Ovarian and Fallopian Tube Surgery

The fallopian tube and ovary are well situated in the pelvis and nearly all operations for nonmalignant problems of these organs can be best done using the laparoscopic approach. The operations are called adnexal surgery and include:

• Ovarian cystectomy – Removal of an ovarian cyst with preservation of the ovary
• Oophorectomy – Removal of the ovary
• Salpingectomy – Removal of the Fallopian tube
• Salpingotomy – Opening the tube to remove an abnormality e.g. ectopic pregnancy
• Adhesolysis – Freeing the tube or ovary from adhesions to reduce pain or improve fertility

Many of these operations can be performed as day surgery. It is advisable to discuss your recovery needs with your doctor to ensure the best planning for you.

Advantages of Laparoscopic Adnexal Surgery

• Small incisions and less scarring
• Better views of the tubes and ovaries
• Gentler handling of the body tissues and organs during the operation
• Less blood loss during the operation
• Less postoperative pain
• Less postoperative narcotic use for pain relief
• Shorter hospitalisation
• Faster overall recovery with an earlier return to normal activity

Techniques of Laparascopic Adnexal Surgery

1. Preoperative preparation may involve a shave and a small enema. Fasting for 6 hours preop is required.
2. A general anaesthetic is administered.
3. The laparoscope and other instruments are introduced as described.
4. The blood supply to the tube or ovary is secured if removal is to occur and then the tube or ovary is freed from its supports.
5. If the tube or ovary is to be saved the cyst or abnormality is removed and the tube or ovary repaired.
6. The specimen is removed and the wounds repaired.

Recovery

Immediate postoperative recovery involves either discharge from the day surgery centre or a night in hospital. Patients are welcome to rest in hospital for as long as they need to. Patients will be given as much pain relief as they request to make sure they are comfortable either as tablets or injections.

The first few days at home should be taken very easily. The patient should have someone to help. Plenty of rest and fluids are advisable. Exercise your calf muscles to prevent clots. Oral pain relief e.g. Panadeine/Panadol may be needed, especially at night. Generally recovery will be complete within a week or so.

All patients should individually assess their recovery rate. Some may need more time off work than others and certificates will always be provided.

Risks of Adnexal Surgery

These risks apply to whichever method is used to approach the adnexa.

1. Infection - Infection rates are low and are mainly superficial wound infections treated with bathing, dressing and perhaps antibiotics. Rarely an internal infection can occur.
2. Bleeding - At the time of the operation some blood will be lost. Very rarely this can be serious and require some emergency treatment such as transfusion.
3. Damage to bowel, bladder and ureter - These structures are very close to the adnexa and can rarely be damaged. The risks are about 1 in 500-600 cases. Damage detected at the time of surgery is repaired immediately and will often not have serious consequences. Sometimes the injury can be undetected or develop over several days after surgery e.g. where a burn is made to stop bleeding. This may cause a delay in diagnosis and a more serious illness.
4. Deep Venous Thrombosis or Pulmonary Embolus - A clot can form in the leg or pelvic veins and travel to the lungs. The risk it will happen is about 1 in 400-500. This is serious and can rarely be fatal. Tell your doctor if these have happened to you before or if you have a family history. During the surgery a number of precautions are taken to prevent these. Early mobilisation after laparoscopic surgery may also reduce the risk compared to larger incision operations.
5. Other risks of laparoscopy - As described in the Laparoscopic Surgery Information Sheet.
6. Adhesions (scarring) - can develop as a consequence of surgery. Sometimes these can cause pain or reduce fertility. Laparoscopic surgery is thought to reduce the risk of adhesions compared to when the same operation is done through a large incision.