OOPHORECTOMY

1. OOPHORECTOMY Genet Helebo MS113 Procedure 11/10/04

2. OOPHORECTOMY Bilateral oophorectomy: a surgical procedure for removal of both ovaries Unilateral oophorectomy: a surgical procedure for removal of only one ovary This is performed in younger women with low-grade or early-stage of ovarian tumors who want to get pregnant This is called fertility-saving or fertility-sparing surgery

3. OOPHORECTOMY Salpingo-oophorectomy: removal of ovaries and fallopian tubes Prophylactic oophorectomy: the removal of ovaries to reduce the possibility of developing a future ovarian cancer

4. The female reproductive system

5. Salpingio-oophorectomy

6. Hysterectomy+salpingioophorectomy

7. Historical Background Until the 1980’s, If a woman above age 40, had hysterectomy healthy ovaries and fallopian tubes were also routinely removed Physicians reasoned that a woman after 40 is approaching menopause and soon her ovaries stop secreting estrogen and releasing eggs Removing ovaries would eliminate the risk of ovarian cancer and only accelerate menopause in few years

8. In the 1990’s The thinking about routine oophorectomy began to change because: The risk of ovarian cancer in women who have no family history of the disease is less than 1% Removing the ovaries increases the the risk of cardiovascular disease and accelerates osteoporosis Bilateral oophorectomy increases a woman’s risk of developing thyroid cancer

9. Reasons for oophorectomy To treat cancer of ovary, uterus, or endometrium To remove a large ovarian cyst To treat chronic pain caused by endometriosis To treat pelvic inflammatory disease To remove fertilized ovum that has incorrectly implanted on the ovary

10. Reasons for… To treat breast cancer Oophorectomy reduce the risk of breast or ovarian cancer in woman with abnormal genes BRCA1 or BRCA2 Oophotectomy reduces the risk of breast cancer by suppressing the hormone produced by ovaries

11. Two different methods of oophorectomy Abdominal incision: The surgeon makes a 10-15cm incision horizontally or vertically Horizontal incisions leave a less noticeable scar Vertical incisions give a surgeon a better view of the abdominal cavity More likely to be done when cancer is suspected Once the incision is done the abdominal muscles are pulled apart to see the ovaries The blood vessels are tied off to prevent excess bleeding Then the ovaries are removed

12. The advantages of abdominal incision The removal of ovaries is possible even if a woman has many adhesions from previous surgery Abdominal incision gives the surgeon a good view of the abdominal cavity to check the surrounding tissue for disease

13. The disadvantages are: Bleeding is more likely to be a complication of this type of operation The operation is more painful than a laparoscopic operation The recovery period is longer A woman can expect to be in the hospital two to five days and will need three to six weeks recovery time

14. Two different methods… Laparoscopic procedure: Laparoscope: is a small telescope like device about the width of pencil, with a light on one end and a magnifying lens on the other end Laparoscope is inserted through a small cut near the navel a camera is attached to help the surgeon to see the pelvic organs on a video monitor. Other small cuts are made in the abdomen, through which the doctor inserts slender instruments with which to cut and tie off the blood vessels and fallopian tubes

15. The advantages of laparoscopic procedure The incisions are small, about 1.3cm long The operation causes less discomfort than an abdominal procedure Bleeding rarely occurs The hospital stay is usually only one day Recovery time is reduced to about two weeks

16. The disadvantage The procedure is relatively new and requires great skill by the surgeon

17. Preparation for oophorectomy Before surgery: The doctor will order blood and urine tests Ultrasound, CT-scan or x-rays are taken to help the surgeon visualize the woman’s condition The woman may also see anesthesiologist for evaluation of any special conditions that might affect the administration of anesthesia

18. Preparation… On the evening before the procedure, the woman should eat a light dinner After midnight, woman shouldn’t eat or drink anything, including water

19. Tumor of the left ovary TV scan

20. Tumor of the left ovary Transabdominal scan

21. Tumor of the left ovary total hysterectomy

22. After the procedure The woman will feel some discomfort Antibiotics are given to reduce the risk of post-surgery infection When both ovaries are removed, women who do not have cancer are started on hormone replacement therapy to ease the symptoms of menopause if even part of one ovary remains, it will produce enough estrogen that a woman will continue to menstruate, as long as her uterus is not removed

23. Risks Oophorectomy is relatively a safe operation however it dose carry some risks like: Unanticipated reaction for anesthesia Internal bleeding Blood clots Accidental damage to other organs Post-surgery infection

24. References: http://www.chclibrary.org/micromed/00058890.html http://community.healthgate.com/GetContent.asp?siteid=holycross&docid=/dsp/oophorectomy http://www.obgyn.net/us/us.asp?page=/us/present/0207/nikolaev_ovarian_tumor