Laparoscopic Oophorectomy

Laparoscopic oophorectomy is the removal of one or both ovaries through small incisions in the abdominal wall. Because the ovaries produce both egg cells and hormones such as oestrogen, their removal can affect fertility and hormonal balance; for this reason, preserving the ovary is the basic principle in benign conditions, and oophorectomy is recommended only in selected situations. The information below provides a general framework and does not replace an individual assessment.

What is oophorectomy?

Oophorectomy is the removal of the ovary. In unilateral oophorectomy, one ovary is removed; in bilateral oophorectomy, both are removed. If the fallopian tube is also removed, the procedure is called salpingo-oophorectomy. Cystectomy, in which the ovary is left in place and only the cyst is removed, is a different operation.

In which situations is removal of the ovary considered?

In some situations, removal of the ovary may be necessary; these can include an ovary damaged beyond repair after torsion, a mass that cannot be separated by removing the cyst or that looks suspicious, advanced endometriosis, severe infection (abscess) affecting the ovary and tube, and certain inherited risk conditions. What is done in a given situation varies according to the individual; the decision is made together with the doctor, weighing benefits and risks.

When can the ovary be preserved?

In most cysts, only the cyst is removed and the ovary is left in place. When an ovary has undergone torsion, even if it looks dark in colour, untwisting it and preserving the ovary may be preferred where possible. Whether the ovaries are removed when the uterus is removed is also not automatic; the risk of ovarian cancer, the need for a further operation, and the effects of surgical menopause on cardiovascular and bone health are weighed together. Removing the fallopian tubes in the context of a hysterectomy or tubal sterilisation performed for a benign reason in a person at average risk can reduce the risk of ovarian cancer but does not eliminate it; this does not apply to high-risk situations such as BRCA.

What happens with inherited risks such as BRCA?

In some people carrying an inherited gene change such as BRCA, removal of the ovaries and tubes can be considered with the aim of reducing the risk of ovarian and tubal cancer. This decision requires genetic counselling and medical assessment; the timing of the operation varies according to the individual, and there is no general rule that can replace personal advice.

How is laparoscopic oophorectomy performed?

The operation is performed under general anaesthesia. Several small incisions are made in the abdominal wall, the abdominal cavity is expanded with gas, and the ovary is separated from surrounding tissue and removed with the help of a camera and fine instruments. The removed tissue is usually placed in a protective bag before being taken out of the abdomen and is sent for pathological examination. Instructions on preparation, fasting and stopping medicines are given by the surgical team; the method of entry and its details are the surgeon's decision. The operation is performed by Assoc. Prof. Dr. Nurettin Türktekin at Memorial Şişli Hospital.

How are hormones, menopause and pregnancy affected after oophorectomy?

In unilateral oophorectomy, the remaining ovary can continue to function; periods and natural pregnancy can usually continue, although the effect varies from person to person and the chance of pregnancy can vary between individuals. In bilateral oophorectomy, hormone production by the ovaries ends; natural pregnancy is not expected. In a person who has not yet reached menopause, this leads to surgical menopause: hot flushes, sleep problems, vaginal dryness, mood changes, and long-term effects on bone and cardiovascular health can occur. The severity of symptoms varies from person to person. Hormone therapy can be considered in surgical menopause; the decision is made with the doctor according to the individual. In people with pregnancy plans, fertility preservation options should be discussed before the operation.

What are the risks and possible complications of surgery?

Like any surgical procedure, laparoscopic oophorectomy carries risk. The main risks are:

• Risks related to anaesthesia
• Bleeding
• Infection
• Injury to the bowel, bladder or a blood vessel during entry into the abdomen (most often occurring at the initial entry stage, and sometimes not noticed during the operation, only becoming apparent afterwards through symptoms)
• Injury to neighbouring organs (urinary tract, bowel)
• Formation of a blood clot in the leg veins
• Laparoscopy not being completed, requiring conversion to open surgery
• Surgical menopause, if both ovaries are removed

Serious complications are rare, but the risk is not zero.

What can you expect during recovery?

Abdominal bloating, incision pain and nausea may occur afterwards. Light spotting, mild cramps and temporary gas-related shoulder-tip pain are considered normal during this time. The same symptoms occur after emergency surgery for torsion or an abscess. Hospital stay and when to return to work, daily life, sport and sex depend on the extent of surgery and your circumstances; the operating team gives instructions.