This video presents a step-by-step approach to laparoscopic cystectomy for ovarian endometriomas, including ovarian mobilization, endometrioma drainage, vasopressin injection, cystectomy, haemostasis, and ovarian suspension.

Read the full transcript here: [ Ссылка ]

Presented By

Dr. Caroline Lee
Dr. Catherine Allaire

Affiliations

University of British Columbia

Timestamps

(00:14) Case Report
(00:32) Approach to Ovarian Endometriomas: Steps 1-6
(01:25 - 05:17) Procedure Video: All Steps
(05:28) Case Continued
(05:43) Summary of Steps

In this educational video from the University of Ottawa, a stepwise approach to laparoscopic cystectomy for ovarian endometriomas is demonstrated on a 37-year-old woman with a history of dysmenorrhea and pelvic pain. The patient, suffering from bilateral endometriomas, was scheduled for conservative surgery due to persistent pain despite suppressive therapy. The procedure aims to provide pain relief and preserve ovarian function.

The surgical process begins with the complete mobilization of the ovary from the pelvic sidewall, followed by the drainage of the ovarian endometrioma. A dilute solution of vasopressin is then injected into the base of the endometrioma to facilitate hydrodissection, enabling the surgeon to develop an avascular plane between the endometrioma and ovarian tissue. This is done using a combination of blunt dissection and limited energy application to minimize damage to normal ovarian tissue. Haemostasis is achieved by suturing the base of the ovary in a purse string fashion, ensuring minimal impact on ovarian reserve.

In some cases, where extensive peritoneal dissection is required, a temporary ovarian suspension is recommended to prevent postoperative adhesion formation. The video emphasizes careful surgical techniques and the use of vasopressin and appropriate suturing methods to optimize outcomes and reduce complications. The surgical findings included stage IV endometriosis with bilateral endometriomas and superficial endometriosis of the posterior cul-de-sac, all of which were successfully excised. This approach demonstrates an effective method for managing ovarian endometriomas while preserving ovarian function.

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