Removal of the fallopian tubes or ovaries is indicated for inflammatory involvement of the adnexa that cannot be relieved by the use of conservative measures including antibiotics, for ovarian cysts, neoplasms, ectopic pregnancies, and so forth. Bilateral oophorectomy is advised by some as a desirable procedure in extensive carcinoma of the rectum because of the susceptibility of the ovaries to tumor transplantation from lesions of the gastrointestinal tract. In the absence of malignancies every effort should be made to conserve even remnants of functioning ovarian tissue in the younger patients.
(See Gynecologic System—Routine for Abdominal Procedures.) The skin is covered by a sterile transparent plastic drape.
The skin is prepared in the routine manner. The surgeon stands on the patient's left side.
See Gynecologic System—Routine for Abdominal Procedures. In the presence of extensive pelvic inflammation, the intestines are often attached to the adnexa by adhesions that must be separated either by blunt or sharp dissection. Haste and roughness must be avoided. By placing the adhesions on tension as they are cut, the cautious surgeon can almost always develop a cleavage plane between the diseased adnexa and the other structures. The intestines are pushed aside carefully and packed away with warm, moist gauze pads, or placed in a plastic bag and moistened with warm saline. The free adnexa are then held upward with a half-length clamp (Figure 1).
The uterus is held forward either by a tenaculum applied to the round ligament adjacent to the uterus (Figure 1) or by a fine absorbable suture through the fundus (Figure 7). The mesosalpinx is clamped with a sufficient number of half-length clamps, usually three pairs, to include its entire length (Figure 3). To avoid possible interference with the blood supply of the ovary, the line of incision is kept near the fallopian tube (Figure 1). As an alternative, the mesosalpinx may be saved by controlling the ...