Laparoscopic ovarian transposition.

ABSTRACT

Preservation of ovarian function is both safe and feasible in many young women with pelvic malignancies. Techniques utilized to transpose the ovaries to date have uniformly required a laparotomy either at the time of surgical treatment or as a separate operation in patients about to undergo pelvic radiotherapy. We report our preliminary results in 3 patients who underwent laparoscopic ovarian transposition and pelvic lymphadenectomy as part of an experimental protocol using intracavitary radiation alone in patients with small node negative stage 1B cervical carcinoma desiring preservation of fertility. Dose calculations were performed to estimate the amount of radiation each transposed ovary received from the intracavitary radiation, as well as the dosage that would have been received had external pelvic (4500 cGy) with or without para-aortic nodal irradiation (4500 cGy) been required. The mean estimated distance each ovary was transposed was 14.4 cm for the right ovary and 14.3 cm for the left ovary. Operative times ranged from 2.75-4.0 hours, and the blood loss 100-300 mls. Post-operative hospital stays ranged from 1-2 days, and no complications were encountered. Two of the 3 patients are menstruating regularly 25-32 months after completion of treatment with serum FSH in the normal premenopausal range. Based on the above distances, the mean dose of radiation each transposed ovary received was estimated to be 126 cGy, whereas the range in dosage of radiation each ovary would have received had external pelvic +/- para-aortic nodal irradiation been required was 135-190 cGy, and 230-310 cGy respectively. One patient has become menopausal after her transposed ovaries slipped back into the pelvis. Laparoscopic ovarian transpositions can be performed. This procedure is technically easy to perform for those surgeons skilled in laparoscopic surgery and its preliminary morbidity appears to be low. More experience, longer followup, and refinement in the methods of ovarian transfixation are required.