China
Africa
Explore chapters and articles related to this topic
Classification and histological diagnosis
Published in Caroline Overton, Colin Davis, Lindsay McMillan, Robert W Shaw, Charles Koh, An Atlas of ENDOMETRIOSIS, 2020
Caroline Overton, Colin Davis, Lindsay McMillan, Robert W Shaw, Charles Koh
In the ovary, endometriosis presents either as superficial haemorrhagic implants or in the more severe form as a haemorrhagic or ‘chocolate’ cyst (Figures 5.11 and 5.12). The histopathology of ovarian endometriosis is characterised by a large variation in the amount of endometrial tissue. The endometrial cyst can be lined by free endometrial tissue, histologically and functionally indistinguishable from eutopic endometrium, or all traces of endometrial tissue can be lost and the cyst wall covered by fibrotic and reactive tissue (Figures 5.13–5.15). No specific pathology can be found in up to one-third of clinically typical endometriosis cases, and these cysts are classified as haemorrhagic cysts (compatible with endometriosis). Both types of ovarian endometriosis are associated commonly with adhesion formation, and endometriosis should be suspected clinically if the ovary is adherent to the ovarian fossa.
Equipment, surgery and practical procedures
Published in T. Justin Clark, Arri Coomarasamy, Justin Chu, Paul Smith, Get Through MRCOG Part 3, 2019
T. Justin Clark, Arri Coomarasamy, Justin Chu, Paul Smith
TechniqueDorso-lithotomy positioning of the patient (Trendelenburg; Lloyd-Davies).‘Bottom end’ – disinfect vagina, empty the urinary bladder, insert uterine manipulator (if applicable).Establish pneumoperitoneum (insert the Veress needle vertically through a 1-cm intraumbilical incision; prior to insertion, the spring mechanism is checked on the needle to help avoid visceral puncture, and insufflator flow/pressure is also checked).Check intraperitoneal placement (drop test; high flow; low pressure).Obtain sufficient pneumoperitoneum (25 mmHg).Insert 10–12 mm umbilical trocar through the Veress needle incision (vertically with slight pelvic tilt).Confirm entry into the peritoneal cavity (visualisation), lower the intra-abdominal pressure (15 mmHg), Trendelenburg position.Systematic inspection of pelvis (uterus, adnexae, utero-vesical pouch, pouch of Douglas, uterosacral ligaments, peritoneal sidewalls, ovarian fossae, upper abdomen).
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
The ovary flops laterally to lie in the ovarian fossa on the lateral pelvic wall. Immediately behind the fossa is the ureter which may be damaged while operating on the ovary and lateral to the ovary is the obturator neurovascular bundle. A diseased ovary may therefore cause referred pain along the cutaneous distribution of the obturator nerve on the inner side of the thigh. Nerve supply to the ovary is sympathetic originating at T10 and therefore ovarian pain may also be referred to the peri-umbilical region.
Comparison of surgical outcomes between 3-dimensional and 2-dimensional laparoscopy of ovarian cyst (LOOC): a randomised controlled trial
Published in Journal of Obstetrics and Gynaecology, 2022
Young Gi Han, Kyung Min Lim, Taejong Song
Next, the surgical technique for ovarian cystectomy used was previously described in detail (Song et al. 2017). In brief, the ovary was completely freed from the ovarian fossa by blunt and sharp dissection before initiating the stripping of the ovarian cyst. Identifying the cleavage plane between the ovarian cortex and the wall of the cyst, the ovary was drawn slowly and gently to opposite directions with two grasping forceps. After the whole cystic wall was removed from the ovarian cortex, bipolar or monopolar coagulation was performed on the ovarian bleeding site for hemostasis. To restore normal ovarian anatomy or achieve additional hemostasis, the ovary was sutured edge-to-edge with a 1-0 V-Loc suture (Covidien, Mansfield, MA, USA). The ovarian cysts were put into the specimen retrieval end pouch and carried out through the umbilical port. Then, the laparoscopic port was removed, the transumbilical fascia was closed with 1-0 Vicryl suture (Ethicon, Somerville, NJ, USA), and the skin was approximated subcuticularly with 4-0 Stratafix suture (Ethicon). Participants were discharged from the hospital after the restoration of bowel activity, the absence of postoperative fever, no longer needed narcotic analgesics and successful ambulation. All of the participants were scheduled for check-up examinations one week and three months after surgery.
Ovarian tissue cryopreservation and transplantation prevents iatrogenic premature ovarian insufficiency: first 10 cases in China
Published in Climacteric, 2020
X. Ruan, J. Cheng, M. Korell, J. Du, W. Kong, D. Lu, Y. Wu, Y. Li, F. Jin, M. Gu, W. Duan, Y. Dai, C. Yin, S. Yan, A. O. Mueck
Retransplantation should be performed as fast as possible after transport of the frozen–thawed ovarian tissue to the operating room. This was within 20 min in the present study. The tissue was placed into a pelvic peritoneal pocket of ovarian fossa, as this has a good blood supply. In nine cases the tissue was transplanted into the right side, and in one case into both sides. Surgery for retransplantation was in accordance with the literature8, which reports that 90% of women’s frozen–thawed ovarian tissue was transplanted into a peritoneal pocket and 10% into both a peritoneal pocket and into the ovary26. Transplantation into or onto the remaining ovaries or into a peritoneal pocket in the pelvic peritoneum (orthotopic retransplantation) may provide the ability to achieve a natural pregnancy.
Heterotopic transplantation of cryopreserved ovarian tissue in cancer patients: a case series
Published in Gynecological Endocrinology, 2019
Olga Bystrova, Elena Lapina, Alla Kalugina, Alla Lisyanskaya, Natalya Tapilskaya, Georgy Manikhas
High-dose chemotherapy and radiotherapy have greatly improved survival rates for female cancer patients, but ovarian failure and sterility are major side effects of treatments. Transplantation of cryopreserved ovarian tissue has restored fertility in patients either in natural cycles or stimulated cycles for IVF when thawed tissue was placed at an orthotopic site: the ovarian medulla, broad ligament, or ovarian fossa [1]. There is a long history of heterotopic ovarian transplantation in animals, and to the limited experience in humans using the abdominal wall (AW) [2–5], forearm (FA) [6–9], breast [10], and peritoneal lining [11–17] there is a second case of twin delivery for a peritoneal graft [16,17]. In contrast to the lean record for heterotopic grafts, there are already 130 live births from orthotopic transplantations [18].