Laparoscopic management of ovarian remnant

The ORS usually results from unintentional incomplete dissection and removal of the ovary during a difficult oophorectomy. Often, there is a past history of endometriosis. Diagnosis is made through clinical history, pelvic examination, use of pelvic imaging, and hormonal profiles with or without the aid of ovulatory stimulants. The pathology of these remnants is usually benign, although malignant transformation has been described. Surgical removal of ovarian remnants is the treatment of choice and is often difficult because of the presence of adhesions and abnormal pelvic anatomy. Recent reports have shown the safety and effectiveness of laparoscopic removal of the ovarian remnant. This approach often requires laparoscopic retroperitoneal dissection with mobilization of the ureter; devascularization of the remnant ovary; extensive enterolysis; and sometimes partial resection of involved organs, such as the bowel, bladder, or ureter. As such, laparoscopic management of ovarian remnant is often one of the most difficult procedures, requiring significant level of experience and proper instrumentation. For example, recent confirmation of advantages of laparoscopic colon resection [18] supports once again the original beliefs in the superiority of operative laparoscopy to open surgery [19]. Video-assisted endoscopic surgery transformed operative laparoscopy from a "one man band" to an "orchestra"; the technologic revolution has begun and will continue to run to its final course of eliminating the need for open surgery. Almost all surgeries (not only a small fraction like today) will be performed on images on television screens. No more surgeons' hands in the body cavities! It is only a matter of time [20,21].