Hystero-oophorectomy
Hystero-oophorectomy is a surgical procedure that involves the removal of the uterus (hysterectomy) and ovaries (oophorectomy). This operation is primarily performed as a treatment for malignant cancers, such as invasive cervical carcinoma and endometrial carcinoma, and is also utilized for benign conditions like uterine leiomyomas (fibroids) that do not respond to other treatments. In postmenopausal women, the removal of the ovaries is often included to mitigate the risk of ovarian cancer. For premenopausal women, ovaries may be removed if they are deemed at high risk for estrogen-related cancers.
Preparation for the surgery includes a thorough preoperative evaluation to ensure the patient's fitness for the procedure. During the operation, a surgical incision is made to access the pelvic cavity, where the relevant organs and their supporting structures are carefully dissected and removed. Post-surgery, patients are monitored until they are stable before transitioning to recovery. While there are risks associated with the procedure, including deep vein thrombosis and potential damage to surrounding organs, the outcomes can lead to significant health benefits by addressing cancer or severe uterine conditions.
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Subject Terms
Hystero-oophorectomy
Also known as: Total abdominal hysterectomy and bilateral salpingo-oophorectomy
Definition: Hystero-oophorectomy is the surgical removal of the uterus and both the right and left Fallopian tubes and ovaries.
Cancers treated: Invasive cervical carcinoma Stage I to IIA, endometrial carcinoma, uterine leiomyomas
Why performed: Hystero-oophorectomy is the primary treatment and staging modality for malignant cancers amenable to resection arising from any of the three tissue layers of the uterus. Benign tumors of the uterus such as fibroids (leiomyomas) that do not regress with time, that degenerate, or that bleed excessively are also an indication. The ovaries are often removed simultaneously in postmenopausal women in order to prevent possible degeneration of cells into ovarian cancer. In premenopausal women undergoing hystero-oophorectomy, the ovaries are removed when they are at high risk for developing estrogen-stimulated cancers such as breast and endometrial cancers.
Patient preparation: The patient undergoes preoperative evaluation for any coexisting diseases to determine her fitness to undergo surgery and general anesthesia. Patients are instructed to take nothing per mouth the night before the procedure.
Steps of the procedure: After the patient is anesthetized, in the lithotomy position, surgically prepped and draped, a transverse or vertical incision is made above the pubic bone. The incision is taken down to the pelvic cavity. The uterine and ovarian vessels are identified, dissected, and separated from the ureters, and the bladder is separated from the uterus. The supporting ligaments and dissected vessels of the Fallopian tubes, ovaries, uterus, and cervix are then isolated, cut, and ligated, and the vaginal and cardinal ligament stumps are sutured together. A laparoscopic approach may be similarly done, except that the uterus, Fallopian tubes, and ovaries are removed vaginally.
After the procedure: The patient is monitored in the postanesthesia care unit until she is fully awake and vital signs are stable. Once the patient is stable in the unit, she may be discharged to the gynecologic ward for postoperative monitoring. Once the patient is stable, ambulatory, voiding, and eating, she may be discharged after a few days.
Risks: The most significant risks of the procedure are deep vein thrombosis, pulmonary embolism, perforation of the bladder or bowel, and accidental ligation of the ureters.
Results: A gross and microscopic examination of large masses may reveal central necrosis and hemorrhage and increased growth of uterine cells but no elements of disordered growth of abnormal cells. Microscopic examinations that reveal disordered proliferation and abnormal uterine or cervical cells are suggestive of uterine cancer or invasive cervical cancer.
Bibliography
Ajithkumar, Thankamma V. Oxford Desk Reference: Oncology. Oxford: Oxford UP, 2011. Print.
Farghaly, Samir A. Advances in Diagnosis and Management of Ovarian Cancer. Dordrecht: Springer, 2013. Print.
"Hysterectomy - How It Is Performed." NHS Choices. UK National Health Service, 9 Apr. 2014. Web. 23 Oct. 2014.
Lopes, Tito, Nick Spirtos, Raj Naik, and John Monaghan. Bonney's Gynaecological Surgery. Chichester: Wiley, 2011. Print.
Streicher, Lauren F. Essential Guide to Hysterectomy: Complete Advice from a Gynecologist on Your Choices Before, During, and After Surgery. 2nd ed. Lanham: Evans, 2013. Print.