Surgical Management and Prevention of Ovarian Remnant

STUDY OBJECTIVE: To provide surgeons with surgical techniques necessary for management and prevention of ovarian remnant syndrome. DESIGN: Instructional video (Canadian Task Force classification III). SETTING: Academic medical center. INTERVENTION: Surgical dissection and retroperitoneal anatomy. MEASUREMENTS AND MAIN RESULTS: Ovarian remnant syndrome occurs when residual ovarian tissue inadvertently remains in situ after salpingo-oophorectomy [1-4]. It can result in pelvic pain and pelvic mass [1-4]. Risk factors include endometriosis, adhesive disease, pelvic inflammatory disease, and prior pelvic surgery [1-4]. Ovarian remnant can also occur as a result of ovarian stroma extending up to 1.4 cm into the infundibulopelvic ligament beyond the visible margin [5]. Medical management and radiotherapy are treatment options but do not provide the definitive management that surgery affords [1-4]. Surgery also avoids missing a potential malignancy within the remnant tissue [1-4]. This video demonstrates the surgical techniques necessary to treat and prevent this condition, including key retroperitoneal anatomy. Mayo Clinic Institutional Review Board approval was not required for this video article. CONCLUSION: Both treatment and prevention of ovarian remnant syndrome follow the same basic surgical principles, including high ligation of the infundibulopelvic ligament, retroperitoneal dissection, and excision of all peritoneum and tissue adherent to the ovary.