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Ovarian cystectomy - Indications and Complications

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

Indications for exploration, cystectomy, oophorectomy

  1. Newborn/Infancy
    1. Any adnexal mass >5 cm persistent beyond 3 months after delivery
  2. Premenarchal or Reproductive Age (with or without pregnancy)
    1. Any adnexal mass causing acute pelvic pain
    2. Any adnexal mass causing chronic pelvic pain
    3. Any simple, cystic adnexal mass greater than 10 cm
    4. Any complex adnexal mass >5 cm with multiple septations, excresences or with a mixed cystic and solid component on imaging or in the presence of ascites
    5. Any adnexal mass >5 cm with increased color doppler flow (increased vascularity)
  3. Postmenopause
    1. Any adnexal mass causing pelvic pain
    2. Any adnexal mass more than 5 cm diameter
    3. Any adnexal mass with multiple septations or with a mixed cystic and solid component on imaging or with associated ascites
    4. Any adnexal mass with increased color doppler flow (increased vascularity)

Complications

  1. Hemorrhage
  2. Infection/abscess
  3. Too much damage to functional ovarian tissue or tube
    1. Premature menopause
    2. Decreased fertility
    3. Ectopic pregnancy
  4. Spreading unanticipated malignancy
  5. Spillage of caustic/irritant material (18%)
  6. Recurrence of ovarian cyst
  7. Bladder injury
  8. Ureteral injury
  9. Persistent pain
    1. Ovarian remnant syndrome
    2. Residual scarring causing pelvic pain
    3. Ovarian vein thrombosis


Prevention of Complications

  1. Hemorrhage
    1. close dead space in ovary
    2. avoid hilum of ovary
  2. Infection/abscess
    1. close dead space in ovary
    2. avoid ovarian tissue necrosis
    3. avoid extensive cautery (use pinpoint if needed)
  3. Too much damage to functional ovarian tissue or tube
    1. Premature menopause
      1. identify any remaining normal germinal epithelium
      2. use cautery/coagulation instruments that limit lateral spread
      3. avoid ovarian hilum (compromising the blood supply)
    2. Decreased fertility
      1. identify any remaining normal germinal epithelium
      2. use cautery/coagulation instruments that limit lateral spread
      3. avoid ovarian hilum (compromising the blood supply)
    3. Ectopic pregnancy
      1. use cautery/coagulation instruments that limit lateral spread
  4. Spreading unanticipated malignancy
    1. use bag
    2. avoid capsule rupture
    3. decompress using suture around sucker
  5. Spillage of caustic/irritant material (18%)
    1. use bag
    2. avoid capsule rupture
    3. decompress using suture around sucker
  6. Recurrence of ovarian cyst
    1. avoid aspiration only of ovarian cyst
    2. perform cystectomy for endometriosis not just cautery
    3. suppress medically postoperatively
  7. Bladder injusry
    1. identify blsdder limits if ovarian adhesions anywhere near the bladder
  8. Ureteral injury
    1. identify ureter in broad ligament if ovarian adhesions to broad ligament
  9. Persistent pain
    1. Ovarian remnant syndrome
      1. Identify entire ovary
    2. Residual scarring causing pain
      1. Minimize any necrotic tissue
    3. Ovarian vein thrombosis
      1. avoid injury to ovarian vessels (IP ligament)

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