The video shows the case of a patient who had had a previous right adnexectomy for a simple dermoid cyst. She had a tender mass at the left adnexa.
The sonography showed a complex mass at the level of the left adnexa of about 6 cm in diameter with a hyposonic content. At laparoscopy we found severe adhesions involving uterus, adnexa and the bowel. The adhesiolysis started, as usually, were the adhesions were less dense and where the dissection was easier. In this way, while the adhesiolysis is carried on, it is possible to have in evidence the right cleavage plane also where the adhesions are thicker.
Adhesiolysis is performed both by sharp and blunt dissection minimizing the use of preventive coagulation because it can give a retraction of the tissues and make difficult to find the right cleavage plane. Eventually it was possible to see a very large hydrosalpinx adherent to the ovary. Than it was possible to do the salpingectomy with bipolar forceps and cold scissors.
The left ovary was left in site and the right hemostasis was checked.