Techniques for Ovarian Fixation Using a Sealing Device to Prevent Ovarian Torsion After Laparoscopic Total Hysterectomy (TLH)

Recently, there have been case reports of ovarian torsion occurring after total laparoscopic hysterectomy (TLH). At our institution, TLH is performed using a lateral approach, which results in a wide opening of the retroperitoneum, increasing ovarian mobility. Increased ovarian mobility may elevate the risk of postoperative ovarian torsion, and although methods for preventing torsion are needed, there is limited evidence supporting preventive measures. In our practice, we perform ovarian fixation to the retroperitoneum using a sealing device during surgery, and here we report the results of this fixation method. Ovarian fixation is achieved by coagulating the ovarian ligament to the retroperitoneum using an Erbe BiClamp® (bipolar coagulation forceps), typically employed for hemostasis during surgery. Between April and July 2024, 12 cases of ovarian fixation were performed during TLH using a BiClamp, and 10 of the 12 cases (83%) demonstrated visible ovaries on follow-up ultrasound post-surgery. Two cases showed successful fixation, with consistent ovarian observation at both immediate postoperative and follow-up transvaginal ultrasound three months later. The fixation is thus considered to persist reliably over time. Successful fixation requires collaboration with the assistant to grasp the ovarian ligament and retroperitoneum, coagulating multiple sites. Care must be taken to avoid thermal damage to blood vessels or the ovaries by elevating the tissue and coagulating the membrane only. No patients in this study reported ovarian loss symptoms postoperatively. The fixation technique we employed is simple, cost-effective, and may contribute to preventing torsion.