Affiliation: 1: Department of gynecology and Minimally Invasive Unit, Vita Batel Hospital, Curitiba, Paraná, Brazil
2: Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida, United States
The surgical technique is essential to adequately manage the disease. The objective of this video is to show a meticulous technique to be necessary to adequately manage of Laparoscopic cystectomy for the treatment of ovarian endometrioma. This video reports in detail our current technique for laparoscopic cystectomy for ovarian endometrioma and all the tricks to permit a good answer to reproduction, and even improvement of the technique by other surgeons.
To describe a reproducible safe laparoscopic technique for the excision of ovarian endometriomas.
Perfect surgical technique and knowledge of the anatomy is essential to adequately excise endometriosis. The ovarian endometrioma may be found in up to 44% of women with endometriosis. The steps of a laparoscopic ovarian cystectomy for ovarian endometriomas are described in this video utilizing a reproducible technique with the aim of reducing trauma to ovarian injury. 10 key steps are highlighted.
Step 1: Patient preparation and establishment of peritoneum.
Step 2: Use of uterine manipulator
Step 3: Systematic diagnostic laparoscopy, endometriotic lesions mapping, and ovariolysis
Step 4: Aspiration and irrigation of endometriotic cyst contents.
Step 5: Identification of the endometrioma cleavage plane.
Step 6: Dissection of the ovarian endometrioma utilizing divergent forces
Step 7: Dissection of the deep aspect of the endometrioma near the ovarian hilum.
Step 8: Hemostasis.
Step 9: Excision of broad ligament and pelvic sidewall peritoneum.
Step 10: Extraction
The ovarian endometrioma is seen in up to 44% of women with endometriosis. Premature surgical menopause and decreased anti-Mullerian hormone (AMH) after ovarian cystectomy is a concern that must be discussed with patients.
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The International Society for Gynecologic Endoscopy was formed in 1988. We fulfill the need for a scientific group who meets at regular intervals to share their knowledge and expertise in gynecologic endoscopy. The ISGE-website was formed by Tamer Seckin, MD in 2004.