Oophorectomy

• Port
  • Midline camera
  • 2x 5mm
• Isolate the IP and identify the ureter
  • Lateral approach
    • Open peritoneum lateral to the infundibularpelvic ligament (suspensory ligament of the ovary)
      • Bluntly open this space pushing the lateral pelvic wall contents lateral
      • There is a triangle of space where the ureter can be found
        • Anterior - round ligament
        • Lateral - internal iliac vessels
        • Medially - tube, ovary and IP ligament
    • Once the avascular space is open the ureter will be found inferior and medical to the IP ligament
  • The window under the IP ligament can now be confidently opened as the ureter postion is known and the IP is skelotonised
• Ligate the IP ligament
• Next steps depends on oophorectomy or salpingo-oophrectomy
  • Oophorectomy only
    • Divded the utero-ovarian ligament close to the ovary
  • SPO
    • Take the peritneum close to the fallopian tube and follow this up to the uterus
    • Take the fallopian tube and utero-ovarian ligament at the level of the uterus