Ovarian Surgery and Ovarian Reserve: The Application of Temporary Compression for Natural Hemostasis to Eliminate Exposure of the Ovary to Chemical Agents and Physical Energies
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 8, Issue 2
Abstract
Surgical interventions are primarily associated with the need for hemostasis. All types of energy (mechanical, electrical, thermal, welding, laser, etc.) as well as chemical adhesives and sealants that are used in surgery affect the ovarian tissue and damage the ovarian reserve in women of reproductive age to a different extent depending on various pathophysiological mechanisms [1-4]. Ovarian suturing causes an intense inflammatory reaction of the tissue to the foreign body (tissue necrosis, granulation tissue) even in the case when the suture material dissolves within 30-60 days. Conservative hemostasis methods involving temporary compression are widely used in surgery to treat liver damage and control acute gastroduodenal ulcer bleeding. Thus, compression hemostasis can be suggested as an alternative to thermal and ultrasound methods in terms of minimizing the impact on the ovarian reserve. Taking into account the peculiarities of ovarian blood supply, as well as natural monthly traumatization of the ovaries accompanied by the formation of hematomas in the area of an ovulation stigma, it was decided to use temporary compression of the ovarian tissue to achieve hemostasis. The first step includes placement of DeBakey Atraumatic Bulldog Clamps (Figure 1) on lig. infundibulopelvicum and lig. ovarii proprium followed by the injection of vasopressor into the mesosalpinx and mesovarium (Figure 1). The vasopressor agent is introduced in the form of solution containing 3-4 drops of adrenaline per 100 ml of saline. The vasopressor provides a temporary constriction of the blood vessels - up to 20-30 minutes, which prevents blood loss during surgery. When vasopressor is administered, the amount of blood that is lost ranges from 20 to 40 ml, compared to 200-300 ml without its use. As a result, surgical intervention on the ovary is performed with minimal capillary hemorrhage and without coagulation (Figure 2). This method allows us to remove various types of cysts including endometrioid ovarian cysts, dermoid ovarian cysts, corpus luteal cysts. Figure 1: Vascular bulldog clamps on lig. infundibulopelvicum and lig. ovarii proprium and injection of vasopressor into the mesosalpinx.The next step includes ovarian compression. Three options have been investigated and are proposed by this study.Stitching: Compression through ventrosuspension is performed with the monofilament thread. The ovarian walls (Figure 3) are stitched with a Z-like suture performed by a straight needle and the ovary itself is tethered to the abdominal wall (Figure 3).Simultaneously, the gauze swab is applied to the skin to control the tension of the thread and prevent its overtension and cutting through the ovary. 6-8 hours after the operation stabilization of clots is completed due to natural hemostasis in the ovary, which makes it possible to easily remove the slippery filament. After that, the ovary returns to its natural location.
Authors and Affiliations
Zhegulovych VG, Ventskovsky BM, V Zhegulovych Yu
Keywords
Related Articles
- EP ID EP591015
- DOI 10.26717/BJSTR.2018.08.001628
- Views 169
- Downloads 0
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