Ovarian transposition: a surgical option for fertility preservation

To describe and demonstrate a novel surgical method for laparoscopic ovarian transposition. In this video, we present a unique minimally invasive technique for transposing the ovaries, whereby the ovary is tunneled through the peritoneum.

Video presentation of clinical article. The video uses animations and a surgical case to demonstrate the detailed surgical technique for laparoscopic ovarian transposition with a unique feature. Institutional review board approval was not required for this video presentation. Institutional review board approval is not required at the Cleveland Clinic for a case report of a single patient.

Teaching University.

A 29-year-old female patient diagnosed with rectal cancer.

The patient underwent laparoscopic ovarian transposition followed by ovarian decortication for ovarian tissue freezing of the contralateral ovary, both performed in one laparoscopic surgery, before further chemotherapy and radiation.

Value and feasibility of laparoscopic ovarian transposition using the unique feature of ovarian tunneling in maintaining the retroperitoneal location of the ovarian vessels and potentially preserving ovarian blood supply.

Creating a retroperitoneal tunnel for passing the ovary through is a feasible and effective technique, while performing laparoscopic ovarian transposition that can be performed in order to prevent the ovarian vessels from taking a sharp turn into the pelvic cavity and thereby preventing alteration of ovarian blood flow.

Ovarian transposition is a great surgical option for fertility preservation in reproductive-aged women before they undergo gonadotoxic pelvic or craniospinal radiation. This surgical procedure is not a beneficial option for those patients receiving concomitant gonadotoxic chemotherapy. Ovarian transposition can be performed using different surgical techniques, including laparotomy and laparoscopy. Laparoscopic ovarian transposition is the preferred surgical technique described in the literature, because it is associated with more rapid recovery and less postoperative pain. This technique has been reported to have a success rate of 88.6% for preservation of ovarian function, as documented by measuring the gonadotropin levels after cancer treatment. Ovarian transposition is considered to be a safe and effective surgical option to prevent from premature ovarian failure and to optimize preservation of fertility.