Are the ovaries connected to ligaments?

Ovarian Ligament Attachments

Yes, the ovaries are connected to multiple ligaments that play crucial roles in their positioning, support, and vascular supply. 1

Primary Ovarian Ligaments

• The ovaries are connected to the ovarian ligament (also called the proper ligament of the ovary), which attaches the ovary to the uterus 1
• The suspensory ligament (also called the infundibulopelvic ligament) connects the ovary to the pelvic sidewall 2, 3
• The round ligament provides a minor connection pathway from the ovaries to the inguinal region 3

Embryological Development of Ovarian Ligaments

• During embryological development, the female fetus maintains the craniosuspensory ligament, which helps the ovary retain its dorsal (retroperitoneal) position 1
• Unlike in male development where the gubernaculum thickens, in females the gubernaculum persists as the ovarian round ligament 1
• The proper development and maintenance of these ligamentous structures are critical for normal ovarian positioning 1

Clinical Significance of Ovarian Ligaments

• The length of ovarian ligaments has been correlated with risk of ovarian torsion, with longer ligaments associated with increased torsion risk 4
• In a prospective study, the right ovarian ligament was significantly longer in patients with ovarian torsion (3.2 ± 0.9 cm) compared to controls (2.2 ± 0.6 cm) 4
• The suspensory ligament contains important vascular structures, including the ovarian blood vessels and lymphatics 2, 3

Lymphatic Drainage via Ligamentous Pathways

• Lymphatic vessels from the ovaries follow three primary pathways that correspond to the ligamentous attachments 3:
  • Via the proper ligament of the ovaries toward lymph nodes in the obturator fossa and internal iliac artery
  • Via the suspensory ligament toward para-aortic and paracaval lymph nodes
  • Via the round ligament to the inguinal lymph nodes 3

Surgical Considerations

• Understanding the ligamentous attachments of the ovaries is critical during gynecologic surgery, particularly for procedures involving ovarian conservation or removal 1
• In cases of recurrent ovarian torsion, surgical fixation techniques may target these ligaments, particularly the ovarian ligament and suspensory ligament 5
• During cancer surgery, knowledge of these ligamentous pathways guides lymph node sampling and cytoreduction techniques 1, 3

Imaging Considerations

• Radiologic identification of the suspensory ligament can facilitate visualization of the ovaries on imaging studies 2
• CT and MRI can sometimes visualize these ligamentous structures, particularly when there is pathology affecting them 2

Understanding these ligamentous connections is essential for comprehending ovarian pathology, surgical approaches, and the patterns of disease spread in conditions such as ovarian cancer.