparoscopic oophorectomy, surgeons use high-resolution cameras and specialized surgical instruments inserted through tiny openings in the abdomen to remove the ovary with greater accuracy and minimal tissue damage.
Advancements in laparoscopic equipment, particularly improved camera quality and surgical tools, have significantly enhanced the safety and effectiveness of these procedures. Compared to traditional open surgery, laparoscopic oophorectomy is associated with less postoperative pain, reduced surgical risks, shorter hospital stays, and quicker recovery, making it an ideal choice for both patients and surgeons, especially in specialized medical centers with extensive laparoscopic expertise.
These developments have made laparoscopic surgery an essential part of modern medical practice, as many countries, such as Turkey, have been quick to adopt these techniques. By providing advanced medical infrastructure and highly qualified, experienced medical personnel, this type of surgery combines high precision with minimal surgical intervention, reducing complications and accelerating recovery.
What is an ovary?
The ovaries are part of the female reproductive system, which also includes the fallopian tubes, uterus, vagina, and vulva. The ovaries are located on either side of the uterus in the pelvis and are small oval glands.
The ovary plays a key role in female reproduction, as it is the primary center for the production of eggs and sex hormones such as estrogen and progesterone, which directly regulate the menstrual cycle, develop secondary female characteristics, and maintain bone, heart, and skin health. Whether due to surgical removal or functional failure, it is a major cause of infertility. As women age and approach menopause, the production of these hormones by the ovaries gradually decreases, and this decrease leads to a complete cessation of the menstrual cycle, during this period a major hormonal change occurs that affects many of the body’s functions.
What are the causes of laparoscopic oophorectomy?
Doctors use oophorectomy for many reasons, including the following:
- Polycystic Ovarian Syndrome (PCOS): Large ovarian cysts can cause complications such as bleeding and pain when the affected ovary is removed.
- Cancer prevention: Doctors may resort to laparoscopic oophorectomy if the patient has a family history or carries mutations in the BRCA1 and BRCA2 genes.
- Endometriosis: Excision may be necessary in some severe cases that do not respond to other treatments, such as medications or conservative surgery.
- Ovarian torsion: In severe cases, particularly with complications such as infection or necrosis, a laparoscopic oophorectomy is performed.
- In cases where it is accompanied by severe inflammation of the ovary or neighboring areas
How does a patient prepare for a laparoscopic oophorectomy?
The patient must prepare and prepare well before undergoing the operation to minimize the risks and achieve the best possible result, and to achieve this, it is necessary to follow steps and do some tests to ensure that she is healthy enough to undergo surgery:
- Details of the procedure are discussed with the surgeon, including risks and benefits
- Bathing: The patient takes a shower to reduce the number of germs on the skin’s surface and thus reduce the risk of infection. The surgeon may recommend antibacterial soap, and showering also helps with mental relaxation.
- Comprehensive medical examination: Blood tests, such as measuring CA-125 levels, and imaging tests are performed to localize the issue, assess ovarian health and surrounding factors, and evaluate any comorbidities.
- Stop eating and drinking: The patient must stop eating and drinking at the time specified by the doctor before the surgery.
- Taking medications: Before undergoing a laparoscopic oophorectomy, your doctor may prescribe certain medications. For example, he or she may prescribe antibiotics to prevent infection, and the patient may be asked to stop taking certain medications, such as anticoagulants, to reduce the risk of bleeding during surgery.
- Exercise: Regular exercise helps prepare for the procedure and aids in recovery, but you should consult your doctor before exercising.
- Psychological health: Psychological factors play an important role in preparing for surgery, so it is advisable to have friends and family present for emotional support.
Quitting smoking and maintaining a healthy weight also reduces the risk of complications.
How is laparoscopic oophorectomy performed?
Gynecologic surgeons perform laparoscopic oophorectomy, which is performed under general anesthesia, where the patient is sedated to ensure that she does not feel any pain during the procedure. The following are the steps of laparoscopic oophorectomy
- First, the surgeon makes two or three small incisions, usually 10-12 mm long, in front of the belly button to insert the scope.
- The surgeon inserts a thin, flexible tube with a lighted camera through the incision near the navel, and images from the camera are displayed on a video screen in the operating room to guide the surgeon throughout the procedure
- Additional small incisions (usually 2-3 incisions of about 5-10 millimeters each) are made laterally to insert fine surgical instruments such as scissors, forceps, and cautery devices
- The surgeon performs a careful examination of the ovaries and surrounding organs, in which the surgeon pinpoints the exact location of the issue
- If an ovarian cyst is present, it may be opened and drained before removal while preserving healthy ovarian tissue whenever possible.
- If a complete oophorectomy is required, the ovary is separated from surrounding ligaments and blood vessels using specialized tools to reduce bleeding and ensure safe removal.
- After completing the resection, the surgeon will carefully examine the surgical area to ensure there is no bleeding or leaks, and an adhesive may be applied as needed.
- The excised tissue is taken out through one of the small openings using a special surgical bag to avoid contamination of the abdomen
- Finally, the surgeon removes the instruments and closes the incisions with absorbable sutures or skin patches
Laparoscopic oophorectomy has several methods, the most appropriate surgical method is determined based on the condition of the ovary in addition to the patient’s health and medical history, also the reason for resorting to oophorectomy is important, the appropriate methods and techniques in the case of tumors are not the same as in the case of an ovarian cyst, the surgeon’s experience and skill, and the availability of tools and techniques play an important role in determining the method.
Traditional laparoscopic oophorectomy
In this technique, the surgeon separates the ligaments supporting the ovary with specialized surgical scissors without applying heat. The blood vessels are then tied before being cut to reduce the risk of bleeding.
One advantage of this method is that it uses standard surgical instruments available in most operating rooms and avoids thermal energy, which lowers the risk of tissue burns. However, the success of the procedure depends heavily on the surgeon’s skill in securing the blood vessels properly, as loose clips may lead to serious bleeding during or after surgery. This technique is commonly used in laparoscopic ovarian cyst surgery.
Laparoscopic oophorectomy with robotic surgery
Small robotic tools are inserted through the incisions, and the surgeon controls them from a separate console, where he sees the surgical field in a magnified three-dimensional image, the robotic arms mimic the movements of the surgeon’s hand with great accuracy and even exceed the capabilities of the human hand, this method is characterized by its high accuracy in cutting and suturing, also there is a risk of hand tremors, as it is ideal for working in narrow and complex places, but the disadvantages of this method lie in its very high cost and requires long experience in dealing with robotic systems. But the disadvantages of this method lie in its very high cost and the need for extensive experience in dealing with robotic systems. Laparoscopic oophorectomy by robotic surgery is used in difficult surgeries or complex tumors, and when the preservation of nerves or other organs is absolutely necessary.
Laparoscopic oophorectomy with electrocoagulation
It uses special tools that pass an electric current through the tissue, which leads to cutting the tissue and coagulating the blood vessels at the same moment, one of the advantages of this technique is that the tools used are simple and low-cost, as it reduces bleeding, but it requires high skill to avoid damage to neighboring tissues such as the intestines or ureters due to heat, used when the vessels are small and there are no dense adhesions or vital organs nearby.
Laparoscopic Oophorectomy with Legacy
In laparoscopic oophorectomy, surgeons use a combination of pressure and low electrical energy to ligate and cut blood vessels at the same time, so that it closes the vessels up to 7 mm in diameter, used in the presence of large vessels as it performs coagulation with minimal heat, as it is used in cases of enlarged ovaries, ovarian tumors, or removal due to ovarian torsion.
Laparoscopic Oophorectomy with Sleeve Harmonic
Laparoscopic oophorectomy with the Silim Harmonic device relies on high-frequency ultrasound waves that vibrate very quickly (55,000 times per second), cutting and coagulating the tissue slowly and with low heat, thereby increasing safety near sensitive organs, though it is less commonly used due to the high cost.
Recovery
Immediately after surgery (the first 24 hours) the patient is transferred to a room to monitor her vital signs such as pulse, pressure and breathing or the patient may be able to go home the same day, it is normal for the patient to suffer from nausea or dizziness due to general anesthesia or feel some pain in the abdomen or shoulder due to the gases Painkillers and anti-nausea medications are given as needed, most women can walk a little within a few hours of the operation to stimulate blood circulation and prevent clots, the doctor may also recommend the patient to rest completely for the first two days and walk lightly daily to avoid clots and improve digestion. Keep the wounds clean and dry, and avoid carrying heavy objects or engaging in strenuous activity.
Because regular exercise will help you return to your normal activities as soon as possible, consult your healthcare team or general practitioner before you start exercising.
What are the complications of laparoscopic oophorectomy?
Laparoscopic oophorectomy may cause complications. The likelihood of complications depends on the type of surgery, the patient’s general health, and the ablation method used. The most common potential complications include the following:
- Nausea and vomiting: After the procedure, rare allergic reactions to anesthesia medications may occur, and respiratory issues may occur during anesthesia.
- Pain: Pain and swelling may occur and are usually managed with analgesic medications.
- Bleeding: During or after surgery, internal bleeding may occur from blood vessels that have been clipped or coagulated, in rare cases the patient may need a blood transfusion or convert the operation to open surgery to control the bleeding.
- Injury to neighboring organs: Due to the proximity of the ovary to other organs, injury to the small or large intestine, injury to the ureter or bladder, or injury to large blood vessels (such as the iliac artery) may occur.
- Infection: Infection after laparoscopic oophorectomy may occur at the skin wound sites or pelvic infections. These risks are minimized by good sterilization and the use of prophylactic antibiotics when needed.
- Deficiency of female hormones: May lead to symptoms of early menopause, mood swings, and vaginal dryness.
- Cardiovascular disease: Low estrogen may contribute to atherosclerosis by increasing blood pressure and promoting fat accumulation in the vessels.
- Blood clots: After laparoscopic oophorectomy, the patient may be immobile for an extended period, increasing the risk of deep vein thrombosis (DVT), especially in the legs.
- Low libido: Laparoscopic oophorectomy may lead to low libido in some women due to a decrease in sex hormones.
- Osteoporosis: Estrogen plays an important role in maintaining bone density, so low estrogen levels increase the risk of osteoporosis.
- Removal of both ovaries: Laparoscopic oophorectomy of both ovaries leads to infertility and may cause symptoms such as hot flashes, night sweats, mood swings, and osteoporosis, and the patient may need hormone replacement therapy depending on her condition and age.
- Formation of internal adhesions: Although laparoscopy reduces the risk of adhesions compared with open surgery, some may still form.
What are the advantages of laparoscopic oophorectomy?
- Better cosmetic appearance: The long-term aesthetic appearance is better because the surgeon performs the procedure through small incisions (usually 0.5-1 cm), resulting in small, unnoticeable scars.
- Less pain: After laparoscopic oophorectomy, because the incisions are smaller and the tissues are less traumatized, the pain is less than after open surgery, and the need for strong painkillers is less.
- Faster recovery time: Most patients can return to their daily activities within 1-2 weeks, compared with 4-6 weeks for open surgery.
- Less bleeding: During laparoscopic oophorectomy, modern laparoscopic techniques (such as Legacy and Harmonic) that enable excellent bleeding control reduce the need for blood transfusions.
- Fewer complications: Compared to open surgery, laparoscopic oophorectomy has a lower risk of infections and a lower chance of abdominal adhesions that may cause future complications such as infertility or bowel obstruction.
- Wide vision: During laparoscopic oophorectomy, the camera provides a magnified, high-definition image of the internal organs, allowing the surgeon to perform the procedure with greater precision, especially when dealing with delicate tissue or small tumors.
- Reduced length of stay in the hospital: Laparoscopic oophorectomy often does not require more than 24 hours in the hospital; in some cases, it is performed as a day surgery (the patient goes home the same day).
In conclusion, laparoscopic ovarian cystectomy is an effective and safe treatment option in many cases, such as the presence of tumors, ovarian cysts, torsion or severe inflammation, or for preventive purposes and to improve the patient’s experience in general, although it is not without risks, but the associated benefits have made it The decision to perform oophorectomy depends on a comprehensive assessment of the patient’s health and treatment goals, this decision should be made in consultation with a specialized medical team, so do not hesitate to seek advice from Bimarestan to ensure the best possible physical and psychological outcomes.
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