Interstitial laser treatment of the ovary: an experimental study in goats.
OBJECTIVE
Interstitial laser treatment (ILT) of the ovary might be a new surgical approach to restore ovulation with a minimal risk of adhesion formation in patients with chronic hyperandrogenic anovulation who are unresponsive to hormone therapy. The objective was to investigate the feasibility of inducing a lesion limited to the center of the ovary in an animal model.


METHODS
ILT was performed in seven goats using Nd:YAG laser in combination with ultrasound monitoring. The extent of direct thermal damage was investigated in two goats, treating both ovaries during a laparotomy at 2, 4, 6, and 8 W, respectively, for 5 min. Adhesion formation was evaluated in five goats 81 days after an unilateral laparoscopic ILT at 1, 2, 4, 6, or 8 W for 5 min. During treatment temperatures on the surface of the ovary were measured.


RESULTS
Histology after 1 day showed sharply demarcated necrotic lesions located centrally or subcapsularly at low powers, whereas at higher powers the lesions extended to the surface of the ovary. At low powers no adhesions were observed, whereas higher powers resulted in periovarian adhesions. Temperatures measured on the ovarian surface during treatment ranged between 38 degrees C and 90 degrees C. Ultrasound monitoring of the extent of thermal damage failed due to poor positioning.


CONCLUSIONS
Although this pilot study does not warrent firm conclusions, the results indicate that ILT of the ovary is feasible and that lesions without adhesions can be produced at low powers. The use of ultrasound to monitor the extent of thermal damage in the ovary should be a subject of further evaluation.
Beek
J F
JF
Laser Center, Academic Medical Center, Amsterdam, Netherlands.
Kaaijk
E M
EM
van der Veen
F
F
de Boer
K
K
Ankum
W M
WM
ten Kate
F J
FJ
Lammes
F B
FB
van Gemert
M J
MJ
D000538:Aluminum Silicates; D000818:Animals; D000858:Anovulation / Q000601:surgery; D001831:Body Temperature; D004195:Disease Models, Animal; D005240:Feasibility Studies; D005260:Female; D006041:Goats; D006358:Hot Temperature / Q000009:adverse effects; D017588:Hyperandrogenism / Q000601:surgery; D007813:Laparotomy; D053685:Laser Therapy / Q000379:methods; D016343:Monitoring, Intraoperative; D009336:Necrosis; D009354:Neodymium; D010049:Ovarian Diseases / Q000517:prevention & control*; D010053:Ovary / Q000473:pathology / Q000601:surgery*; D010060:Ovulation; D010865:Pilot Projects; D012307:Risk Factors; D000267:Tissue Adhesions / Q000517:prevention & control; D018084:Ultrasonography, Interventional; D015019:Yttrium
D000538:Aluminum Silicates; D009354:Neodymium; D015019:Yttrium