title: Combined ultrasonographically guided drainage and laparoscopic excision of large endometriomas: a pilot study.
abstract: We report a prospective pilot study which evaluated the feasibility of combined ultrasonographically guided drainage and laparoscopic excision after pre-operative administration of a gonadotrophin-releasing hormone analogue for 3 months in the management of ovarian endometriotic cysts >5 cm. Ten patients with an ultrasonographic diagnosis of large unilateral or bilateral ovarian endometriotic cysts received an intramuscular injection of leuprorelinum acetate 3.75 every 4 weeks for 12 weeks. After 4 weeks of medical treatment, the endometrioma was carefully drained transabdominally under ultrasonographic control. Within 8 weeks since the last injection, the patients were submitted to a second ultrasonography, and laparoscopy-guided stripping of the endometrioma was performed. A videotape review was undertaken to evaluate duration and complexity of the different phases of surgery. Stripping of endometriomas with preservation of residual ovarian parenchymas was obtained in all cases; adhesiolysis was complete in 6 cases. There were neither intra-operative complications nor conversions in laparotomy. In conclusion, gonadotrophin-releasing hormone analogue and cyst drainage seem to permit an easy laparoscopic approach of large endometriomas; the findings of our pilot phase seem to justify a randomized trial to better define the effectiveness of this approach with respect to standard procedures.
authors.affiliation: Institute of Obstetrics and Gynaecology, University of Ancona, Italy. garzetti@popcsi.unian.it
authors.forename: G G
authors.initials: GG
authors.lastname: Garzetti
authors.forename: A
authors.initials: A
authors.lastname: Ciavattini
authors.forename: M
authors.initials: M
authors.lastname: Tiriduzzi
mesh_terms: D000328:Adult; D004322:Drainage / Q000379:methods*; D004715:Endometriosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D016729:Leuprolide / Q000627:therapeutic use; D010048:Ovarian Cysts / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D010865:Pilot Projects; D011446:Prospective Studies; D014463:Ultrasonography
chemical_list: D016729:Leuprolide