Laparoscopic Oophorectomy (Keyhole Surgery to Remove an Ovary)

A laparoscopic oophorectomy is a surgical procedure to remove one ovary (unilateral) or both ovaries (bilateral) using keyhole surgery. Instead of a large abdominal cut, the surgeon makes a few small incisions (usually 0.5-1 cm) and uses a thin camera (laparoscope) and specialised instruments.

Your gynaecologist may recommend this procedure for:

• Ovarian Cysts: Large, persistent, or complex cysts that are causing pain or are suspicious, especially in post-menopausal age.
• Ovarian Tumours: Benign (non-cancerous) or, in some cases, cancerous growths.
• Endometriosis: Severe endometriosis involving the ovaries (e.g., endometriomas or “chocolate cysts”).
• Reducing Cancer Risk: For women at very high genetic risk (e.g., BRCA gene mutation) of ovarian cancer (risk-reducing surgery).
• Chronic Pelvic Pain: When the ovary is identified as a source of pain that hasn’t responded to other treatments.
• As part of another surgery: Often performed during a hysterectomy or for conditions like tubo-ovarian abscesses.

Preparing for Surgery

Pre-operative Assessment

• Consultation: Detailed discussion with your surgeon about the reasons for surgery, the plan (one or both ovaries), and what to expect.
• Imaging: An ultrasound or MRI scan to assess the ovary/ovaries.
• Blood Tests: Including tumour markers (like CA-125, HE4) if needed.
• Cancer Risk Discussion: If applicable, you may speak with a genetic counsellor.

• Medications: You will get instructions on which medications to stop (especially blood thinners).
• Bowel Prep: Sometimes a mild laxative or enema is advised to empty your bowels.
• Fasting: No food or drink (fasting) for 6-8 hours before surgery.
• Support: Arrange for someone to drive you home and stay with you for at least 24-48 hours after discharge.

• Anaesthesia: Always performed under general anaesthesia (you are completely asleep).
• Procedure Steps:
  1. A small incision is made near your navel for the camera.
  2. Carbon dioxide gas is used to inflate your abdomen gently, creating space to work.
  3. 2-3 other tiny incisions are made in the lower abdomen for instruments.
  4. The ovary is carefully separated from its attachments (fallopian tube and blood supply) and removed.
  5. The ovary is placed in a special bag and removed through one of the small incisions (it may be cut into smaller pieces to fit).
• Duration: The operation typically takes 1 to 2 hours, depending on complexity.
• Hospital Stay: This is usually a day-case procedure however, some women may stay one night.

Recovery After Surgery

In Hospital & First Week

• Pain: You will have pain/discomfort, mainly from the gas used (can cause shoulder-tip pain) and at the incision sites. This is managed with pain medication.
• Wound Care: The small incisions are closed with dissolvable stitches or skin glue. Keep them clean and dry for about 5 days. You can shower the next day.
• Gas & Bloating: The trapped gas can cause bloating and discomfort for 24-48 hours; walking helps it dissipate.
• Activity: Rest but walk gently from day one to prevent blood clots. Avoid heavy lifting (> 5 kg / 10 lbs), strenuous exercise, and driving for at least 1-2 weeks.

Returning to Normal (2-6 Weeks)

• Work: Return to desk work is often possible in 1-2 weeks. A physical job may require 4-6 weeksoff.
• Sex & Tampons: Avoid sexual intercourse and using tampons for at least 4-6 weeks to allow internal healing.
• Exercise: Gradually increase activity. You can usually resume most exercises by 4-6 weeks.

Long-Term Considerations and Effects

• If One Ovary is Removed: Your remaining ovary will usually take over hormone production. Your menstrual cycle and fertility are typically preserved, unless you are nearing menopause.
• If Both Ovaries are Removed (Bilateral Oophorectomy): This causes surgical menopause immediately, regardless of your age.
  • Symptoms: You may experience hot flushes, night sweats, vaginal dryness, and mood changes.
  • Hormone Replacement Therapy (HRT): Your gynaecologist will discuss if HRT is appropriate and safe for you to relieve these symptoms and protect bone/heart health, especially if you are under 45.
• Fertility: Removal of both ovaries results in permanent infertility. If you hope to have children, discuss fertility preservation options (like egg freezing) with your gynaecologist before surgery.
• Follow-up: You will have a post-operative appointment at 2-6 weeks to discuss pathology results (if the ovary was sent for testing) and your recovery.

Risks and Potential Complications

While generally safe, keyhole surgery carries risks:

• General Risks: Reaction to anaesthesia, bleeding, infection, blood clots (DVT/PE), hernia at an incision site.
• Surgical Risks:
  • Damage to nearby organs (bladder, ureters, bowel, blood vessels).
  • Need to convert to an open procedure (laparotomy) with a larger incision if complications arise.
• Specific Risks:
  • Early Menopause Symptoms (if both ovaries removed).
  • Long-term health effects of early menopause (increased risk of osteoporosis and heart disease if no HRT is used).