Name of the Procedure:

Transposition, ovary(s)

• Common name(s): Ovarian transposition
• Medical terms: Oophoropexy

Summary

Ovarian transposition is a surgical procedure that repositions one or both ovaries to a different part of the pelvis. This is often done to protect the ovaries from damage due to radiation therapy or other treatments.

Purpose

• Medical condition or problem it addresses: Protects ovaries from radiation-induced damage, typically in patients undergoing pelvic radiation therapy for cancers such as cervical, rectal, or colorectal cancer.
• Goals or expected outcomes: Preserve ovarian function and fertility by moving the ovaries out of the radiation field.

Indications

• Specific symptoms or conditions: Cervical, rectal, colorectal, or other pelvic cancers requiring radiotherapy.
• Patient criteria or factors: Women of reproductive age who wish to retain fertility and ovarian function post-treatment.

Preparation

• Pre-procedure instructions: Fasting typically required for at least 8 hours before the procedure. Adjustments to medications, particularly blood thinners, may be necessary.
• Diagnostic tests or assessments: Blood tests, pelvic imaging (ultrasound, MRI), and a detailed medical history.

Procedure Description

• Step-by-step explanation:

  1. Anesthesia is administered (general anesthesia is commonly used).
  2. Small incisions are made in the abdomen (laparoscopic approach often preferred).
  3. The ovaries are carefully detached from their original location.
  4. The ovaries are repositioned to a new location outside the pelvic radiation field, typically higher in the abdomen.
  5. The ovaries are secured in their new position.
  6. The incisions are closed with sutures or surgical glue.
• Tools, equipment, or technology used: Laparoscope, surgical instruments for repositioning and securing ovaries.
• Anesthesia or sedation details: General anesthesia is usually administered.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

• Lead surgeon: Often a gynecologic oncologist or a general surgeon.
• Surgical assistants: May include other surgeons or surgical residents.
• Anesthesiologist: Administers anesthesia and monitors the patient.
• Operating room nurses and surgical technologists: Assist with the procedure.

Risks and Complications

• Common risks: Infection, bleeding, pain at incision sites.
• Rare risks: Ovarian function loss despite transposition, ovarian cysts, damage to surrounding organs.
• Possible complications and their management: Management may involve antibiotics for infections, pain medications, or further surgical interventions if complications arise.

Benefits

• Expected benefits: Preservation of ovarian function, decreased risk of premature ovarian failure and infertility.
• How soon benefits might be realized: Protective benefits are immediate, though ovarian function is monitored post-radiation therapy to confirm success.

Recovery

• Post-procedure care and instructions: Pain management with prescribed medications, keeping incision sites clean and dry, gradual return to normal activities.
• Expected recovery time: Typically, 1 to 2 weeks for full recovery, though light activities may resume sooner.
• Restrictions: Avoid heavy lifting and strenuous activities for several weeks. Follow-up appointments for monitoring ovarian function and overall recovery.

Alternatives

• Other treatment options available: Hormone suppression therapy, ovarian shielding during radiation, egg or embryo freezing (cryopreservation).
• Pros and cons of alternatives:
  • Hormone suppression may not be as effective in preserving fertility.
  • Ovarian shielding may not provide complete protection.
  • Cryopreservation is effective but involves separate procedures and financial costs.

Patient Experience

• During the procedure: The patient will be under general anesthesia and will not feel or remember the procedure.
• After the procedure: Patient may experience mild to moderate pain at incision sites, managed with pain relief medications. Potential discomfort from abdominal bloating or gas due to laparoscopic approach.
• Pain management and comfort measures: Prescription pain medications, over-the-counter options, and non-pharmaceutical comfort strategies like warm compresses.