This information will help you prepare for your ovarian transposition surgery at Memorial Sloan Kettering (MSK), and help you understand what to expect during your recovery.
Ovarian transposition is a surgery that moves your ovaries away from the field of radiation. Your ovaries are located in the lower area of your pelvis (see Figure 1). Figure 2 shows where your ovaries will be located after your surgery.
Figure 1. Location of ovaries before ovarian transposition surgery
Figure 2. Location of ovaries after ovarian transposition surgery
Moving your ovaries will reduce how much radiation your ovaries will be exposed to, with the goal of keeping your ovaries working properly. This increases the chances that you can have children after your cancer treatment, will not go into early menopause, or both.
If you are interested in having children after your cancer treatment, here are some things you should know.
- Once you have the surgery, you will not be able to get pregnant on your own. If you are interested in getting pregnant in the future, you will need to see a reproductive endocrinologist (fertility specialist).
- Even if you have an ovarian transposition, your ovaries will still be exposed to some radiation. This can affect your chances of having biologic children, especially if you are also being treated with chemotherapy.
- Some women have eggs collected and frozen before the surgery to improve their chances of having biologic children. Ask your surgeon if this is an option for you. If it is, and you are interested in this, ask for a referral to a reproductive endocrinologist.
- We cannot move your uterus outside the field of radiation. Depending on the dose of radiation received, your uterus may be damaged. This could affect your ability to get pregnant or carry a pregnancy to term. Ask your radiation oncologist if you will be able to carry a pregnancy.
Before Your Surgery
Within 30 days of your surgery, you will have an appointment for presurgical testing (PST). Your doctor's office will schedule this for you.
During your appointment, you will meet with a nurse practitioner who works closely with anesthesiology staff (doctors and specialized nurses who give you medication to sleep during surgery). He or she will review your medical and surgical history with you, including your medications. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests necessary to plan your care. Your nurse practitioner may also recommend you see other healthcare providers.
It is very helpful if you bring the following with you to your PST appointment:
- A list of all the medications you take
- Reports of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study
- The name and telephone number of your doctor(s)
During your PST appointment, your nurse practitioner will tell you which medications you should take the morning of your surgery. Use the space below to write them down.
10 days before your surgery
You will need to stop taking some medications 10 days before your surgery. Your nurse will give you a resource called Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs) which contains important information about these medications, and what you can take instead.
There are some medications that you may need to talk with your doctor about before your surgery. For example:
- If you take medication to thin your blood, ask the doctor who prescribes it for you if you should stop taking it. Some examples are warfarin (Coumadin®), dalteparin (Fragmin®), heparin, aspirin, tinzaparin (Innohep®), enoxaparin (Lovenox®), clopidogrel (Plavix®), fondaparinux (Arixtra®), dabigatran (Pradaxa®), cilostazol (Pletal®), and rivaroxaban (Xarelto®), and there are many more. Do not stop taking these medications without talking with your doctor first.
- If you take insulin or other medications for diabetes, you may need to change the dose. Ask the doctor who prescribes this medication for you what you should do the day before and the morning of your surgery.
Arrange for someone to take you home
You must have someone 18 years or older take you home after your surgery. If you don't have anyone, call one of the agencies below. They will provide someone to accompany you home; however, there is usually a charge for this service and you will also need to provide transportation.
In New York:
Partners in Care: 888-735-8913
Prime Care: 212-944-0244
In New York or New Jersey:
Caring People: 877-227-4649
The Day Before Your Surgery
A clerk from the Admitting Office will call you after 2:00 pm the day before your surgery. He or she will tell you what time you should arrive at the hospital for your surgery. If you are scheduled for surgery on a Monday you will be called on the Friday before. If you do not receive a call by 7:00 pm, please call 212-639-5014. Use this area below to write in information when the clerk calls:
Do not eat or drink anything after midnight the night before your surgery. This includes water, hard candy, and gum.
The Day of Your Surgery
Things to remember
- Do not eat or drink anything the morning of your surgery. This includes water, gum, and hard candy.
- Take only the medications you were instructed to take the morning of your surgery. Take them with a few sips of water.
- Do not put on any lotion, cream, powder, deodorant, makeup, powder, or perfume.
- Remove all jewelry, including body piercings.
- Leave valuables, such as credit cards and jewelry, at home.
- Before you are taken into the operating room, you will need to remove your hearing aid(s), dentures, prosthetic device(s), wig, and religious articles, such as a rosary.
Where to park
Parking at MSK is available in the garage on East 66th Street between York and First Avenues. To reach the garage, enter East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a pedestrian tunnel that goes from the garage into the hospital. For questions about prices, call 212-639-2338.
There are also garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.
Where to go
Your surgery will be done at the Surgical Day Hospital (SDH) in the main hospital, which is located at 1275 York Avenue (between East 67th and East 68th Streets). Take the M elevator to the 2nd floor.
What to expect
Once you arrive at the hospital, doctors, nurses, and other staff members will ask you to state and spell your name and date of birth many times. This is for your safety. Others with the same or similar names may be having surgery on the same day.
After changing into a hospital gown, you will meet your nurse. He or she will place an intravenous (IV) catheter into a vein, usually in your hand or arm. At first you will receive fluids through the IV, but it will be used later to give you anesthesia (medication to make you sleepy). Your doctor will explain the surgery, and answer any questions you have. When it’s time for your surgery, you will be brought into the operating room.
Once you're in the operating room, you will be attached to equipment to monitor your heart, breathing, and blood pressure. You will also receive oxygen through your nose or mouth. You will receive anesthesia through your IV to make you sleepy.
During your surgery, your surgeon will make a small incision (surgical cut) on your abdomen (stomach area). He or she will put a small, telescope-like tool into the incision to see the inside your body. Carbon dioxide (gas) will be pumped into your abdomen so that your surgeon has room to work.
Your surgeon will then make several small incisions so that other small tools can be put inside your body. The exact location and number of incisions is different depending on how the surgery is performed.
Your ovaries and fallopian tubes will then be separated from your uterus. They will be moved as high as possible out of the pelvic area held in place with stitches. You will not be able to feel your ovaries in the new position.
After Your Surgery
In the recovery room
After your surgery, you will be taken to the Post-Anesthesia Care Unit (PACU) to recover. Your nurse will continue to monitor your heart, breathing, and blood pressure. Family members can visit you in the PACU.
You will feel some pain after your surgery, but your nurse will give you medication to help. If your pain does not get better, tell your nurse.
You will have several small incisions on your abdomen. The incisions will be closed with Steri-Strips® (small strips of tape) or Dermabond® (surgical glue). Before you leave the hospital, your nurse will show you how to care for your incisions.
You will be discharged the same day of your surgery once you:
- Can eat solid food. It may take several weeks for your appetite to return to what it was before your surgery.
- Have normal bowel activity. This will be based on a physical exam. Most people do not pass gas or have a bowel movement for several days after surgery. You do not have to pass gas or have a bowel movement before you leave the hospital.
- Are not in too much pain.
- Are able to walk and urinate.
Caring for Yourself at Home
You can shower 24 hours after your surgery.
Clean your incisions with soap and water daily. If you are discharged with Steri-Strips or Dermabond covering your incisions, you can shower with it on. The Steri-Strips will begin to peel off in about 1 week. If they have not fallen off after 7 to 10 days, remove them in the shower. If you have Dermabond on your incisions, do not remove it; it will dissolve over time.
You may not have a bowel movement for a few days after surgery. This is normal. However, if you don't have a bowel movement for 3 days, call your doctor or nurse.
If you have diarrhea, call your doctor or nurse. Do not take an antidiarrheal medication, such as loperamide (Imodium®) or bismuth subsalicylate (Kaopectate®), until you speak with your doctor or nurse.
Activities after your surgery
It will take 2 to 4 weeks for your incisions to heal. Until your doctor or nurse has told you that you are healed:
- Do not strain yourself or lift anything over 10 pounds (4.5 kg).
- Do not place anything in your vagina or have vaginal intercourse for 4 weeks or until your doctor tells you it’s okay.
- Do not drive if you are taking narcotic pain medications. If you are not taking narcotic pain medications, you can drive 24 hours after your surgery.
If you are traveling by plane within a few weeks after your surgery, get up and walk around every hour while you are on the plane. Be sure to stretch your legs, drink plenty of fluids, and keep your feet raised whenever possible.
Call Your Doctor or Nurse Immediately if You:
- Have swelling or tenderness in your calves or thighs.
- Become short of breath.
- Cough up blood.
- Have a temperature of 101° F (38.3° C) or higher.
- Have severe abdominal pain that is not helped by taking pain medication.