During surgical removal of an ovarian mass, which structure passing inferior to the ovary must be protected?

• A. Ureter
• B. Uterine artery
• C. Round ligament of the uterus
• D. Vaginal venous plexus

Answer: (A)

The key idea is that the ureter runs very close to the ovary as it travels to the bladder. It courses in the retroperitoneum and passes under the ovarian vessels within the suspensory (infundibulopelvic) ligament as those vessels reach the ovary. Because an ovarian mass is manipulated and its vessels are ligated during removal, the ureter lies just inferior to the ovary and can be injured if not carefully protected. So protecting the ureter during the procedure is essential to avoid damaging this vital tube.