14201 The Four-Step Approach to Oophorectomy Post Hysterectomy

The objective of this study is to demonstrate a systematic approach to oophorectomy post hysterectomy. Two surgical cases and accompanying literature are shown to demonstrate the systematic approach to oophorectomy post hysterectomy. Each of the surgical interventions occurred in an inpatient operating room, and both were in an elective setting. Two patients consented for participation in the video. Our first patient was diagnosed with a left ovarian cyst and was seeking oophorectomy. She previously had a laparoscopic hysterectomy for adenomyosis. The second patient had BRCA2 and was seeking a risk reducing bilateral oophorectomy. She previously had an abdominal hysterectomy for heavy menstrual bleeding. Two different laparoscopic oophorectomies post hysterectomy are demonstrated. This video demonstrates common surgical encounters post hysterectomy. Notably the ovaries are often found in the retroperitoneum and behind bowel adhesions. To ensure safety of critical structures, and that no ovarian remnant is left behind, a systematic approach is required. This video reviews a step-wise approach to oophorectomy post hysterectomy, and demonstrates its application in a simple and more complex case. The steps are: first, perform a general survey and lysis of adhesions. Second, enter the retroperitoneum and perform ureterolysis. Third, skeletonize the infundibulopelvic ligament, seal, and transect. Fourth, excise the ovary off the pelvic side wall. This presented surgical method to oophorectomy post hysterectomy allows for a systematic approach, helping ensure safety of critical structures and that no ovarian remnant is left behind. The approach can be applied to simple and complex cases.