Checklist for Ovarian cystectomy

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This checklist is part of the Gynsurgery guidelines used in an educational setting for residents in Ob-Gyn.

The pdf form of the Ovarian Cystectomy Checklist may not contain the latest changes

Preoperative Checklist

(The pdf form of the checklist for Ovarian Cystectectomy may not reflect the latest changes below)

Determine probability of malignancy (greater or less than 5%)

  1. ___ Image ovary/adnexa using transvaginal ultrasound (prevent spreading unanticipated malignancy)
  2. ___ Obtain serum specimen for CA-125 antigen (prevent unanticipated malignancy, monitor post operative progress if malignancy found)
    1. If Ca-125 >67 units/ml in premenopausal woman or >35 units/ml in a postmenopausal woman, consider gyn oncology stand-by or referral

Choose type of abdominal incision/surgical approach

  1. ___ If malignancy probability >5% or previous midline incision, use midline incision (prevent inability to perform surgery through chosen incision, prevent spreading malignancy)
  2. ___ If malignancy probability <5% and cyst size < 8-10 cm, use laparoscopic approach (prevent wound infection, minimize hospital stay)
  3. ___ If malignancy probability <5% and cyst size 8-15 cm, and adequate intraspinous for transverse incision, choose Pfannenstiel or Maylard incision (minimize chance of wound dehiscence)
  4. ___ If malignancy probability <5% and cyst size >15 cm, choose midline abdominal incision (prevent inability to perform surgery through incision)
  5. ___ Inform patient of wound complications and their likelihood of occurrence (wound infection, hematoma, dehiscence, pain, cosmetic changes) along with complications of the primary procedures being performed (prevent incorrect expectations)
  6. ___ Inform patient and sign consent for possible complications: bleeding, infection/pelvic or ovarian abscess, premature menopause, decreased fertility, ectopic pregnancy, spreading unanticipated malignancy, spillage of caustic/irritant material (18%), recurrence of ovarian cyst, bladder injury, ureteral injury, persistent pelvic/adnexal pain (prevent unreasonable expectations of surgery)
  7. ___ Recommend to clip abdominal/mons hair prior to surgery but no shaving (prevent infection)
  8. ___ Recommend to shower/cleanse incision site prior to surgical prep with antibacterial soap (prevent wound infection)
  9. ___ Order mechanical bowel prep for the day before surgery (prevent bowel injury) (prevent inadequate visualization)
  10. ___ Discontinue ASA (5 days preop), Plavix (3 days preop) and other anti-clotting meds prior to surgery

Intraoperative Checklist

Cautery Management

  1. ___ Confirm that patient is grounded (prevent cautery injury)
  2. ___ When cauterizing using metal instruments check for any unintended skin/tissue contact (prevent cautery injury)
  3. ___ Use cautery on ovary very sparingly, pinpoint, if at all (avoid necrotic ovarian tissue, prevent ovarian abscess, prevent premature menopause)
  4. ___ Minimize cautery damage with endometriosis or ovarian bleeding (prevent residual ovarian scarring, prevent pelvic pain)

Intraabdominal Procedure

  1. ___ If dissecting ovary which is adhesed posteriorly to the broad ligament, identify ureter in broad ligament if ovarian peritoneal plane at all not obvious (prevent ureter injury)
  2. ___ If performing oophorectomy, elevate ovary anterior and medially when ligating ovarian ligament (prevent ureteral injury)
  3. ___ If performing oophorectomy, be sure to remove all ovarian tissue (prevent persistent pain, prevent ovarian remnant syndrome)
  4. ___ If performing ovarian cystectomy, incise ovarian cortex just below junction of cyst and functional ovarian epithelium (prevent spillage of caustic cyst contents, prevent premature menopause)
  5. ___ Close ovarian dead space (prevent ovarian hematoma, prevent ovarian abscess)
  6. ___ Use rapidly absorbing suture when closing the ovary (prevent ovarian infection)
  7. ___ Avoid ovarian hilum (prevent ovarian hematoma)
  8. ___ Identify any remaining normal germinal epithelium (prevent premature menopause, prevent reduced fertility)
  9. ___ Use bag (prevent spreading unanticipated malignancy, prevent abdominal adhesions due to cyst spillage
  10. ___ If laparotomy decompress cyst using suture around sucker (prevent spillage of caustic/irritant material (18%)
  11. ___ If performing cystectomy, remove cyst wall, don't just aspirate cyst (prevent recurrence of ovarian cyst)
  12. ___ If performing ovarian cystectomy, suppress ovaries medically postoperatively (prevent early recurrence of an ovarian cyst)
  13. ___ If performing cystectomy, avoid injury to ovarian vessels/infundibulopelvic ligament (prevent Ovarian vein thrombosis)

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