This video demonstrates Laparoscopic Oophorectomy for Ovarian Torsion performed by Dr. R K Mishra. Ovarian torsion is a surgical emergency. If not treated quickly, it can result in the loss of an ovary. It's unclear how often ovarian torsion occurs, but doctors agree that it's an uncommon diagnosis. You may be more likely to experience ovarian torsion if you have ovarian cysts, which can cause the ovary to swell. The most common ultrasound finding in torsion is enlargement or edema of the ovary. Commonly an ovarian mass or cyst can be visualized and in, later stages, free pelvic fluid (indicating hemorrhage) can be seen. CT in ovarian torsion is nonspecific, with the most common finding being an enlarged ovary or ovarian mass.

Ovarian torsion is a gynecological emergency that occurs when an ovary twists around the ligaments that support it, cutting off its blood supply. This condition can lead to severe abdominal pain, nausea, vomiting, and if not treated promptly, can cause ovarian necrosis. Laparoscopic oophorectomy is a minimally invasive surgical procedure often performed to manage ovarian torsion, especially when the ovary is non-viable.

Understanding Ovarian Torsion

Ovarian torsion occurs more commonly in women of reproductive age and is often associated with ovarian cysts or masses. The twisting of the ovary compromises venous and arterial flow, leading to ischemia. If left untreated, it can result in permanent damage to the ovary or peritoneal complications.

Symptoms

Sudden, severe pelvic or abdominal pain, often unilateral

Nausea and vomiting

Adnexal mass on pelvic examination

Intermittent pain in cases of partial torsion

Diagnosis

Diagnosis is primarily clinical but is confirmed with imaging studies:

Ultrasound with Doppler: Assesses ovarian blood flow.

CT or MRI scans: Occasionally used to rule out other causes of abdominal pain.

Early diagnosis is critical to preserve ovarian function when possible.

Laparoscopic Oophorectomy: Procedure Overview

Laparoscopic oophorectomy is a minimally invasive surgical approach to remove a damaged ovary. Compared to open surgery, laparoscopy offers faster recovery, less postoperative pain, and minimal scarring.

Indications

Non-viable ovary due to torsion

Large ovarian cyst or mass contributing to torsion

Recurrent torsion in women who have completed childbearing

Surgical Steps

Anesthesia and Patient Positioning: The patient is placed in the lithotomy or supine position under general anesthesia.

Port Placement: Small incisions are made for laparoscopic ports, usually one at the umbilicus for the camera and others for surgical instruments.

Visualization: The surgeon inspects the pelvic organs to confirm torsion and assess ovarian viability.

Detorsion (Optional): If the ovary is potentially salvageable, untwisting may be attempted.

Oophorectomy: The ovary is carefully dissected and removed, taking care to control blood vessels.

Specimen Retrieval: The ovary is removed using a specimen bag to prevent spillage into the abdominal cavity.

Closure: Ports are closed with sutures or adhesive strips, and the patient is monitored during recovery.

Advantages of Laparoscopic Approach

Shorter hospital stay

Reduced postoperative pain

Faster return to normal activities

Better cosmetic outcomes

Lower risk of adhesions

Postoperative Care

Pain management and antiemetics as needed

Early ambulation to reduce the risk of blood clots

Monitoring for signs of infection or bleeding

Follow-up imaging if needed

Prognosis

If the ovary is removed promptly and there are no complications, patients generally recover quickly. Fertility may be affected if the remaining ovary is compromised, but in most cases, women can continue to conceive with one healthy ovary.

Conclusion

Laparoscopic oophorectomy is a safe and effective treatment for ovarian torsion, especially when the ovary is non-viable. The minimally invasive nature of laparoscopy ensures rapid recovery, minimal discomfort, and excellent surgical outcomes. Prompt recognition and intervention are crucial to prevent complications and preserve reproductive health whenever possible.