Watch this detailed video on Bilateral Salpingo-Oophorectomy for Ovarian Mass with Transvaginal Retrieval. Learn the step-by-step surgical technique, patient management, and minimally invasive approach for safe and effective removal of ovarian masses.

We performed a microlaparoscopic bilateral salpingo-oophorectomy using a 10-mm umbilical port for laparoscope insertion and two 5-mm ports for the ligasure and the grasper. The transvaginal route was used for specimen retrieval. A unilateral salpingo-oophorectomy is the surgical removal of one ovary and one fallopian tube, both of which are located on the same side of the body and share a common blood supply (in contrast, a bilateral procedure involves the removal of both ovaries and fallopian tubes). Laparoscopy, also known as diagnostic laparoscopy, is a surgical diagnostic procedure used to examine the organs inside the abdomen. It's a low-risk, minimally invasive procedure that requires only small incisions. The instrument is inserted through an incision in the abdominal wall.

Bilateral salpingo-oophorectomy (BSO) is a surgical procedure involving the removal of both ovaries and fallopian tubes. It is commonly performed for patients diagnosed with ovarian masses, particularly when malignancy is suspected or when there is a high risk of ovarian cancer. The advent of minimally invasive techniques, including transvaginal retrieval, has significantly improved patient outcomes by reducing surgical trauma, hospital stay, and recovery time.

Indications

BSO is indicated in patients with:

• Benign or malignant ovarian tumors.

• Recurrent ovarian cysts unresponsive to conservative management.

• Genetic predisposition to ovarian or breast cancer (e.g., BRCA mutations).

• Endometriosis involving the ovaries.

Preoperative Preparation
Proper preoperative evaluation is essential and includes:

• Detailed pelvic imaging (ultrasound, MRI, or CT scan) to assess the size, location, and nature of the ovarian mass.

• Tumor markers (CA-125, HE4) to help evaluate malignancy risk.

• Complete blood work, coagulation profile, and anesthesia assessment.

• Counseling the patient about fertility implications and hormonal consequences if premenopausal.

Surgical Technique

1. Patient Positioning: The patient is placed in the lithotomy position under general anesthesia.

2. Port Placement: Laparoscopic ports are inserted to access the pelvic cavity.

3. Ovarian Mass Assessment: The ovarian mass and surrounding structures are carefully inspected to ensure safe removal.

4. Bilateral Salpingo-Oophorectomy: Both ovaries and fallopian tubes are dissected and removed with minimal manipulation to avoid rupture.

5. Transvaginal Retrieval: The excised ovarian masses are retrieved via the transvaginal route using an endoscopic specimen bag. This technique reduces the risk of abdominal wall contamination and allows for a minimally invasive extraction of large masses.

6. Closure: The vaginal cuff and laparoscopic port sites are closed, and hemostasis is ensured.

Advantages of Transvaginal Retrieval

• Avoids enlarging abdominal incisions.

• Minimizes postoperative pain and scarring.

• Reduces the risk of port-site metastasis in malignant cases.

• Shortens hospital stay and speeds up recovery.

Postoperative Care

• Monitoring for bleeding, infection, or urinary complications.

• Pain management with minimal opioid use.

• Early ambulation to prevent thromboembolic events.

• Follow-up imaging or lab tests if malignancy was suspected.

• Hormonal therapy consideration for premenopausal patients.

Conclusion
Bilateral salpingo-oophorectomy with transvaginal retrieval is a safe and effective minimally invasive approach for managing ovarian masses. It combines the benefits of laparoscopy with the advantages of transvaginal specimen extraction, leading to improved patient outcomes and faster recovery. Proper patient selection, meticulous surgical technique, and comprehensive pre- and postoperative care are key to achieving optimal results.