BILATERAL SALPINGO OOPHERECTOMY (BSO)

​

 

Bilateral Salpingo-Oophorectomy (BSO) is a surgical procedure that involves the removal of both fallopian tubes (salpingectomy) and both ovaries (oophorectomy) from a woman's body. This surgery is typically performed due to various medical reasons, such as the presence of ovarian cancer, endometriosis, benign ovarian tumors or cysts, ectopic pregnancy, or as a preventive measure for women with a high risk of developing ovarian cancer due to genetic factors (e.g., BRCA1 or BRCA2 gene mutations).

​

Indications for BSO:

 

1. Ovarian cancer: BSO is often performed when a woman is diagnosed with ovarian cancer or has a high risk of developing it due to a genetic predisposition.

2. Endometriosis: In severe cases of endometriosis, BSO may be performed to alleviate pain and other symptoms.

3. Benign ovarian tumors or cysts: When non-cancerous growths cause pain, discomfort, or other complications, BSO may be recommended.

4. Ectopic pregnancy: In rare cases, BSO may be necessary if an ectopic pregnancy has caused significant damage to the fallopian tube and ovary.

5. Prophylactic surgery: BSO may be performed as a preventive measure in women with a strong family history of ovarian cancer or those who carry BRCA1 or BRCA2 gene mutations.

 

​

BSO can be performed using different surgical techniques, such as:

​

1. Laparotomy: This is an open surgery where a large incision is made in the lower abdomen to access the pelvic organs. This approach is used in cases where the surgeon needs a clear and direct view of the pelvic area, or when extensive surgery is anticipated.

2. Laparoscopy: This is a minimally invasive procedure in which small incisions are made in the abdomen, and a laparoscope (a thin tube with a light and camera) is inserted to view the pelvic organs. Special surgical instruments are then used to perform the surgery. Laparoscopy generally has a shorter recovery time and fewer complications compared to laparotomy.

3. Robotic-assisted surgery: This technique involves the use of a robotic system that allows the surgeon to perform the surgery through small incisions with greater precision and control. This approach combines the advantages of laparoscopy with enhanced dexterity and visualization.

​

The recovery time and possible complications of BSO vary depending on the surgical approach used and the individual patient's health. Some of the potential complications include infection, bleeding, damage to nearby organs, and anesthesia risks. After BSO, a woman will no longer have menstrual periods and will experience menopause, as her body will no longer produce the hormones estrogen and progesterone.

​

Premenopausal women who undergo a bilateral salpingo-oophorectomy are placed into surgical menopause.

​

The sudden loss of estrogen will trigger an abrupt premature menopause that may involve severe symptoms of hot flashes, vaginal dryness, painful intercourse, and loss of sex drive.

 

Hormone replacement therapy (HRT) may be considered to alleviate menopausal symptoms and reduce the risk of certain health issues related to the lack of these hormones.

​

                                                                                                 

                                     Anesthetic Implications for Bilateral Salpingo-Oophorectomy (BSO)

​

Anesthesia type: General with ETT

​

Airway: Endotracheal tube

​​

Preoperative:

​​

• The ovaries are the female pelvic reproductive organs responsible for the production of sex hormones

• Ovarian carcinoma is usually diagnosed at a late stage

• Patients may have ascites and/or pleural effusion (respiratory compromise)

• Cardiotoxicity can result from doxorubicin chemotherapy

• Cisplatin can cause peripheral neuropathy

• RSI is usually indicated for patients with an ectopic pregnancy

​

Intraoperative:

​

• For an abdominal approach, the patient is placed in the supine position

• For a laparoscopic or vaginal approach, the patient is placed in the lithotomy position

• Sciatic and femoral nerve injuries may occur in the lithotomy position

• Intraoperative insufflation complications (laparoscopic case)

​

Postoperative:

​

• Pain management

• PONV prophylaxis

​

Complications:

​

• Infection

• Hemorrhage 

• Injury to internal organs (bowel, bladder, ureter, blood vessels, and nerves)

• PONV

• Deep vein thrombosis

• Adhesion formation

• Incisional hernia

• Ovarian remnant syndrome

​

Sources:

​

Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. 

​

Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). 

​

Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.

​

​

​

​

 

​​

​​