47: Pelvic congestion syndrome: A laparoscopic approach

Abstract

The goal of this video is to demonstrate a laparoscopic approach for the management of chronic pelvic pain secondary to pelvic congestion syndrome presented by large tortuous ovarian vessels. Pelvic congestion syndrome is found in 30% of patients complaining of chronic pelvic pain and in who work up reveals no pathologies. Although the etiology of pelvic congestion syndrome is still not clear, multiple treatment modalities are available for the symptomatic patient. Our patient is a 69-year-old patient with one-year history of left lower quadrant pelvic pain. CT abdomen/ pelvis showed congested pelvic vessels on the left side and a small persistent ovarian cyst. Decision was made to perform laparoscopic ligation of the left ovarian veins with concurrent bilateral salpingo-oophorectomy. Laparoscopic high ligation of the ovarian vessels is described. After adequate exposure of the infundibulopelvic ligament and identification of the surrounding structures, the ovarian vein was isolated, sealed, and transected above the pelvic brim. Careful systematic dissection of the pelvic sidewall ensures uncomplicated resection of the congested ovarian venous plexus. Our video demonstrates a minimally invasive approach to pelvic congestion syndrome. The laparoscopic high ligation technique is often chosen when a concurrent gynecologic surgery is required.