A Novel Technique for Resection of Endometrioma

Publish Year: 1398
نوع سند: مقاله کنفرانسی
زبان: English
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شناسه ملی سند علمی:

COBGY15_023

تاریخ نمایه سازی: 11 آبان 1398

Abstract:

Background: Endometrioma resection with minimal ovarian tissue damage and resection of all involved tissues is gold standard of Endometrioma surgery. There are two main endometrioma resection techniques which are performed by surgeons. During the first technique, ovarian cyst fluid is aspirated and the surgery is followed by cyst resection from the bulged surface of cyst. Second technique includes mobilizing the ovary over the surrounding adhesive-tissues(caused by endometriosis), and cyst penetration is performed in the location of invaginated ovarian endometrioma tissue. Then the surgery is followed by cyst excision and resection. This technique has been simplified by trimming of fibrosed edges, caused by endometrioma, and finding an appropriate plane. The surgery procedure is accompanied by less ovarian tissue damage. Due to complete excision of ovarian endometrioma, the second technique has been adopted as the preferred method Although entering into the cyst probably causes difficulties in finding small endometriomas and multiloculated cysts because of intermixed ovarian and cyst tissue, hemorrhage from the site of excision during surgery and overlapping ovarian edges.Methods: The novel endometrioma surgery techniques which I called The bell pepper method , includes detachment of ovary from surrounding adhesive-tissues that could be followed by spontaneous chocolate cyst rupture and fluid extraction. The second step is determining fibrotic areas which are developed by endometriosis invagination. After that we don’t enter to the cyst. The surgery will be followed by penetrating appropriate plane and complete resection of endometriosis tissue around the determined periphery and after completing the border determining, the cyst walls will be appeared and extraction of involved tissues will be done. During the surgery, we always focus on preserve the maximum integrity of ovarian tissue.After cyst excision, the remained chocolate fluid will be washed out from the ovary using serum, and when the complete removal of endometriotic lesions is confirmed we don’t use cauterization and only use hemostatic sutures in the ovarian bed and sub edges with trying to use most of sutures inside the ovary as much as possible to prevent ovarian cortex damage and to maintain natural ovarian anatomy. We also try to maintain the tubo-ovarian angle during suturing. After that we suspend the ovary to lateral pelvic side wall. The final step includes total resection of endometriosis lesions from peritoneum and the pelvic floor and every other superficial or deep Endometriosis.Conclusion: Managing endometrioma using minimally invasive surgeries is an effective method. The bell pepper method as a novel technique in endometrioma resection surgeries, is able to provide appropriate plane of cleavage and extraction of endometriotic cysts, as well as complete endometrioma lesions resection and ovarian hemostatic repair. Better ovarian tissue preservation could be obtained by this surgical precision and it also would be resulted with lowest recurrence rate of ovarian and surrounded Endometriosis.

Authors

Ameneh Haghgoo

Advanced Laparoscopic surgery fellowship, Nikan Hospital, Tehran, Iran.