Securing the tubo-ovarian or infundibulo-pelvic (IP) ligament

The general principle in this young cohort is to conserve the ovaries to avoid an abrupt surgical menopause and the associated bony and cardiovascular sequelae. Patients should, however, be counselled that undergoing hysterectomy alone without removal of ovaries is still associated with an earlier onset of menopause, by approximately 1.9 years.

Ovarian conservation

A Zeppelin clamp is placed vertically across the tubo-ovarian ligament and transected using the Ligasure impact device (Medtronic, UK). The free end is then tied with a transfixion suture, with a 1-0 Vicryl suture (Ethicon, UK) for additional hemostasis.

Oophrectomy

The IP ligament is not a ligament proper, but adjoins the ovary to the pelvic sidewall and carries the ovarian vessels, nerve plexus and lymphatics.

By elevating and medialising the fallopian tube, a window can be made in the posterior leaf of broad ligament – with the ureter in view – to isolate the IP ligament. We apply a Robert’s and Zeppelin clamp across the IP distal to the ovary, and use the Ligasure Impact device (Medtronic, UK) to seal before transfixing with a 1-0 Vicryl suture (Ethicon, UK) for additional haemostasis.