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.
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
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.