Oophorectomy: surgery to remove the ovaries
The oophorectomy is called the operative procedure consisting of removal of one or both of the ovaries (uni- or bilateral).
The ovaries or gonads are a pair of almond-shaped organs, the size of a medium walnut. They are located one on each side of the uterus, just below the fallopian tubes. In addition to containing the ova - which grow within the follicles - the ovaries produce some hormones, the main estrogen and progesterone, the actions of which are fundamental for femininity, reproduction, skin and mucous membranes, maintenance of bone mineral density and others .
The ovaries are "tumorigenic" organs, that is, they can develop tumors more frequently than other organs. This happens because almost every cycle grows a kind of cyst, full of liquid and very rich in estrogen, where the egg develops. The ovum is released when the follicle ruptures, in a process called ovulation. Sometimes the rupture does not occur and the follicle can grow very large - its dimensions can reach many centimeters, sometimes reaching large dimensions. We call these follicular cystic tumors.
Follicular cystic tumors are usually benign cysts, but if they do not regress in one or two menstrual cycles, they should be well investigated through the association of diagnostic methods such as ultrasonography (US) and magnetic resonance imaging (MRI) of the pelvis (MRI) to obtain an accurate diagnosis. Sometimes, after ovulation, a small vessel is bleeding into the ovary forming the so-called corpus luteum, which also disappears after one or two menstruations. Both are called functional cysts and virtually require no surgery. We should be aware of the possibility that increases in the ovary caused by the cysts may predispose to twisting of the pedicle, interrupting its vascularization with consequent ovarian necrosis, causing severe pain and complete organ loss.
Formations that do not regress and that reveal some "worrying" characteristics on their surface, their content or vascularity, often accompanied by pain, should be very well evaluated through pelvic examination, especially gynecological touch and imaging features, US Doppler or MRI with contrast and which will guide the need for surgery, either for removal of the tumor or for one or both of the ovaries, in cases compatible with suspected malignancy.
Other types of tumors may recommend partial oophorectomy or oophoropoplasty. In this, only the removal of the tumor (benign) is carried out as in cases of endometriosis, hemorrhagic corpus luteum cyst or benign teratomas (dermoid cysts).
In certain cases of breast cancer, removal of the ovaries may be indicated with the objective of eliminating the source of hormone production, whose effects may aggravate the progression of the mammary tumor.
Oophorectomy, especially the removal of both ovaries, should not be performed indiscriminately. The lack of ovarian hormones reverberates dramatically in the woman's body, especially those that are in full reproductive capacity. This is because oophorectomy abruptly creates the permanent stop of menstruation (menopause) with all its symptomatic repercussions, such as heat waves, palpitations and insomnia, in addition to metabolic impact, increasing the risk of osteoporosis, genital atrophy, repetitive cystitis and others .
Thus, young or non-menstruating women are only indicated for removal of the ovaries in dramatic situations of malignant disease.
The key is that care should always be preventive. All women, from adolescence and especially if they already have active sex life, should undergo examinations of their reproductive apparatus, including the breasts, at least once a year. The ideal is to make periodic visits every six months, especially for those at risk for sexually transmitted diseases, those who use hormonal contraceptives or who have a family history or more severe gynecological disease.Women who have reached the age of 40 and have gone through menopause also have a special recommendation for gynecological follow-up, since ovarian cancer most often affects women between the ages of 55 and 75.
Exams Needed to Perform Surgery
Beyond Routine laboratory examinations, required for most surgeries, are indispensable for ultrasonography and magnetic resonance imaging. These tests allow the doctor to accurately diagnose the type of tumor, whether cystic or solid. Some of the so-called "tumor markers", such as CA-125, may be elevated, but their specificity is reduced.
8-Hour Fast, Including Fluids
Light / of surgery
- Use of laxative in the preoperative period
- Ask the clinician for advice about medications that should or should not be temporarily suspended
- Talk to the medical staff about general instructions, diet, care and medication for the post
- Types of Anesthesia
- Elective anesthesia is the general one. Sometimes the blockade is associated with spinal anesthesia, which gives excellent postoperative analgesia of up to 24 hours.
Which doctor performs the surgery
Most oophorectomies are performed by gynecologists. Surgeons are qualified to do. In both cases professionals need to have specialist title in the field. In certain cases of malignancy the presence of a surgeon with oncology training may be required.
How it is performed
The surgical approach may be performed by laparotomy through the wide opening of the abdominal wall, or by mini- invasive technique of videolaparoscopy, a modern endoscopic technique that removes the tumor or organ through small holes - from 5 to 10 millimeters - and allows the tumor or organ resected to be collected inside a bag or bag. In the case of very large tumors or suspicion of malignancy, the approach should preferably be by laparotomy.
Patients during surgery are lying on their backs (dorsal horizontal position) often associated with the semi-gynecological position, which is adopted for laparoscopic surgeries. In these, the table should be tilted up to 40 degrees toward the head.
The patient will be operated in a surgical room, with all the surgical and anesthetic support necessary for any unforeseen event. Laparotomy
In laparotomy, the incision can be made through a horizontal or slightly arcuate cut, and the incision can be made through a horizontal or slightly arcuate incision, just above the pubis, with about 10-12 cm. In situations of great suspicion of malignancy an extensive vertical "cut" may be made, which begins above the umbilicus and goes to the pubis (median laparotomy).
After the cut, the ovaries or tumors are removed. A meticulous inspection of the operated site is done reviewing the obtained result and taking care to avoid any bleeding point. Finally, the medical team closes the abdominal wall by planes. The stitches are removed between 7 and 10 days.
Videolaparoscopy Most oophorectomy can be done endoscopically (videolaparoscopy). After distending the abdominal cavity with carbon dioxide, a 1 cm puncture is made in the umbilical scar, where a cable is introduced that projects a high intensity "cold" light (up to 400 watts) from a special source coupled to a mini camera that transfers the internal images to high-definition TV monitors. Three other small punctures of approximately 5 mm (very aesthetic) are made at the height of the region of use of a bikini, which practically leave no visible scars, through which all the delicate and precise surgical instruments are introduced. Images are viewed in bright light and can be magnified up to 20 times, providing sharper detail than seen with the naked eye.
After the ovaries or tumors are removed, a meticulous inspection of the operated site is done reviewing the result obtained and taking care to avoid any bleeding point. Finally, the previously infused gas is withdrawn and the patient receives one to two stitches in each puncture.
Procedure duration time
The time of oophorectomy will depend on the degree of complexity of the existing disease. In benign cases, the procedure lasts one hour and may be prolonged in the presence of malignant tumors, severe endometriosis, or in cases of complications during surgery or technical difficulties.
Length of hospitalization
In general, hospitalization is 24 hours. In laparoscopy, it is normal for the person to be discharged on the same day.
Care after surgery
In general oophorectomy is technically simple and not aggressive surgery, providing a very comfortable convalescence, especially when the intervention is performed by videolaparoscopy.
Usual post-operative care should be taken, such as:
Light diet for the first three days
Resting relative, compatible with the extension of the surgical procedure
- Adequate sexual rest
- Taking the prescribed medicines
- Schedule the postoperative visit for reassessment and removal of points
- In theory, withdrawal should never be made of the ovaries without an absolute indication, due to the drastic commitment to the woman's body that can come with this intervention. However, even in these cases, modern medicine, through the resources of hormone replacement therapy (HRT), is able to efficiently compensate for the lack of the hormones that came from the ovaries. It is a process similar to that which happens gradually when the woman enters climacteric and menopause.
- Possible complications / risks
- Even when performed with good technique, every surgical act is subject to some risks. The possibilities are all the greater the more complex and invasive the intervention. Some parameters should be observed to avoid or minimize these risks, such as accurate diagnosis, trained staff, competent anesthetic staff, efficient nursing, quality surgical instruments and good hospital conditions.
Except in cases of endometriosis or malignant diseases, for example, oophorectomy does not require greater care to optimize the results. It is necessary, however, to be attentive to eventual and often obligatory hormonal supplementation in the postoperative period due to the abrupt hormonal fall that occurs when the ovaries are withdrawn, particularly when the surgery is performed on younger women. Costs of Surgery
Oophorectomy can be done by the Unified Health System (SUS). The procedure is also covered by some health plans and can be done on the private network.
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