LB109
Needle oophropexy: a new simple technique for ovarian transposition prior to pelvic irradiation
Waheed Gareer, Zeiad Gad
National Cancer Institute, Cairo University, Egypt
Background
Treatment of some cancers has permitted the consideration of salvaging the
reproductive function of premenopausal female patients. To protect the ovaries,
an oophoropexy may be performed, which involves moving the ovaries away from
the pelvic lymph node fields.
Aim
The objective of this study was to evaluate the feasibility, morbidity, and
efficacy of laparoscopic ovarian transposition using simple percutaneous needle
technique.
Method
A laparoscopic technique has been described that allows transposition of
the ovaries just prior to pelvic radiation. This is a report of the outcome of
ten patients (seven with rectal cancer and three with Hodjkins disease) who
underwent laparoscopic oophoropexy at the National Cancer Institute, Cairo University. Three were excluded from analysis, because two died and the third had a
second malignancy for which radiation was aborted. The operative technique
consisted of laparoscopic releasing of the ovary through cutting the
uteroovarian ligament followed by placing the ovaries on the anterior abdominal
wall medially and above the anterior superior iliac spine. Percutaneous
straight needle is introduced through 2 mm skin incision at site of fixation.
Repositioning of the ovaries has been simply done through cutting the
subcutaneous suture using local anesthesia on outpatient basis without the need
for readmission to the operating theatre.
Results
The technique showed its effectiveness, reliability and simplicity with no
morbidities. The mean time was ten minutes and patients returned home day of
surgery. At follow-up, these seven patients had evidence of ovarian function,
and the five patients of these seven who desired children achieved pregnancies.
Conclusion
Percutaneous needle transposition is simple, effective, reliable, and easy
technique for both ovarian transposition and repositioning. It has short
learning curve and can be easily done by less experienced laparoscopic
surgeons.
