Indications and preparation for surgery
The main indications for surgery are a confirmed ovarian cyst or developed torsion of its pedicle.
Before starting the procedure, the patient is placed in the supine position on the operating table with a small roll placed under the sacrum. General anesthesia is used as the method of anesthesia. Access to the pelvic organs is provided by a lower midline laparotomy.
Steps of extraction and pedicle management
The surgical technique consists of the following sequential steps:
- Extraction of the cyst: for large tumors, it is permissible to preliminarily puncture and aspirate their contents for convenience. The exception is cases with a suspected malignant process — puncture must not be performed under any circumstances in the presence of neoplasms. After aspiration, a clamp is applied to the resulting opening, and the neoplasm is delivered into the surgical wound.
- Management of the pedicle: the anatomical pedicle of the formation consists of the ovarian proper ligament (lig. ovarii proprium) and the suspensory ligament of the ovary (lig. suspensorium ovarii). Clamps are applied to it, and tissues are transected between two rows of clamps. All anatomical structures of the pedicle are sequentially ligated.
- Peritonealization and closure: the stump is peritonealized using the broad ligament of the uterus (lig. latum uteri) or a purse-string suture. The procedure concludes with layered tight closure of the abdominal cavity.
Specifics of managing pedicle torsion
If the patient is diagnosed with ovarian cyst pedicle torsion, the surgeon must follow strict safety rules.
Medical guidelines prohibit untwisting the altered pedicle prior to removal. This rule prevents dangerous complications: rupture of pathologically altered blood vessels and subsequent thromboembolism. Instead, clamps are applied directly to the twisted area, after which the pedicle is transected and managed using the standard method.
Briefly: answers to topical questions
What are the components of the surgical pedicle of an ovarian cyst?
The surgical pedicle of an ovarian cyst includes the elements of the anatomical pedicle and an additional structure.
- Ovarian proper ligament (lig. ovarii proprium) — an element of the anatomical pedicle.
- Suspensory ligament of the ovary (lig. suspensorium ovarii) — the second element of the anatomical pedicle.
- Fallopian tube — a stretched structure that joins the anatomical pedicle, forming the surgical pedicle, which is transected during the operation.
What is the main danger of ovarian cyst puncture when malignancy is suspected?
The main danger of ovarian cyst puncture when malignancy is suspected is the high risk of tumor cell dissemination. Aspiration biopsy has low diagnostic value for differential diagnosis and violates the principle of ablastic surgery; therefore, the procedure is strictly not recommended in the presence of ultrasound signs of malignancy.
Safety rule for puncture: "Suspicion of cancer — forget the syringe and puncture!" (malignant cysts must not be punctured).
Class and exam questions
What surgical approach is used for ovarian cyst removal?
A lower midline laparotomy is used for the surgical intervention.
Is it permissible to puncture any cyst prior to its extraction?
No. Puncture with aspiration of contents is performed only for large benign cysts. If malignancy is suspected, puncturing the neoplasm is prohibited.
What are the anatomical components of the ovarian cyst pedicle?
The pedicle is formed by the ovarian proper ligament (lig. ovarii proprium) and the suspensory ligament of the ovary (lig. suspensorium ovarii).
How should a twisted cyst pedicle be managed during surgery?
Untwisting the twisted pedicle is strongly discouraged, as this may cause rupture of altered vessels and lead to thromboembolism.
What else to study on this topic
- Anatomical features of the ovarian ligamentous apparatus
- Differential diagnosis of benign and malignant ovarian tumors
- Techniques for layered closure of the abdominal wall in laparotomy
- Pathogenesis and risks of thromboembolic complications in pelvic organ torsion
- Techniques for placing purse-string sutures and stump peritonealization
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