The majority of operations performed on the tube and ovary are done because of unilateral disease in one or the other. At times, however, the pathological condition demands that both adnexa be removed. In this case the operation of choice is a total hysterectomy and bilateral salpingectomy performed as an en bloc removal.

The operation described here is a salpingo-oophorectomy, which is indicated when the disease process involves a tube and ovary on one side only.

As in all operations on the uterus and adnexa the tube and ovary should be completely mobilized before any attempt is made to remove them. It is also important to remember that when indications call for removal of the tube the isthmial portion must be excised where it transverses the musculature of the uterine horn.

Figure 1. The uterus is held to the left and the tube and ovary elevated by a Kelly clamp in the left hand of the operator in order to expose the infundibulopelvic ligament containing the ovarian artery and vein. The position of the ureter is noted in relation to the vessels and a stitch ligature placed around them under direct vision with complete safety.

Figure 2. The suture is tied by the assistant and held long as the surgeon places a Kelly clamp on the vessels toward the adnexa in order to prevent back bleeding. As the surgeon cuts the vessels, the assistant stands ready to apply another clamp to the cuff beyond the tie.

Figure 3. The first suture is then divided and a second stitch ligature applied. The ovarian vessels are thus doubly ligated. The tube and ovary are pulled toward the midline, and the anterior sheath of the broad ligament below the tube is divided obliquely with scissors up to the point of insertion of the round ligament.

Figure 4. The posterior leaf of the broad ligament below the ovary is incised in similar fashion.

Figure 5. The ovarian branch of the uterine artery lies within the ovarian ligament close to the uterus. This vessel is secured by Kelly clamps, divided and tied with a stitch ligature on the uterine side.

Figure 6. A deep mattress suture is placed in the uterine muscle at the cornu where the tube inserts in the uterus to control a troublesome bleeding vessel which is invariably present at this point.

Figure 7. The tube is removed by a wedge-shaped resection of the uterine wall. The mattress suture is th6n tied.

Figure 8. The peritoneum is closed by a running suture beginning laterally in order to bury the stump of the infundibulopelvic ligament below the level of the peritoneum.

Operations on tube and ovary salpingo-oophorectomy


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