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This information leaflet explains laparoscopic gonadectomy.

This leaflet will explain why your doctor has discussed this operation with you, how the surgery is performed, and the risks of the surgery.

This is a 'keyhole' surgery to remove someone’s gonads.

Gonads are the organs that develop into either ovaries or testes. Gonads produce ‘sex’ hormones including oestrogen, progesterone and testosterone. These hormones cause the changes bodies go through in puberty and are important for a person's on-going health.

Gonads can be found inside the tummy (abdomen) or in the groin. Typically, someone will have two gonads – one on the left and one on the right.  

A laparoscopic gonadectomy is a keyhole operation to remove gonads from someone’s abdomen.

In some Differences of Sexual Development (DSD) conditions, the gonads can carry a risk of developing abnormal changes that could become cancer.  

Some DSD conditions can mean that people’s gonads may produce hormones which could cause unwanted body changes (produce testosterone type hormones which can cause deepening of voice, to develop facial and body hair, and increase in the size of their clitoris). Removing the gonads can help to stop or avoid these changes.

DSD conditions where gonadectomy is recommended include 46XY gonadal dysgenesis (commonly referred to as Swyer’s syndrome). 

DSD conditions where the option of laparoscopic gonadectomy will be discussed include Androgen Insensitivity Syndrome (AIS).

If someone has a womb and fallopian tubes then we would recommend combining the surgery to remove their gonads with removal of their fallopian tubes. This is recommended as their fallopian tubes are not able to contribute to their fertility and the fallopian tubes can also carry a small risk of developing cancer. Removing fallopian tubes with gonadectomy does not significantly increase the operating time or surgical risks.

The surgery is carried out in the operating theatre with you asleep (under a general anaesthetic). As you will be asleep with an anaesthetic you will not feel pain. 

The operation usually takes around an hour to perform.  

After you are asleep a small tube (urinary catheter) will be passed into your bladder. This will allow for your urine to be drained into a collection bag during the surgery.

Three to four small cuts are made on the tummy (0.5 - 1cm in size). The abdomen is filled with carbon dioxide gas so that the bowel and other organs do not get in the way. 

A telescope camera (laparoscope) is inserted through the cut in the belly button and acts as our eyes to see inside your tummy. 

The gonads are removed and brought out through the cuts in your tummy. 

The carbon dioxide gas is removed at the end of the operation. The cuts on the tummy are closed with dissolvable sutures (stitches) or surgical glue.

Once the gonads have been removed, they will be sent to the laboratory so they can be examined under a microscope. This is to confirm that your gonads have been removed and to identify if there have been any cancerous changes.

The surgery typically takes one hour. You will wake up in recovery and after a short while will be transferred back to the ward.  

You will have a fine tube in your arm (drip or iv) until you are drinking.

You will have some pain from the cuts on your tummy, the vagina and you may have some shoulder tip pain. (The shoulder tip pain is due to the gas used for the laparoscopy and usually lasts a couple of days.)

You will be able to discuss the best options for pain relief with the anaesthetist before your operation.

The surgical team will see you afterwards on the ward to let you know how the operation has gone.  

If the procedure was straightforward, you will be able to go home either the same or next day as surgery. 

This will depend on your condition and why you are having surgery. The surgical team will advise you on this. 

If you are already on hormonal treatment for your DSD condition you may not need to change your hormonal treatments. 

If you have complete androgen insensitivity syndrome then your doctor will have discussed the need for long-term hormonal treatment, and what form this could take.

Your team will discuss this with you after the procedure, depending on the operation you had and how you are feeling.  

Generally, we recommend two weeks off school, college or work. To help with healing we recommend showers rather than baths for the first few weeks after the operation. 

A follow up appointment will be arranged for around six to eight weeks after the operation.

When can I get back to exercise?

You should avoid heavy lifting or strenuous exercise for four to six weeks.   

When will I be able to drive?

You can drive again once you are able to do an emergency stop safely and without being in discomfort. You must make sure you are not drowsy from any painkillers you may be taking. You must tell your insurance company that you have had surgery. 

When can I fly?

We recommend that you don’t fly for one to two weeks after your surgery. Your doctor will also advise you about precautions to take before and during your flight.

All operations and anaesthetics carry risks that your doctor will discuss with you when you sign the consent form. 

Risks of this procedure include injury to the neighbouring body parts, such as the urethra (tube that urine leaves the bladder through), bladder, ureters (tube that brings urine from the kidneys to the bladder), blood vessels and the bowel. These are serious but uncommon risks with this operation.

If an injury happened and was recognised, then it would be repaired during the operation. This may involve a camera into the bladder (cystoscopy). 
It is possible that damage to the urethra, bladder, or bowel may cause long-term incontinence (leakage of urine or stools).  

There is a risk of developing blood clots in the veins of the leg (deep vein thrombosis: DVT) which can travel to the lungs (pulmonary embolism). To reduce this risk you will have some special socks to wear and you will also need injections to keep your blood thin whilst you are in hospital.  

Rarely we are unable to safely complete the procedure laparoscopically and need to complete the procedure as an open surgery (laparotomy).

There is a small risk of bleeding, but this is uncommon to be heavy and require blood transfusion. It’s common to have some temporary bruising around the wounds on the tummy and it’s rare that any treatment for this is needed. 

Infection can affect how the wounds on the tummy heal, or the bladder (UTI), these infections are generally treated with a short course of antibiotic tablets.

It is rare to have severe infection within the abdomen. If you feel unwell with fever, chills, increasing pain or diarrhoea or vomiting you should attend your local A&E. You may need to be admitted for antibiotics through a drip (your local team can contact the UCLH team for advice).  

The gonads will be sent to the laboratory after removal. It is uncommon to need further investigations or procedures for concerns on laboratory analysis of the gonads.

The risks of not having this procedure will depend on your condition and your individual circumstances.  

Your doctor will consider the benefits and risks of having this surgery with you and your alternative options.

Our team’s psychologists can help you decide if this operation is the right choice for you. They can also help you consider when would be the right time for you to have this operation.

In the clinic your doctor will discuss the option of this surgery and your alternative options. They will talk through the procedure what to expect on the day and recovery from the operation as well as go through the surgical risks. 

You will have the opportunity to meet the team’s psychologist who can help you with the decision process and your feelings on having and not having the procedure. 

You will need to sign a consent form for the surgery. A short while before the operation you will need to come to the hospital for a pre-operative assessment to have some blood tests and other routine investigations.

On the day of the operation, you will be seen by the surgical and anaesthetic teams on the ward before the operation. You will have the opportunity to ask any questions you may have since your last clinic appointment.

Louise Perry: Clinical Nurse Specialist