Name of the Procedure:

Oophorectomy, partial or total, unilateral or bilateral; for ovarian, tubal, or primary peritoneal malignancy, with para-aortic and pelvic lymph node biopsies, peritoneal washings, peritoneal biopsies, diaphragmatic assessments, with or without salpingectomy.

Summary

An oophorectomy is a surgical procedure to remove one or both ovaries. This can be done to treat or prevent ovarian, tubal, or primary peritoneal cancer. The procedure may also include biopsies of lymph nodes and other tissues, washing of the peritoneal cavity, and inspection of the diaphragm. It can be performed with or without the removal of the fallopian tubes (salpingectomy).

Purpose

The purpose of this procedure is to treat or prevent the spread of ovarian, tubal, or primary peritoneal malignancies. The goal is to remove cancerous tissues and assess the extent of cancer spread to improve outcomes and survival rates.

Indications

• Diagnosed ovarian, tubal, or primary peritoneal cancer.
• High risk of developing ovarian or related cancers due to genetic factors.
• Persistent pelvic pain or masses suspicious for malignancy.
• Preventive measure for individuals with BRCA mutations or other high-risk profiles.

Preparation

• Patients may be required to fast for 8-12 hours before the surgery.
• Preoperative blood tests, imaging studies (CT, MRI), and possibly a colonoscopy.
• Stopping certain medications such as blood thinners.
• Pre-procedure consultations including anesthesia evaluation.

Procedure Description

1. Administering general anesthesia.
2. Placing the patient in a position to allow adequate access to the pelvic area.
3. Making an abdominal incision (laparotomy) or several small incisions (laparoscopy).
4. Removing one or both ovaries (partial or total, unilateral or bilateral oophorectomy).
5. Conducting biopsies of para-aortic and pelvic lymph nodes.
6. Performing peritoneal washings and biopsies.
7. Assessing the diaphragm.
8. Optionally removing fallopian tubes (salpingectomy).
9. Closing the incision(s) and applying dressings.

Duration

The procedure typically takes 2-4 hours, depending on the extent of surgery and complexity.

Setting

Usually performed in a hospital operating room.

Personnel

• Gynecologic oncologist or surgeon.
• Anesthesiologist.
• Surgical nurses.
• Operating room technicians.

Risks and Complications

• Common: Infection, bleeding, pain, scarring.
• Rare: Injury to surrounding organs (bladder, intestines), blood clots, adverse reaction to anesthesia, hormonal changes if both ovaries are removed.

Benefits

• Removal of cancerous tissues to prevent spread.
• Potentially life-saving for patients with advanced malignancies.
• Reduced risk of cancer development in high-risk patients.

Recovery

• Hospital stay of a few days post-surgery.
• Restrictions on heavy lifting and strenuous activity for several weeks.
• Pain management with medications.
• Follow-up appointments for wound checks and monitoring recovery.

Alternatives

• Chemotherapy and/or radiotherapy.
• Hormonal therapy.
• Watchful waiting in less aggressive cases.
• Pros: Less invasive, can preserve ovarian function.
• Cons: May not be as definitive as surgical removal for cancer treatment.

Patient Experience

• During: Under general anesthesia, the patient will be unconscious.
• After: Pain and discomfort managed with medications. Tiredness and limited activity initially, gradually improving over a few weeks. Emotional support might be beneficial due to the impact on reproductive health and hormonal balance if both ovaries are removed.