Objective: To report the authors' experience with laparoscopic ovarian transposition and ovarian function preservation in women who require pelvic irradiation as part of their cancer therapy.

Design: Cohort study.

Setting: The gynecologic oncology service in a referral tertiary/quaternary medical center in Saudi Arabia.

Patients: Twenty-three premenopausal patients treated with radiotherapy for a pelvic malignancy.

Interventions: Laparoscopic ovarian transposition to paracolic gutters with uterine conservation.

Main Outcome Measures: Preservation of ovarian function assessed by patients' symptoms and serum follicle-stimulating hormone level.

Results: Bilateral laparoscopic ovarian transposition was performed in 23 patients: 15 with cervical cancer, 4 with rectal cancer, 3 with Ewing sarcoma, and 1 with Hodgkin lymphoma. No immediate intraoperative or postoperative complications were observed. Three patients were lost to follow-up. Ovarian preservation was achieved in 13 (65%) of 20 patients. Seven patients with low follicle-stimulating hormone levels had regular uterine bleeding at follow-up.

Conclusions: Laparoscopic ovarian transposition is a safe and effective procedure for preserving ovarian function. This procedure should be considered in all premenopausal women who need to undergo pelvic irradiation as part of their cancer treatment.