Ovarian Transposition

This information will help you understand and prepare for your ovarian transposition surgery at Memorial Sloan-Kettering Cancer Center (MSKCC). 

Ovarian transposition is a surgery that moves the ovaries away from the field of radiation.

The surgery will reduce the exposure of the ovaries to radiation with the goal to keep the ovaries working properly. This increases the chances that a woman can have children after her 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.

• 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 (fertility specialist).
• Your uterus cannot be completely blocked from radiation. Depending on the dose of radiation, it may damage your uterus. This could affect your ability to get pregnant or carry a pregnancy to term. Ask your radiation oncologist if you are at risk for these problems.
• 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.

About Your Surgery

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.

Ovarian Transposition

You will be given general anesthesia before your surgery. During your surgery, a small telescope-like tool will be put into your abdomen (stomach area) through a small incision (surgical cut) so that the surgeon can see inside your body. Carbon dioxide (gas) will be pumped into your abdomen so that the surgeon has room to work.

The surgeon will then make several small incisions so that small tools can be put inside your body. The exact location and number of incisions is different depending on how the surgery is performed. Figure 3 below shows an example of where the incisions may be located.

The ovaries and the fallopian tubes will then be separated from the uterus. They will be moved as high as possible out of the pelvic area and will be stitched together to hold them in place. You will not be able to feel the ovaries in their new position.

Before Your Surgery

You will have a presurgical testing (PST) appointment to meet with a nurse practitioner who works closely with anesthesiology staff (doctors and specialized nurses who give you medicine to sleep during surgery). Your nurse practitioner will review your medical and surgical history with you. 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:

• Medication list
• Reports of any tests done outside of MSKCC, such as a cardiac stress test, echocardiogram, or carotid doppler study
• The name and telephone number of your doctor(s)

Arrange for someone to take you home

You must have someone 18 years or older take you home after your procedure. Please call one of the agencies below if you do not have someone who can do this. They will help find someone to take you home.

Partners in Care (888) 735-8913

Caring People (877) 227-4649

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 Monday you will be called on Friday. If you do not receive a call by 7:00 pm, please call (212) 639-5014. Use this area to write in information when the clerk calls:

Date______________ Time______________

Do not eat or drink anything after midnight the night before your surgery. This includes water, hard candy, and gum.

Day of Your Surgery

• You may shower, but do not put on any lotion, cream, powder, deodorant, makeup, powder, or perfume.
• Do not wear any metal objects. Remove jewelry, including body piercings. The equipment used during your procedure can cause burns if they touch metal.
• Leave valuables, such as credit cards, jewelry, or checkbooks at home.
• Before you are taken into the operating room, you will need to remove your hearing aids, dentures, prosthetic device(s), wig, and religious articles such as a rosary
• Your doctor or nurse practitioner may have told you to take certain medications. Take only these medications with a small sip of water the morning of your procedure.

Your will have your surgery at the Surgical Day Hospital (SDH) 1275 York Avenue (Between 67^th and 68^th Streets). Take the M elevator to 2^nd floor.

After Your Surgery

After your surgery, you will be taken to the Post-Anesthesia Care Unit (PACU) to recover. Family members may visit you in the PACU.

Pain management

You will feel some pain after your surgery, but your nurse will give you medicine to help. If your pain does not get better, tell your nurse.

Your incisions

You will have several small incisions in your abdomen. The incisions are 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 may shower 24 hours after your surgery.

Discharge

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

Incisions

Clean your incisions with soap and water daily. If you are discharged with Steri-Strips^®or Dermabond^®covering your incisions, you may shower with these 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.

Activity after 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 sexual intercourse for 4 weeks or until your doctor tells you it is ok.
• Do not drive if you are in pain or 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 airplane 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

Call Your Doctor or Nurse If You Have:

• Not had a bowel movement in 3 days
• Diarrhea. Do not take an antidiarrheal medicine [such as loperamide (Imodium^®) or bismuth subsalicylate (Kaopectate^®)] until you speak to your doctor or nurse
• Any questions or concerns