Laparoscopic management of endometriomas using a combined technique of excisional (cystectomy) and ablative surgery.
OBJECTIVE
To describe and evaluate a new technique of laparoscopic treatment of endometriomas that combines excisional and ablative surgery.


METHODS
Descriptive and prospective study.


METHODS
Gynecology research unit in a university hospital.


METHODS
Fifty-two women under 35 years of age presenting for infertility and/or pelvic pain with endometriomas larger than 3 cm were included in the study. None had undergone any surgery for endometriosis.


METHODS
A large part of the endometrioma wall was first excised according to the cystectomy technique. After this first step, CO(2) laser was used to vaporize the remaining 10%-20% of the endometrioma wall close to the hilus.


METHODS
The feasibility of this new technique was assessed. Ovarian volume and antral follicle count (AFC) were compared between operated ovaries and nonoperated ovaries of patients with endometriosis and controls (women with male factor infertility).


RESULTS
The combined technique was possible in all cases. The volume of the ovary after the combined technique was similar to that of the contralateral normal ovary, as well as to that observed in infertile women without endometriosis presenting for male factor infertility. The AFC on day 2-5 showed the same number of antral follicles in all subgroups. Histopathology of the excised part of the endometrioma revealed the presence of follicles in only one case (2%). The pregnancy rate was 41% at a mean follow-up of 8.3 months. Recurrence of a small endometrioma was observed in only one case (2%).


CONCLUSIONS
The combined technique (stripping and ablation) has proved not to be deleterious to the ovary.
Department of Gynecology, Université Catholique de Louvain, Brussels, Belgium. jacques.donnez@uclouvain.be
Jacques
J
Donnez
Jean-Christophe
JC
Lousse
Pascale
P
Jadoul
Olivier
O
Donnez
Jean
J
Squifflet
D000328:Adult; D015653:Cystectomy / Q000379:methods; D019468:Disease Management; D055356:Endometrial Ablation Techniques / Q000379:methods*; D004715:Endometriosis / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000175:diagnosis / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D010049:Ovarian Diseases / Q000175:diagnosis* / Q000601:surgery*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies