Unilateral Uterosacral Oophoropexy Procedure Summary:
- The video presents a unilateral uterosacral oophoropexy technique for a 19-year-old PCOS patient with recurrent idiopathic ovarian torsion and previous failed surgeries.
- Traditional techniques like utero-ovarian plication and the “hotdog in a bun” method were deemed impractical due to the patient’s elongated right utero-ovarian ligament and torn mesosalpinx.
- The proposed technique involves fixing the ovary to the utero-sacral ligament, ensuring safe suturing by inspecting the right ureter and its distance from the ligament, and using a non-absorbable suture like 2-0 Prolene.
- This technique provides more stability to the ovary, reduces the recurrence of ovarian torsion, and preserves the fallopian tube for future fertility.
- Uterosacral oophoropexy is a viable alternative for recurrent idiopathic ovarian torsions; follow-up is crucial to monitor recurrence, fertility impact, and potential risk of dysmenorrhea and dyspareunia.
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University de Montreal
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What is Unilateral Uterosacral Oophoropexy?
- Unilateral uterosacral oophoropexy is a surgical technique used to treat recurrent ovarian torsion, particularly in cases where traditional methods have failed or are impractical.
- The procedure involves fixing one ovary (unilateral) to the utero-sacral ligament to provide stability and prevent further torsion events.
- This technique aims to preserve the patient’s fallopian tube and future fertility while reducing the risk of recurrent torsion.
- Uterosacral oophoropexy is recommended as an alternative option for managing recurrent idiopathic ovarian torsions when other methods are deemed unsuitable.
What are the risks of Unilateral Uterosacral Oophoropexy?
- Potential damage to surrounding organs or nerves, which may result in chronic pain or functional impairment.
- Risk of scar tissue forming between the ovary and nearby organs or tissues, potentially leading to pelvic pain or bowel obstruction.
- In some cases, the original symptoms or issues may reappear despite surgery.
- Potential emotional or psychological impacts, especially if the surgery does not relieve symptoms or leads to complications.
Video Transcript: Unilateral Uterosacral Oophoropexy For Refractory Idiopathic Ovarian Torsion In A PCOS Adolescent Patient
In this video, we present the technique for a unilateral utero-sacral oophoropexy for refractory idiopathic ovarian torsion in a PCOS adolescent patient. This is a case of a 19-year-old nulligravid woman with PCOS who presented for recurrent right ovarian torsion without adnexal pathology such as a cyst or a mass, and despite two detorsion surgeries and two failed oophoropexies. The first intervention consisted of an ovarian detorsion, followed by two laparoscopic right utero-ovarian plication.
The final episode of torsion was simply reversed laparoscopically in an emergency setting. Pelvic examination was unremarkable. Pelvic ultrasonography showed polycystic ovaries bilaterally with increased volume. No cysts or masses were detected. The following technique consists of laparoscopic utero-sacral oophoropexy for refractory idiopathic ovarian torsion.
As we can see on the laparoscopy, the right utero-ovarian ligament is elongated and the mesosalpinx is torn apart, making another utero-ovarian plication or a hotdog in a bun technique, including the elongated [unclear] ligament technically impractical. The first technique described in the treatment of recurrent ovarian torsions is folding the utero-ovarian ligament and fixating it to the round ligament shown here in yellow. And the hotdog in a bun technique, the round ligament, and utero-ovarian ligament shown in yellow act as the bun, while the fallopian tube shown in red serves as the hotdog.
The fallopian tube is cushioned in between the two ligaments. The proposed technique is to fix the ovary to the utero-sacral ligament in the demonstrated fashion. To ensure safe suturing, we start by inspecting the right ureter and its distance from the utero-sacral ligament. As we can see, the utero-sacral ligament is easily identified. For permanent results, a non-absorbable suture is preferably used. Here we use 2-0 Prolene.
The first suture was taken from the right utero-sacral ligament through the right ovary. For better fixation, a second suture was taken more medially. This technique gives more stability to the right ovary and prevents the recurrence of ovarian torsion. Care must be taken to prevent damage to the fallopian tube for future fertility. Here we see the tube free without torsion. At the end, the ureter is inspected. This is the final picture after completion of the procedure.
In conclusion, utero-sacral oophoropexy is a viable alternative to the standard oophoropexy techniques and should be considered in cases of recurrent idiopathic ovarian torsions. Follow-up on these patients is important to detect recurrence rate, impact on fertility, and the risk of dysmenorrhea and dyspareunia.