Ovariopexy-Before and after Endometriosis Surgery

Abstract

Endometriosis surgery is often very challenging. Key to complete resection of endometriosis is access to the retroperitoneum. Endometriosis can involve the ureter and uterine vessels, and ovary on the lateral pelvic wall makes retroperitoneal access difficult. Primary and post-surgical adhesions prevalence in endometriosis is very high. Ovariopexy, transposition of ovaries temporarily, is done for better surgical access and to reduce postoperative adhesions. We concluded that although limited evidence, ovariopexy is an excellent tool to aid endometriosis surgery and prevent postoperative adhesions. It is cost effective, simple and complication rate almost nil. More robust trials are required to substantiate evidence for its impact on preventing postoperative adhesions and its effect on fertility. In this review, we describe our technique of ovariopexy supplemented with a video, with the aim to put light on this useful and important technique, which is beneficial both for surgeons and patients.

Keywords: endometriosis; laparoscopy; ovariopexy; postoperative adhesion; retro-peritoneum; surgical access; technical feasibility.

Figure 1

Laparoscopic view of the pelvis, depicting the ovaries hampering vision and access to the lateral pelvic wall.

Figure 2

Laparoscopic view of the lateral pelvic wall on the left side after ovariopexy with endometriosis easily visualized and accessible.

Figure 3

Left side ovary suspended to the anterior abdominal wall, with dissection of the left lateral pelvic wall.

Figure 4

Illustration showing left suspended ovary to the anterior abdominal wall after endometriosis surgery with important anatomical structures. (A) Inferior epigastric vessels in the lateral umbilical fold. (B) Medial umbilical ligament. (C) Uterine Artery. (D) Ureter.