What happens during prophylactic ovary removal depends on the kind of surgery you have: laparoscopic ovary removal or abdominal ovary removal.
Laparoscopic ovary removal
Laparoscopic ovary removal is usually performed in the hospital or outpatient surgical center under general anesthesia. In some cases, the surgery can be done using local anesthesia, which numbs only the area to be operated on. This allows you to stay awake. Laparoscopic ovary removal typically lasts about an hour to 90 minutes.
Laparoscopic ovary removal is technically called “laparoscopic bilateral salpingo-oophorectomy (BSO),” which means “removal of the ovaries and fallopian tubes on both sides.” The surgeon makes several small incisions in the abdominal wall and then uses a special device called a laparoscope to perform the procedure:
- First, a tube is inserted through the navel, or “belly button,” to inflate the pelvis with carbon dioxide gas. Inflating the pelvis gives the surgeon better access to the ovaries and fallopian tubes.
- Then the surgeon will insert a lighted camera that allows for viewing of the internal organs on a television monitor.
- The surgeon will use special surgical instruments to remove the ovaries and fallopian tubes through the small incisions. If these organs and the surrounding tissue appear healthy, there is no need for the surgeon to go any further.
- The surgeon will send the tissue to a laboratory for close examination under a microscope, just to be certain that no early-stage cancer is present.
If ovarian cancer is present, more extensive surgery is needed to remove all of the cancer. A gynecologic oncologist can perform this more extensive surgery right away. If your ovary removal is being performed by a gynecologist, he or she should call in a gynecologic oncologist if cancer is found, or refer you to a gynecologic oncologist for more complete surgery at a later date.
Abdominal ovary removal
Abdominal ovary removal is performed under general anesthesia and generally lasts about 1-2 hours. It may last longer if the surgeon needs to do some further exploration.
Abdominal ovary removal requires making a larger incision to remove the ovaries and fallopian tubes. Typically, the surgeon will use a bikini incision, a horizontal incision just above the pubic bone. This procedure is technically called “abdominal bilateral salpingo-oophorectomy (BSO).”
The larger incision may be needed if the surgeon cannot access the ovaries and fallopian tubes through the smaller incisions used for laparoscopy. Abdominal ovary removal is often a better choice than laparoscopic ovary removal when:
- You have scar tissue (technically known as adhesions) from previous abdominal or pelvic surgeries.
- You have a condition such as endometriosis, in which the tissue that normally lines the uterus is growing outside of the uterus.
- You are excessively overweight.
- You’re having a hysterectomy, or removal of the uterus and/or cervix, due to some other health issue or concern. (Hysterectomy does not further reduce breast and ovarian cancer risk, but it does prevent cancers of the uterus and cervix.)
Depending on your unique situation, the surgeon may attempt the less invasive laparoscopic ovary removal first, making the larger incision only if it’s needed. In other cases, the surgeon may decide up front that the surgery requires the larger abdominal incision.
The surgeon also will make a longer vertical incision up and down the abdomen if there is anything unusual that suggests cancer may be present. The surgeon will inspect the area thoroughly and send any suspicious tissue for immediate examination by a pathologist. This process is known as a “frozen section.” If the tissue is healthy, no further surgery is needed.
If ovarian cancer is present, more extensive surgery is required to remove all of the cancer. A gynecologic oncologist can perform this more extensive surgery right away. If your ovary removal is being performed by a gynecologist, he or she should call in a gynecologic oncologist if cancer is found, or refer you to a gynecologic oncologist for more complete surgery at a later date.