Laparoscopic Lateral Ovarian Transposition

Introduction: Transposition of the ovaries outside of the pelvis to protect them from pelvic radiation was initially described in 1958. The procedure is indicated in patients diagnosed with malignancies that require pelvic radiation, but not removal of the ovaries, as part of their treatment. It can be performed by laparotomy or laparoscopy, depending on gynecologist’s surgical skill. The aim of this article is to describe the technique of lateral ovarian transposition by laparoscopy. Surgical Technique: The patient is placed in Trendelenburg position, under general anesthesia. Pneumoperitoneum is insufflated using Veress needle and four abdominal trocars are placed: 10mm at the umbilicus, 10mm at the suprapubic region, and two 5mm at the anterior superior iliac spine bilaterally. The ovaries are completely separated from the uterus and fallopian tubes by dividing the utero-ovarian ligament and incising the mesovarium. The peritoneum along the infundibulopelvic ligament can be also incised and the ovaries are transposed laterally to the paracolic gutters and sutured. Two titanium clips are placed at the ovaries to mark the most cephalad and caudal extent. It allows postoperative localization of the ovaries to program pelvic radiation. Conclusion: Lateral ovarian transposition can be performed safely and effectively. Laparoscopic approach has some advantages compared to open surgery, including reduced length of hospital stay, less postoperative pain, smaller incisions and faster recovery. For these reasons, we advocate laparoscopy as the gold standard approach for ovarian transposition.