Laparoscopic Endometrioma Excision Using Hydrodissection with Dilute Vasopressin

Abstract

<h3>Study Objective</h3> To demonstrate the surgical technique of hydrodissection with dilute vasopressin for laparoscopic endometrioma excision. <h3>Design</h3> A narrated stepwise video demonstration of surgical technique. <h3>Setting</h3> Academic Hospital, demonstrated by an experienced surgeon trained in minimally invasive gynecologic surgery. <h3>Patients or Participants</h3> Two patients with infertility and stage 4 endometriosis. Both with large bilateral endometriomas. Desiring to preserve and improve fertility. <h3>Interventions</h3> We perform laparoscopic excision of large endometriomas using hydrodissection with dilute vasopressin (20 units in 100-200cc). Vasopressin is injected with a laparoscopic injection needle into the potential space between the endometrioma wall and ovarian capsule. This technique helps to develop the correct surgical plane while decreasing blood loss and tissue trauma. The ovarian capsule is dissected off the cyst using blunt dissection and traction-countertraction techniques, with a goal of minimal use of electrocautery and maximum preservation of healthy ovarian follicles. <h3>Measurements and Main Results</h3> Both cases resulted in complete excision of bilateral endometriomas with minimal blood loss and exceptional hemostasis at the conclusion of the procedure. <h3>Conclusion</h3> Hydrodissection with dilute vasopressin is a simple and effective method for decreasing blood loss during laparoscopic excision of endometriomas. This method helps decrease use of electrocautery and potential thermal spread to surrounding viable ovarian follicles.