Ovarian remnant syndrome after laparoscopic oophorectomy, Ceana Nezhat, MD, Daniel Seidman, MD, Farr Nezhat, MD, S.A. Mirmalek, MD& Camran Nezhat, MD; Fertility and Sterility, 2000;74(5):1024-28

To report the surgical history, clinical characteristics, and operative technique used in patients with ovarian remnant syndrome after laparoscopic oophorectomy. Observational study at teaching hospital and private practice office. Nineteen patients with documented history of unilateral or bilateral laparoscopic oophorectomies with histologic confirmation of ovarian remnants. Operative laparoscopy for resection of ovarian remnants. Risk factors and surgical technique contributing to ovarian remnant syndrome. The patients underwent a mean of 4.7 previous surgical procedures (range, 2 to 9): 12 had bilateral oophorectomy, and 7 had unilateral oophorectomy. The infundibulopelvic ligament had been secured with bipolar desiccation in 11 patients, pretied surgical loops in 6, and a linear stapler in 2. Cystic ovarian remnants were identified by pelvic sonography in 12 women and by computed tomography (CT) scan in 1. Six women underwent reoperation, 2 for ovarian remnants in different sites. With laparoscopic oophorectomy there is risk of ovarian remnant due to improper tissue extraction or misapplication or improper use of pretied surgical loops, linear stapler, or bipolar electrodesiccation on the infundibulopelvic ligament, especially in women with a history of multiple pelvic surgeries, adhesions, or endometriosis.

Videolaseroscopy for Oophorectomy, Farr Nezhat, MD, Camran Nezhat, MD, & Sheryl L. Silfen, MD; Am J Obstet Gynecol, 1991;165:1323-30

Laparoscopic oophorectomy was performed on 94 ovaries in 76 patients, Indications included recurrent pain associated with endometriosis and adhesions in 47 patients (18 ovaries), ovarian endometriomas in 40 patients (40 ovaries), prophylactic oophorectomy (breast cancer) in one patient (2 ovaries), removal of the ovaries at the time of laparoscopic assisted vaginal hysterectomy in 15 patients (30 ovaries), and other indication in three patients (4 ovaries).

Use of Laparoscopic Ultrasonography to Detect Ovarian Remnants, Farr Nezhat, MD, Camran Nezhat, MD, Ceana H. Nezhat, MD, Erika Sly, BS, RPMS, Daniel S. Seidman, MD; J Ultrasound Med, 15:487-88/1996

Ovarian remnant syndrome is a complication of oophorectomy. It usually occurs in patients with distorted anatomy from adhesions and endometriosis, which makes surgical dissection difficult. The adhesions frequently result from pelvic inflammatory disease or previous pelvic operations. Although it is often technically difficult, resection is the most effective treatment for ovarian remnant syndrome. We have managed ovarian remnant syndrome successfully during laparoscopy. However, difficulty in diagnosing ovarian remnants during laparoscopy is not uncommon. Laparoscopic ultrasonography has been suggested to overcome the lack of tactile information. This technique has been used successfully to delineate the hepatobiliary anatomy during laparoscopic cholecystectomy, and for identifying hepatic and pancreatic malignancies. We report the use of laparoscopic ultrasonography to locate and monitor resection of bilateral ovarian remnants.

Operative Laparoscopy for the Treatment of Ovarian Remnant Syndrome, Farr Nezhat, MD, Camran Nezhat, MD; Fertility & Sterility, Vol. 57, No. 5, May 1992

To present the technique and assess the efficacy of operative laparoscopy to manage ovarian remnant syndrome. Observational with a follow-up of 6 to 32 months. Thirteen women, 9 with previous bilateral salpingo-oophorectomy and 4 with previous unilateral salpingo-oophorectomy and pain on the ipsilateral side. Multipuncture advanced operative laparoscopy. Patient pain relief was assessed through return examinations, telephone interviews, or contact with referring physicians. Nine patients reported complete pain relief. One reported incomplete but satisfactory pain relief. Two required bowel resection by laparotomy to obtain pain relief, and one, despite subsequent laparotomy, had persistent pain. No intraoperative or postoperative complications were noted. Laparoscopy can be effective in managing ovarian remnant syndrome when performed by an experienced laparoscopist.

Laparoscopically-Assisted Hysterectomy for the Management of a Borderline Ovarian Tumor: A Case Report, Camran Nezhat, MD, Farr Nezhat, MD, Matthew Burrell, MD; J of Laparoendoscopic Surgery, Vol. 2, No. 4, 1992

Borderline ovarian tumors account for 4% of ovarian neoplasms, an incidence which remains constant despite advancing age. Management for younger women can be unilateral oophorectomy, although simple hysterectomy with bilateral salpingo-oophorectomy is more appropriate for women beyond childbearing age. The authors report a laparoscopic approach to a case of borderline ovarian tumor.

Laparoscopic Removal of Dermoid Cysts, Camran Nezhat, MD, Wendy K. Winer, RN, BSN, Farr Nezhat, MD; Obstet Gynecol, 73:278, 1989

Nine reproductive-age women underwent removal of unilateral or bilateral dermoid cysts via laparoscopy. Over a follow-up period of 12-42 months, there were no immediate or long-term complications. Four patients have had repeat laparoscopy for evaluation of possible pelvic adhesion formation; one had mild periovarian adhesions and the pelvis appeared normal in the other three.

Laparoscopic Ovarian Surgery, William H. Parker, MD, Farr Nezhat, MD, Michel Canis, MD; J Am Assoc of Gynecologic Laparoscopists, Vol. 1, No. 1, 11/93

The following is a summary of an important panel discussion that took place in Chicago, Illinois, at the 21st annual meeting of the American Association of Gynecologic Laparoscopists (AAGL) on September 25, 1992.

Laparoscopic Ovarian Cystectomy During Pregnancy, Farr Nezhat, MD, Camran Nezhat, MD, Sheryl L. Silfen, MD, & Stephen H. Fehnel, MD; J Laparoendoscopic Surgery, Vol. 1, No. 3, 1991

A pregnant woman with a history of endometriosis and persistent bilateral adnexal masses underwent laparoscopic ovarian cystectomies at 16 weeks of gestation. There were no adverse sequelae, and the patient had an otherwise uneventful pregnancy and delivery. Operative laparoscopy should be considered to replace laparotomy in appropriate cases during pregnancy.

Is Hormonal Treatment Efficacious in the Management of Ovarian Cysts in Women with Histories of Endometriosis? Ceana H. Nezhat, Farr Nezhat, Soheila Borhan, Daniel S. Seidman, & Camran R. Nezhat; Human Reproduction, Vol. 11, No. 4, p.874-77, 1996

In a controlled, randomized study, we evaluated the effectiveness of various hormonal regimens in treating 70 women (mean age 34.7 + 5.7 years) who had unilateral or bilateral ovarian cysts presumed to be physiological (functional) and a history of endometriosis. The patients were assigned randomly to one of the following groups: group I (control), no treatment; group II, oral contraceptives (35 ug ethinyl oestradiol and 1 mg norethindrone); group III, oral contraceptives (50 ug ethinyl oestradiol and 1 mg norethindrone); group IV, danazol 800 mg/day. Serum CA-125 concentrations were measured in 32 women. All medications were taken continuously for 6 weeks. Subjects were re-evaluated by pelvic examination and transvaginal ultrasound. Those with persistent cysts were offered diagnostic and possible operative laparoscopy. As 11 patients did not complete the study and five did not follow-up, the final study population comprised 54 women. At 6 weeks follow-up, complete resolution of cysts was found in: group I, 12 out of 18 (66.7%); group II, five out of nine (55.6%); group III, eight out of 14 (57l1%); and group IV, seven out of 13 (53.9%), Two of the 22 women with persistent cysts opted for 6 weeks further medical therapy and achieved complete resolution; 19 underwent laparoscopy, and one was lost to follow-up. All laparoscopic findings revealed benign masses. We found no statistically significant effect when hormonal treatment was compared with expectant management. There was no correlation between serum CA-125 concentrations and the persistence or resolution of cysts.

A Fresh Look at Ovarian Endometriomas, Farr Nezhat, MD, Ceana Nezhat, MD, Camran Nezhat, MD, & Dahlia Admon, MD; Contemporary Ob/Gyn, Vol. 39, No. 11, 11/94

Endometriosis of the ovaries has unique manifestations. A new classification of endometriomas offers practical implications for diagnosis and treatment.

Clinical and Histologic Classification of Endometriomas: Implications for a Mechanism of Pathogenesis, Farr Nezhat, MD, Camran Nezhat, MD, Christopher J. Allan, MD, Deborah A. Metzger, PhD, MD, Donald L. Sears, MD; J Reproductive Medicine, 0024-7758/92/3709-0771

One hundred eighty-seven consecutive patients with persistent ovarian cysts and endometriosis underwent laparoscopic evaluation and ovarian cystectomy. All patients had been followed for a minimum of 6 weeks prior to surgery. The cysts were identified initially to be endometriomas based on their gross appearance and the presence of endometriosis at other pelvic sites. Presumed endometriomas were classified into three types based on size, cyst contents, ease of removal of the capsule, adhesions of the cyst to other structures and location of superficial endometrial implants relative to the cyst wall. After clinical laparoscopic classification, the cysts were evaluated histologically without knowledge of the clinical assessment. Histologically small (<2 cm), superficial ovarian cysts were always endometriomas, and the cyst wall was very difficult to remove (type I). Large cysts with easily removed walls were usually luteal cysts (type II). Large cysts with walls adherent in multiple areas adjacent to superficial endometriosis wee generally endometriomas but some also had histologic characteristics of functional (luteal or follicular) cysts (types IIIa and IIIb). These findings led to the conclusion that superficial ovarian endometriosis is similar to endometriosis in extraovarian sites in that the formation of superficial cysts is limited in size by fibrosis and scarring. In contrast, large endometriomas may develop as a result of secondary involvement of functional ovarian cysts by the endometriotic process.

Laparoscopic Excision of Ovarian Neoplasms Subsequently Found to be Malignant; Camran Nezhat, MD, Farr Nezhat, MD, Sheryl L. Stilfen, MD, Benedict Benigno, MD, Matthew Burrell, MD, Charles Welander, MD; Obstet Gynecol Vol 78, No. 2, Aug/1991

Letter to the editor in reference to article: "Laparoscopic excision of ovarian neoplasms subsequently found to be malignant", (Obstet Gynecol 1991:77:563-5), Maiman et al surveyed gynecologic oncologists to assess the quality of care and effect on the outcome of ovarian masses initially managed laparoscopically. We would like to suggest that the quality of laparoscopic care in the survey needs to be examined more carefully...