Bilateral Salpingooophorectomy
Bilateral salpingo-oophorectomy (BSO) is a surgical procedure involving the removal of both fallopian tubes (salpingectomy) and both ovaries (oophorectomy). It is commonly performed in women for various benign, premalignant, and malignant conditions of the ovaries, fallopian tubes, or uterus. In certain cases, it is performed prophylactically to reduce the risk of ovarian or breast cancer, particularly in women with genetic predispositions such as BRCA1 or BRCA2 mutations.
Dr. R. K. Mishra, a pioneer in minimally invasive and robotic surgery, has emphasized the importance of meticulous surgical technique, careful patient selection, and laparoscopic approaches to maximize safety and outcomes in BSO.
Indications for Bilateral Salpingo-Oophorectomy
BSO may be indicated for therapeutic, prophylactic, or diagnostic purposes. Common indications include:
Ovarian Cancer – In cases of confirmed or suspected ovarian malignancy, BSO may be part of staging or cytoreductive surgery.
Severe Endometriosis – When endometriotic cysts involve both ovaries and medical management fails.
Benign Ovarian Masses – Large, complex cysts or recurrent benign tumors may necessitate removal.
Risk Reduction – Women with a high genetic risk of ovarian or breast cancer (BRCA mutation carriers) may undergo prophylactic BSO.
Postmenopausal Women – Sometimes performed in conjunction with hysterectomy to reduce the risk of ovarian pathology.
Pelvic Infections or Tubal Pathology – Chronic tubo-ovarian abscesses unresponsive to medical treatment.
Proper preoperative evaluation, including imaging and tumor marker assessment, helps guide surgical planning and ensure that BSO is safe and appropriate.
Surgical Techniques
Bilateral salpingo-oophorectomy can be performed through several approaches:
Open Surgery (Laparotomy)
Traditionally, BSO was performed through a lower abdominal incision. While effective, this approach is associated with:
Increased postoperative pain
Longer recovery time
Higher risk of wound complications
Laparoscopic Surgery
Minimally invasive laparoscopy is now the preferred approach due to smaller incisions, faster recovery, and less postoperative pain. Dr. R. K. Mishra has demonstrated that laparoscopic BSO is safe and effective, even in complex cases involving adhesions or large ovarian masses.
Laparoscopic BSO Procedure:
Patient Preparation and Positioning – The patient is placed under general anesthesia in the lithotomy or supine position.
Port Placement – Small incisions are made for the laparoscope and working instruments.
Pelvic Exploration – The uterus, adnexa, and pelvic peritoneum are inspected.
Dissection of Fallopian Tubes and Ovaries – The suspensory ligaments, ovarian vessels, and adhesions are carefully dissected.
Removal – Both ovaries and fallopian tubes are detached and removed, often using an endobag to prevent spillage of cystic content.
Hemostasis and Closure – Meticulous bleeding control is essential, followed by closure of small port incisions with absorbable sutures.
Robotic-Assisted Surgery
In select complex cases, robotic-assisted BSO may be performed, offering:
Enhanced precision
Improved visualization in deep pelvis
Reduced risk of injury to surrounding structures such as ureters and bowel
Advantages of Laparoscopic BSO
Minimally Invasive – Smaller incisions, reduced scarring, and better cosmetic outcomes.
Faster Recovery – Patients often resume normal activities within 1–2 weeks.
Reduced Pain and Blood Loss – Minimal tissue trauma compared to open surgery.
Improved Visualization – Magnified view allows precise dissection of vessels and ligaments.
Simultaneous Procedures – Can be combined with hysterectomy, endometriosis excision, or other pelvic surgeries.
Risks and Considerations
Although BSO is generally safe, potential complications include:
Bleeding – Injury to ovarian or uterine vessels.
Injury to Adjacent Organs – Ureter, bladder, or bowel injuries, particularly in patients with adhesions.
Early Menopause – Surgical removal of both ovaries induces immediate menopause, causing hot flashes, bone loss, and cardiovascular risks. Hormone replacement therapy may be considered in selected patients.
Infection – Reduced risk in minimally invasive approaches but still possible.
Dr. R. K. Mishra emphasizes preoperative counseling regarding the effects of surgically induced menopause and the need for long-term follow-up.
Conclusion
Bilateral salpingo-oophorectomy is a critical surgical procedure for managing a variety of gynecological conditions, ranging from benign ovarian cysts to malignancies. Minimally invasive approaches, particularly laparoscopy and robotic-assisted surgery, have revolutionized BSO by reducing postoperative pain, shortening hospital stay, and improving cosmetic outcomes.
Careful patient selection, meticulous surgical technique, and expert execution, as advocated by Dr. R. K. Mishra, ensure that BSO is performed safely and effectively. By combining precision with minimally invasive methods, modern gynecologic surgery continues to offer patients better outcomes, faster recovery, and improved quality of life.
Dr. R. K. Mishra, a pioneer in minimally invasive and robotic surgery, has emphasized the importance of meticulous surgical technique, careful patient selection, and laparoscopic approaches to maximize safety and outcomes in BSO.
Indications for Bilateral Salpingo-Oophorectomy
BSO may be indicated for therapeutic, prophylactic, or diagnostic purposes. Common indications include:
Ovarian Cancer – In cases of confirmed or suspected ovarian malignancy, BSO may be part of staging or cytoreductive surgery.
Severe Endometriosis – When endometriotic cysts involve both ovaries and medical management fails.
Benign Ovarian Masses – Large, complex cysts or recurrent benign tumors may necessitate removal.
Risk Reduction – Women with a high genetic risk of ovarian or breast cancer (BRCA mutation carriers) may undergo prophylactic BSO.
Postmenopausal Women – Sometimes performed in conjunction with hysterectomy to reduce the risk of ovarian pathology.
Pelvic Infections or Tubal Pathology – Chronic tubo-ovarian abscesses unresponsive to medical treatment.
Proper preoperative evaluation, including imaging and tumor marker assessment, helps guide surgical planning and ensure that BSO is safe and appropriate.
Surgical Techniques
Bilateral salpingo-oophorectomy can be performed through several approaches:
Open Surgery (Laparotomy)
Traditionally, BSO was performed through a lower abdominal incision. While effective, this approach is associated with:
Increased postoperative pain
Longer recovery time
Higher risk of wound complications
Laparoscopic Surgery
Minimally invasive laparoscopy is now the preferred approach due to smaller incisions, faster recovery, and less postoperative pain. Dr. R. K. Mishra has demonstrated that laparoscopic BSO is safe and effective, even in complex cases involving adhesions or large ovarian masses.
Laparoscopic BSO Procedure:
Patient Preparation and Positioning – The patient is placed under general anesthesia in the lithotomy or supine position.
Port Placement – Small incisions are made for the laparoscope and working instruments.
Pelvic Exploration – The uterus, adnexa, and pelvic peritoneum are inspected.
Dissection of Fallopian Tubes and Ovaries – The suspensory ligaments, ovarian vessels, and adhesions are carefully dissected.
Removal – Both ovaries and fallopian tubes are detached and removed, often using an endobag to prevent spillage of cystic content.
Hemostasis and Closure – Meticulous bleeding control is essential, followed by closure of small port incisions with absorbable sutures.
Robotic-Assisted Surgery
In select complex cases, robotic-assisted BSO may be performed, offering:
Enhanced precision
Improved visualization in deep pelvis
Reduced risk of injury to surrounding structures such as ureters and bowel
Advantages of Laparoscopic BSO
Minimally Invasive – Smaller incisions, reduced scarring, and better cosmetic outcomes.
Faster Recovery – Patients often resume normal activities within 1–2 weeks.
Reduced Pain and Blood Loss – Minimal tissue trauma compared to open surgery.
Improved Visualization – Magnified view allows precise dissection of vessels and ligaments.
Simultaneous Procedures – Can be combined with hysterectomy, endometriosis excision, or other pelvic surgeries.
Risks and Considerations
Although BSO is generally safe, potential complications include:
Bleeding – Injury to ovarian or uterine vessels.
Injury to Adjacent Organs – Ureter, bladder, or bowel injuries, particularly in patients with adhesions.
Early Menopause – Surgical removal of both ovaries induces immediate menopause, causing hot flashes, bone loss, and cardiovascular risks. Hormone replacement therapy may be considered in selected patients.
Infection – Reduced risk in minimally invasive approaches but still possible.
Dr. R. K. Mishra emphasizes preoperative counseling regarding the effects of surgically induced menopause and the need for long-term follow-up.
Conclusion
Bilateral salpingo-oophorectomy is a critical surgical procedure for managing a variety of gynecological conditions, ranging from benign ovarian cysts to malignancies. Minimally invasive approaches, particularly laparoscopy and robotic-assisted surgery, have revolutionized BSO by reducing postoperative pain, shortening hospital stay, and improving cosmetic outcomes.
Careful patient selection, meticulous surgical technique, and expert execution, as advocated by Dr. R. K. Mishra, ensure that BSO is performed safely and effectively. By combining precision with minimally invasive methods, modern gynecologic surgery continues to offer patients better outcomes, faster recovery, and improved quality of life.
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