The infundibulopelvic ligament (suspensory ligament of the ovary) is a peritoneal fold connecting the lateral pole (infundibulum) of the fallopian tube and the ovary to the pelvic side wall. It contains the ovarian artery, ovarian vein, lymphatics, and the ovarian nerve plexus. It is the primary vascular pedicle of the ovary, and its division is required for oophorectomy.
Suspends the lateral ovary and fallopian tube from the pelvic side wall while conveying the ovarian neurovascular supply from the aortic and renal level down to the adnexa.
Division of the infundibulopelvic ligament is the primary step in laparoscopic oophorectomy and salpingo-oophorectomy. The ureter runs immediately medial and posterior to the ligament at the level of the pelvic brim, creating the most common site of ureteric injury in gynaecological surgery: inadvertent inclusion of the ureter in the clamp applied to the IP ligament. IP ligament division in prophylactic bilateral salpingo-oophorectomy for BRCA mutation carriers requires identification and retraction of both ureters. Ovarian torsion twists the IP ligament and the utero-ovarian ligament, compromising blood flow.
The ureter passing medial to the infundibulopelvic ligament at the pelvic brim is at its highest risk of injury when the IP ligament is clamped for oophorectomy, requiring systematic ureteric identification before any clamp is placed on the IP ligament pedicle.
An ovarian cyst or enlarged ovary twists its vascular pedicle formed by the infundibulopelvic and utero-ovarian ligaments, causing progressive venous then arterial occlusion producing sudden severe unilateral pelvic pain requiring urgent laparoscopic detorsion and ovarian preservation if the ovary is viable.
