Two-way deletion
The decision is made together with an oncologist or mammologist: for BRCA mutations, preventive surgery after 35–40 years reduces the risk of ovarian cancer by 80–90% and breast cancer; for hormone-dependent breast cancer in young people, it replaces drug suppression of ovarian function. The surgeon usually removes the ovaries along with the tubes (the risk of cancer often comes from the tubes), with prophylactic surgery - with abdominal lavage and careful histology. Consequences in women before menopause - hot flashes, dryness, risk of osteoporosis; Hormonal therapy is prescribed in the absence of contraindications. Recovery after surgery is 1–2 weeks.
Indications
- polycystic ovary syndrome with anovulation, resistant to stimulation (cautery/drilling);
- large cysts, tumors, endometriomas with destruction of ovarian tissue (resection);
- benign ovarian tumors in peri- and postmenopausal women, torsion with necrosis, tubo-ovarian abscess (oophorectomy, salpingo-oophorectomy);
- prophylactic removal of appendages for hereditary risk (BRCA), as part of the treatment of breast cancer;
- irreversibly changed appendages due to inflammation.
Scope of surgery and ovarian function
The gynecologist selects the smallest sufficient volume: for PCOS - pinpoint cauterization of the cortex to restore ovulation; for a cyst with preserved tissue - cystectomy; for a tumor replacing the ovary, or in menopause, removal of the ovary (oophorectomy) or along with the tube (salpingo-oophorectomy). One remaining ovary completely provides hormonal function and the possibility of pregnancy. Removal of both ovaries before menopause causes surgical menopause and requires replacement therapy unless contraindicated. All removed tissue undergoes histological examination; if malignancy is suspected, urgent examination is performed during surgery.
Benefits of laparoscopy
Laparoscopy is the standard of modern operative gynecology: magnifying the image by 10–15 times allows you to work more accurately than an open operation and is more gentle on the ovarian tissue and tubes, blood loss is minimal, adhesions form less frequently (important for future pregnancy), the pain after the operation is mild, and the patient gets up on the day of the operation and is discharged on the 1st–3rd day; Instead of a cut, three barely noticeable scars remain. In the clinics below, laparoscopic operations are performed by gynecological surgeons with extensive experience on modern endoscopic stands.
Risks and contraindications
- rare complications: bleeding, injury to neighboring organs, infection, thrombosis - prevention and the experience of the surgeon reduce the risk to a minimum;
- contraindications: severe heart and lung diseases, coagulation disorders, severe adhesions after many operations, large tumors (>15–20 cm) - then laparotomy is chosen;
- Obesity and previous operations are not a contraindication, but require an experienced team.
