of dermoid, follicle, and corpus luteum cysts, the cyst is usually enucleated, and most of
the ovarian parenchyma is preserved. In tubal pregnancy, the pregnant tube is
removed and, in some cases, the ovary also.
b. Operative Procedure. The abdominal peritoneal cavity is opened, the cyst is
(1) For removal of a large ovarian cyst, a purse-string silk suture is placed in
the cyst wall, and a trocar is introduced in its center; the suture is tightened around the
trocar as the fluid is aspirated. The trocar is removed, and the purse-string suture is
tied. All normal ovarian tissue is preserved.
(2) For removal of dermoid cyst, the field is protected with laparotomy
packs, since the contents of such cysts produce irritation if they are spilled into the
peritoneal cavity. An incision is made along the base of the cyst between the wall and
the normal ovarian tissue. The cyst is dissected free and removed intact. The ovary is
closed with interrupted fine chromic gut sutures.
(3) For decortication of the enlarged ovary and bridge resection, a large
segment of the ovarian cortex opposite the hilum is removed. The cysts are punctured
with a needle point and collapsed. A wedge of ovarian stroma, extending deep in the
hilum, is resected with a small knife; the cortex of the ovary is closed with interrupted
chromic gut number 3-0 suture.
(4) To prevent prolapse of the tube into the cul-de-sac, it may be sutured to
the posterior sheath of the broad ligament.
The abdominal wound is closed as for laparotomy.
a. General. This operation is the removal of a tube and all or part of the
associated ovary. It may be done in some young women who are anxious to have
children after all other methods of treatment have failed to cure chronic
salpingo-oophoritis, in patients with ectopic tubal gestation, or in those with tuberculosis
of the adnexa or large adnexal cysts. If both tubes and ovaries are diseased, they are
removed with total hysterectomy.
b. Operative Procedure.
The abdominal wall and peritoneal cavity are opened, as for laparotomy.
(2) The affected tube is grasped with Allis or Babcock forceps. The
infundibulo-pelvic ligament is clamped with Mayo hemostats, cut, and ligated with
chromic gut number 0 or number 2-0, swaged to a 1/2- circle, taper-point needle, or
number 2-0 silk on a French-eye needle.