Use of Titanium Spiral Tacks for Long-term Oophoropexy Before Pelvic Irradiation

2014 ◽  
Vol 24 (6) ◽  
pp. 1133-1136 ◽  
Author(s):  
Tamar Perri ◽  
Gilad Ben-Baruch ◽  
Tima Davidson ◽  
Mario E. Beiner ◽  
Limor Helpman ◽  
...  
Keyword(s):  
Operative Time ◽  
Ovarian Function ◽  
Young Patients ◽  
Pelvic Irradiation ◽  
Cervical Carcinomas ◽  
Ovarian Transposition ◽  
Pelvic Malignancies ◽  
Imaging Results ◽  
Median Period

BackgroundOvarian transposition before planned pelvic irradiation can preserve ovarian function in young patients with pelvic malignancies. The transposed ovaries are fixed to the posterolateral abdominal wall. We described the use of a titanium spiral tack as a fixation device and compared it with other methods of oophoropexy.MethodsMedical and surgical records of all consecutive patients who underwent oophoropexy in our institution between 2007 and 2013 were reviewed. Demographic and clinical data were summarized; follicle-stimulating hormone values, recorded; and imaging scans, reviewed.ResultsOophoropexy was performed in 30 patients: 28 with cervical carcinomas and 2 with pelvic sarcomas. The procedure was done through laparoscopy in 13 patients and through laparotomy in 17. Titanium spiral tack was used for ovarian fixation in 14 patients, Vicryl suturing in 14, and in 2 cases the ovaries were pulled up through a retroperitoneal tunnel and fixed to the peritoneum with sutures. Titanium spiral tack fixation took a few seconds to perform. There were no immediate intraoperative or postoperative complications. Ovarian function was preserved in 15 patients (7/14 with spiral tack, 6/14 with sutures, and in both patients with retroperitoneal tunneling). Postoperative imaging results showed that all ovaries retained their extrapelvic location for a median period of 11.6 months (range, 2.3–63 months).ConclusionsSpiral tack is a simple, reliable method for oophoropexy before pelvic irradiation. Its efficacy is comparable with that of suture fixation, with the added advantage of ultrashort operative time. It is therefore worth considering as an alternative to suturing.

scholarly journals PO-1086: Benefits of ovarian transposition in young patients after pelvic irradiation

2018 ◽  
Vol 127 ◽  
pp. S611-S612
Author(s):  
R. Roncero ◽  
N. Aymar ◽  
I. Ortiz ◽  
M. LLopis ◽  
D. Morera ◽  
...  
Keyword(s):  
Young Patients ◽  
Pelvic Irradiation ◽  
Ovarian Transposition

Laparoscopic Ovarian Transposition Before Pelvic Irradiation: A Saudi Tertiary Center Experience

2010 ◽  
Vol 20 (6) ◽  
pp. 1082-1086 ◽  
Author(s):  
Ismail A. Al-Badawi ◽  
Murad Al-Aker ◽  
Jamal AlSubhi ◽  
Hany Salem ◽  
Alaa Abduljabbar ◽  
...  
Keyword(s):  
Ovarian Function ◽  
Medical Center ◽  
Gynecologic Oncology ◽  
Follicle Stimulating Hormone ◽  
Premenopausal Women ◽  
Pelvic Irradiation ◽  
Ovarian Transposition ◽  
Tertiary Center ◽  
Stimulating Hormone

Objective:To report the authors' experience with laparoscopic ovarian transposition and ovarian function preservation in women who require pelvic irradiation as part of their cancer therapy.Design:Cohort study.Setting:The gynecologic oncology service in a referral tertiary/quaternary medical center in Saudi Arabia.Patients:Twenty-three premenopausal patients treated with radiotherapy for a pelvic malignancy.Interventions:Laparoscopic ovarian transposition to paracolic gutters with uterine conservation.Main Outcome Measures:Preservation of ovarian function assessed by patients' symptoms and serum follicle-stimulating hormone level.Results:Bilateral laparoscopic ovarian transposition was performed in 23 patients: 15 with cervical cancer, 4 with rectal cancer, 3 with Ewing sarcoma, and 1 with Hodgkin lymphoma. No immediate intraoperative or postoperative complications were observed. Three patients were lost to follow-up. Ovarian preservation was achieved in 13 (65%) of 20 patients. Seven patients with low follicle-stimulating hormone levels had regular uterine bleeding at follow-up.Conclusions:Laparoscopic ovarian transposition is a safe and effective procedure for preserving ovarian function. This procedure should be considered in all premenopausal women who need to undergo pelvic irradiation as part of their cancer treatment.

Correlation Between Location of Transposed Ovary and Function in Cervical Cancer Patients Who Underwent Radical Hysterectomy

2015 ◽  
Vol 25 (4) ◽  
pp. 688-693 ◽  
Author(s):  
Aera Yoon ◽  
Yoo-Young Lee ◽  
Won Park ◽  
Seung Jae Huh ◽  
Chel Hun Choi ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Ovarian Function ◽  
Medical Center ◽  
Young Patients ◽  
Surrogate Marker ◽  
Ovarian Transposition ◽  
Median Serum ◽  
Early Cervical Cancer ◽  
And Function

ObjectiveThe study investigated the association between the location of transposed ovaries and posttreatment ovarian function in patients with early cervical cancer (IB1-IIA) who underwent radical hysterectomy and ovarian transposition with or without adjuvant therapies.MethodsRetrospective medical records were reviewed to enroll the patients with early cervical cancer who underwent ovarian transposition during radical hysterectomy at Samsung Medical Center between July 1995 and July 2012. Serum follicle-stimulating hormone (FSH) level was used as a surrogate marker for ovarian function.ResultsTwenty-one patients were enrolled. The median age and body mass index (BMI) were 31 years (range, 24–39 years) and 21.3 kg/m2 (range, 17.7–31.2 kg/m2), respectively. The median serum FSH level after treatment was 7.9 mIU/mL (range, 2.4–143.4 mIU/mL). The median distance from the iliac crest to transposed ovaries on erect plain abdominal x-ray was 0.5 cm (range, −2.7 to 5.2 cm). In multivariate analysis, posttreatment serum FSH levels were significantly associated with the location of transposed ovaries (β = −8.1, P = 0.032), concurrent chemoradiation (CCRT) as an adjuvant therapy (β = 71.08, P = 0.006), and BMI before treatment (underweight: β = −59.93, P = 0.05; overweight: β = −40.62, P = 0.041).ConclusionsLocation of transposed ovaries, adjuvant CCRT, and BMI before treatment may be associated with ovarian function after treatment. We suggest that ovaries should be transposed as highly as possible during radical hysterectomy to preserve ovarian function in young patients with early cervical cancer who might be a candidate for adjuvant CCRT and who have low BMI before treatment.

Preservation of ovarian function by ovarian transposition performed before pelvic irradiation during childhood

1992 ◽  
Vol 121 (6) ◽  
pp. 880-884 ◽  
Author(s):  
E. Thibaud ◽  
M. Ramirez ◽  
R. Brauner ◽  
F. Flamant ◽  
J.M. Zucker ◽  
...  
Keyword(s):  
Ovarian Function ◽  
Pelvic Irradiation ◽  
Ovarian Transposition

Laparoscopic ovarian transposition in patients with early cervical cancer

2008 ◽  
Vol 18 (3) ◽  
pp. 584-589 ◽  
Author(s):  
J. PAHISA ◽  
S. MARTÍNEZ-ROMÁN ◽  
M. A. MARTÍNEZ-ZAMORA ◽  
A. TORNÉ ◽  
X. CAPARRÓS ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Ovarian Function ◽  
Young Patients ◽  
Figo Stage ◽  
Pelvic Radiotherapy ◽  
Ovarian Transposition ◽  
Hormonal Function ◽  
Pathologic Evaluation ◽  
Minimum Delay ◽  
Early Cervical Cancer

The aim of this study was to evaluate the feasibility, efficacy, and morbidity of laparoscopic ovarian transposition on the preservation of hormonal function in patients younger than 45 years operated for early cervical cancer. According to risk factors on pathologic evaluation of the specimen, some of them will receive postoperative pelvic radiotherapy. This subset of patients could benefit from taking the ovaries away from the irradiation field in an effort to preserve their functionality. This prospective study included 28 FIGO stage IB1 cervical cancer patients, 45 years old or younger, maintaining menstrual cycles, who were considered suitable for conservation of the ovaries. The ovarian transposition was performed by laparoscopy as a part of the same celio-Schauta operation. Twelve patients underwent adjuvant pelvic radiotherapy. No intraoperative or postoperative morbidity related to the ovarian transposition was observed, and the procedure only entailed a minimum delay of the operative time. There were no cases of ovarian metastasis. At a mean follow-up of 44 months, 63.6% of patients receiving radiotherapy and 93% of those who nonirradiated maintained normal ovarian function. Two patients developed benign ovarian cysts, requiring oophorectomy, but no other long-term adverse effects of the transposition were identified. To the best of our knowledge, this is the largest series of the laparoscopic procedure reported to date in this setting. According to our results, laparoscopic ovarian transposition is a safe and effective procedure for the preservation of ovarian function in young patients with early cervical cancer undergoing adjuvant radiotherapy after surgery

Ovarian transposition in young patients with invasive cervical cancer receiving radiation therapy

1994 ◽  
Vol 4 (1) ◽  
pp. 61-65 ◽  
Author(s):  
N. Husseinzadeh ◽  
M. L. Van Aken ◽  
B. Aron
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Ovarian Function ◽  
Invasive Cervical Cancer ◽  
Young Patients ◽  
Average Dose ◽  
External Radiation ◽  
Adequate Treatment ◽  
Ovarian Transposition ◽  
Postmenopausal Symptoms

Twenty-two patients with invasive cervical cancer had ovarian transposition. Fifteen patients received whole pelvic external radiation therapy via a teletherapy unit, and nine patients also received one or two intracavitary insertions. Ovarian function was measured by serum gonadotropins, FSH, and LH. We were unable to measure gonadotropin levels in four patients because they were lost to follow-up after completion of radiation therapy. Five patients developed postmenopausal symptoms; in two the ovaries were not shielded and they received radiation by lateral ports with an average dose above 2500 cGY. Therefore, ovarian function was preserved in seven of 11 patients (64%), all of whom received ≤ 500 cGY with an average dose of 250 cGY to the ovaries via external radiation and intracavitary insertion(s). FSH values ranged from 3.3 to 38.8 mlU ml−1 (mean = 17.7 mlU ml−1). Two patients developed symptomatic ovarian cysts. Ovarian function can be preserved by transposing the ovaries at the time of surgery prior to radiation with adequate treatment planning which limits the radiation dose to the ovaries to ≤300 cGY.

Ovarian transposition in patients with cervical cancer prior to pelvic radiotherapy: a systematic review

2021 ◽  
Vol 31 (3) ◽  
pp. 360-370
Author(s):  
Barbara Buonomo ◽  
Francesco Multinu ◽  
Jvan Casarin ◽  
Ilaria Betella ◽  
Vanna Zanagnolo ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Ovarian Function ◽  
Young Patients ◽  
Complication Rates ◽  
Pelvic Radiotherapy ◽  
Ovarian Transposition ◽  
Risk Benefit Assessment ◽  
Menopausal Women ◽  
Informed Preferences ◽  
Function Preservation

Ovarian transposition aims to minimize ovarian exposure and damage during pelvic radiotherapy. One or both ovaries are separated from the uterus and mobilized away from the area where the radiation will be administered. A review of the available literature was conducted to evaluate the efficacy and safety of ovarian transposition among pre-menopausal women diagnosed with cervical cancer and eligible for pelvic radiotherapy. Outcomes evaluated were ovarian function preservation and complication rates. We also searched for information on pregnancy/live birth rates after ovarian transposition. Our search yielded a total of 635 manuscripts, of which 33 were considered eligible. A total of 28 full texts were selected for the current review, including 1377 patients who underwent ovarian transposition. The median or mean follow-up ranged between 7 and 87 months. Ovarian function preservation after ovarian transposition and pelvic radiotherapy, with or without chemotherapy, was 61.7% (431/699 patients), ranging from 16.6% to 100%. A total of 12 studies reported on 117 complications, accounting for 8.5%. Ovarian metastases were described in 5 (0.4%). Data about fertility preservation after ovarian transposition are scarce and definitive conclusions cannot be drawn. Based on the available data, ovarian transposition could be performed on young patients with tumors smaller than 4 cm, and it should be avoided in those with bulky tumors. A risk/benefit assessment should be carefully evaluated by a multidisciplinary team, and the decision regarding ovarian transposition should be always guided by the values and informed preferences of the patient.

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