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Use of Titanium Spiral Tacks for Long-term Oophoropexy Before Pelvic Irradiation
  1. Tamar Perri, MD*,,
  2. Gilad Ben-Baruch, MD*,,
  3. Tima Davidson, MD,
  4. Mario E. Beiner, MD*,,
  5. Limor Helpman, MD*,,
  6. Liat Hogen, MD*,,
  7. Ariella Jakobson-Setton, MD*,,
  8. Dror Meirow, MD§,
  9. Simona Ben Haim, MD and
  10. Jacob Korach, MD*,
  1. *Department of Gynecologic Oncology, Sheba Medical Center, Tel Hashomer;
  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv;
  3. Institute of Nuclear Medicine, and
  4. §Center for Fertility Preservation, Sheba Medical Center, Tel Hashomer, Israel.
  1. Address correspondence and reprint requests to Tamar Perri, MD, Department of Gynecologic Oncology, Sheba Medical Center, 52621 Tel Hashomer, Israel. E-mail: tamarperri{at}gmail.com.

Abstract

Background Ovarian transposition before planned pelvic irradiation can preserve ovarian function in young patients with pelvic malignancies. The transposed ovaries are fixed to the posterolateral abdominal wall. We described the use of a titanium spiral tack as a fixation device and compared it with other methods of oophoropexy.

Methods Medical and surgical records of all consecutive patients who underwent oophoropexy in our institution between 2007 and 2013 were reviewed. Demographic and clinical data were summarized; follicle-stimulating hormone values, recorded; and imaging scans, reviewed.

Results Oophoropexy was performed in 30 patients: 28 with cervical carcinomas and 2 with pelvic sarcomas. The procedure was done through laparoscopy in 13 patients and through laparotomy in 17. Titanium spiral tack was used for ovarian fixation in 14 patients, Vicryl suturing in 14, and in 2 cases the ovaries were pulled up through a retroperitoneal tunnel and fixed to the peritoneum with sutures. Titanium spiral tack fixation took a few seconds to perform. There were no immediate intraoperative or postoperative complications. Ovarian function was preserved in 15 patients (7/14 with spiral tack, 6/14 with sutures, and in both patients with retroperitoneal tunneling). Postoperative imaging results showed that all ovaries retained their extrapelvic location for a median period of 11.6 months (range, 2.3–63 months).

Conclusions Spiral tack is a simple, reliable method for oophoropexy before pelvic irradiation. Its efficacy is comparable with that of suture fixation, with the added advantage of ultrashort operative time. It is therefore worth considering as an alternative to suturing.

  • Ovarian transposition
  • Oophoropexy
  • Malignancy
  • Radiation
  • Spiral tacks

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Footnotes

  • The authors declare no conflicts of interest.

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