Laparoscopic ovarian suspension prior to radiation

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Division of Reproductive Endocrinology/Infertility, McGill University, Women’s Pavilion, 687 Pine Avenue West, Montreal PQ, H31 1A1, Canada

Radiotherapy is one of the treatment modalities in the management of patients with cancer. It is highly effective in women with early stages of malignancy but it results in the loss of ovarian function.

One of the methods which can be used to preserve ovarian function is laparoscopic–ovarian suspension. Lateral ovarian transposition by laparoscopy is associated with preservation of ovarian function in 83% of cases after pelvic radiation whereas ovarian transposition by laparotomy is associated with considerable abdominal incision, long hospital stay and increased risk of adhesion formation.

In this video a laparoscopic technique of ovarian transposition in a young woman with rectal carcinoma prior to radiation therapy is described. The ovaries were transposed laterally and anteriorly outside the field of radiation. The steps involved are outlined. First, division of the ovarian ligament separating it from the uterus; second, freeing the ovary from the surrounding tissue. Third, relaxing incision inferior to the ovary may be needed to free it. A piece of the ovary may be removed for cryopreservation (Nugent et al., 1997). The patient’s menstrual cycles were never interrupted and she continued to menstruate regularly every 28 days (Tulandi and Al-Took, 1998).

References:

References

1. Nugent, D., Meirow, D., Brook, P.F. et al. (1997) Transplantation 1.in reproductive medicine: previous experience, present knowledge and future prospects. Hum. Reprod. Update, 3, 267–280.

2. Tulandi, T. and Al–Took, S. (1998) Laparoscopic ovarian transposition prior to radiation. Fertil. Steril.., 70, 381–383.