Wedge Resection of the Ovary

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Wedge Resection of the Ovary

Wedge resection of the ovary is most often performed in the treatment of polycystic ovary syndrome (Stein-Leventhal). After appropriate gynecologic and endocrinologic evaluation and after all possible medical therapy with estrogen antagonists has failed, wedge resection may be the procedure of choice to induce ovulation and menstrual periods.

Physiologic Changes. The precise mechanism for the induction of ovulation by wedge resection of the ovary is not known at this time. There are two possible explanations for this physiologic change: (1) the hyperplastic ovarian capsule is removed, thereby mechanically allowing ovulation, and (2) the mass of ovary is reduced, thus shifting the ratio between the level of pituitary gonadotropin and the mass of the ovary in such a way as to favor induction of ovulation.

Points of Caution. There are two important points of caution of this operation: (1) the control of hemorrhage from the biopsy site in the ovary and (2) the reduction in the peritublar adhesion formation associated with wedge resection of the ovary. Therefore, fine meticulous technique must be utilized if peritubular adhesion formation is to be avoided.

Technique

The patient is placed in the supine position. The bladder is emptied with a Foley catheter, and a Pfannenstiel or lower midline incision is made. The abdominal cavity is entered. The uterus is retracted caudally against the pubic symphysis. The polycystic ovary should be large with a smooth oyster-like capsule.	A Babcock clamp is placed on the suspensory ligament of the ovary. An additional Allis clamp may be placed on the inferior pole of the ovary to stabilize the structure so that adequate wedge resection can be performed. A scalpel is used to incise the ovary down to and including the hilum. Occasionally, a small dermoid cyst may be located in the hilum. It is also important to remove a portion of the hilum to evaluate the possibility of a hilar cell tumor that can mimic many signs and symptoms of Stein-Leventhal syndrome.

After an adequate wedge has been taken, the ovary is closed in two layers. The first layer is closed by a running lateral mattress suture that enters the deep body of the ovary and exits through the opposite side of the ovary. The needle is reversed and reenters the body of the ovary, exiting on the opposite side. In this manner, the walls of the ovary are plicated in the midline, and dead space is eliminated.
At the completion of the running mattress suture, the capsule of the ovary can be closed by continuing the fine synthetic absorbable suture through the epithelium of the ovary. Care should be taken to invert all raw edges to reduce the problem of postoperative adhesions that could have an adverse effect on future fertility. Complete hemostasis is essential if adhesions are to be avoided. Postoperative care is similar to that for patients who have undergone pelvic laparotomy. Prophylactic antibiotics are not used.