Introduction to Ovarian Cystectomy

TABLE OF CONTENTS 1 Name of Procedure 2 Alias for Ovarian Cystectomy 3 Classification 4 ICD Codes 5 Overview 6 Indications 7 Contraindications 8 Preoperative Preparation 9 Anesthesia and *** 10 Surgical Procedures This is a redirected entry *** enjoying Ovarian Cystectomy. For ease of reading, Ovarian Cyst Stripping has been automatically replaced with Ovarian Cystectomy below, which can be restored by clicking here, or presented using the remarks 1 Name of procedure

Ovarian Cystectomy

2 Alias for Ovarian Cystectomy

Ovarian Cyst Stripping

3 Classification

Obstetrics and Gynecology/ Gynecologic Endoscopy/ Laparoscopy

4 ICD code

65.2501

5 Overview

The anatomy of the ovary and ovarian cysts is shown below (Figures 11.5.1.41, 11.5.1.42A and B).

6 Indications

Ovarian cystectomy is indicated for:

1. Small ovarian cysts requiring preservation of fertility.

2. The normal tissue portion of the affected ovary is not destroyed.

3. Ovarian crown cysts (Figures 11.5.1.43, 11.5.1.44).

7 Contraindications

1. Severe cardiovascular disease, pulmonary insufficiency.

2. diffuse peritonitis.

3. Umbilical, diaphragmatic, abdominal wall, inguinal or femoral hernia.

4. Abnormal coagulation.

5. Extensive scarring of the abdominal wall or extensive adhesions in the abdominal cavity due to a history of surgery.

6. Excessive obesity.

8 Preoperative preparation

1. Skin preparation of the abdomen and vulva (including cleansing of the umbilicus).

2. Bowel preparation? Perform 0.1% soapy water *** the night before surgery. For procedures that may involve the intestinal canal, perform a 3d preoperative bowel preparation.

3. Preoperative medication? If the scope of surgery is large and may involve the intestines, antibiotics should be used 3d preoperatively to prevent infection. Sedation, atropine or scopolamine should be injected 30min before surgery.

4. Indwelling urinary catheter.

5. Prepare blood or prepare autologous back blood.

9 Anesthesia and ***

1. Epidural or general anesthesia.

2. Head-down supine position.

10 Surgical Procedure

1. Head-low-foot-high supine position, routine three-point puncture, placement and exploration, attention to the affected side of the ovary with or without adhesions and the opposite side of the ovary, uterine condition.

Routine collection of peritoneal fluid or lavage fluid was sent for cytologic examination.

The ovary is exposed anteriorly to the uterus. This usually involves carefully lifting the ovary and cyst with a probe along the medial aspect of the ovary, following the posterior lobe of the broad ligament in an outward and superior direction, and allowing the uterus to naturally sink posteriorly, so that the ovary is located in the anterior aspect of the uterus for ease of manipulation.

If the cyst is larger than 10 cm, it is usually necessary to place a collar at the site of the proposed puncture, then use a long needle to connect the suction tube, puncture and then aspirate the contents of the fluid, and then pull out the needle after completion of the procedure, i.e., lift the wall of the cyst with a separating forceps clamped on the puncture hole and tighten the collar to prevent the rest of the cystic fluid from leaking out (Fig. 11.5.1.45).

2. Incise the normal ovary on the surface of the cyst? Usually need to avoid the vascular area, with water injection method to separate the cyst surface envelope, or after electrocoagulation or directly cut, usually first cut a small opening, with a curved scissors curved surface facing up or outward, and cut after separating one by one along its gap. After more than half a week, the operator and the assistant each hold a pair of separating forceps, respectively, clamp one side of the edge, in the opposite direction to tear open the cyst surface peritoneum, generally can be intact cyst stripping. It is also possible to use a probe to separate the cyst in the direction of the normal ovarian tissue after more than half a week of cutting, and when it is difficult to separate, scissors can be used to expand the incision, and the cyst can generally be stripped out completely (Figures 11.5.1.46 to 11.5.1.48).

3. Hemostasis of the residual ovarian wound? Treat active bleeding from the trauma with bipolar or monopolar electrocoagulation.

4. Trimming the excess peritoneal tissue to shape the residual normal ovary, usually with bipolar electrocoagulation forceps clamping the periphery of the electrocoagulation, the tissue will be contracted centrally, the trauma will be reduced, and is usually not sutured, as it increases the postoperative adhesions. The crusted membrane due to electrocoagulation is beneficial in preventing adhesions after surgery.

5. Fully irrigate the pelvic cavity and check for active bleeding;