The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD.
Division of Urogynecology, Department of Obstetrics and Gynecology, Walter Reed National Medical Center, Bethesda, MD.
J Obstet Gynaecol Can. 2022 May;44(5):515-516.e2. doi: 10.1016/j.jogc.2021.11.012. Epub 2021 Dec 15.
Post-hysterectomy salpingo-oophorectomy can be surgically complex. Up to 9% of women who chose ovarian preservation at the time of hysterectomy require future adnexal surgery. Some of the common indications for post-hysterectomy salpingo-oophorectomy are persistent adnexal masses or masses with concern for malignancy, chronic pelvic pain, and risk-reducing surgery. This video presents a 5-step strategy to facilitate a post-hysterectomy bilateral salpingo-oophorectomy to include pelvic and abdominal exploration, restoring normal anatomy, identification of the ureter, isolation, coagulation and transection of the infundibulopelvic ligament, and, lastly, hemostasis with re-evaluation of ureter. This stepwise procedure was highlighted in a patient with a prior total abdominal hysterectomy and a complex adnexal mass. We utilize these techniques on the side without anatomic abnormality and then safely apply this same 5-step strategy to remove a more challenging adnexal mass on the opposite side. We describe a 5-step surgical strategy to ensure safe, efficient, and reproducible salpingo-oophorectomy in the post-hysterectomy patient using a minimally invasive approach. Although this surgery can be challenging to perform in post-hysterectomy patients given anatomical variance and adhesive disease, by following these 5 simple principles we aim to standardize and simplify this potentially difficult procedure.
子宫切除术后的输卵管卵巢切除术可能具有手术复杂性。多达 9%的在子宫切除术中选择保留卵巢的女性需要进行未来的附件手术。子宫切除术后输卵管卵巢切除术的一些常见适应证包括持续性附件肿块或有恶性肿瘤、慢性盆腔疼痛和降低风险手术顾虑的肿块。本视频介绍了一种 5 步策略，以促进子宫切除术后双侧输卵管卵巢切除术，包括盆腔和腹部探查、恢复正常解剖结构、识别输尿管、分离、结扎和切断输卵管卵巢固有韧带，最后进行止血并重新评估输尿管。在一位既往行全子宫切除术且附件肿块复杂的患者中强调了这一逐步手术。我们在无解剖异常的一侧使用这些技术，然后安全地将相同的 5 步策略应用于对侧更具挑战性的附件肿块。我们描述了一种 5 步手术策略，以确保使用微创方法对子宫切除术后患者进行安全、高效和可重复的输卵管卵巢切除术。尽管由于解剖变异和粘连性疾病，子宫切除术后的此类手术具有挑战性，但通过遵循这 5 个简单原则，我们旨在使这一潜在困难的手术标准化和简化。
