Bilateral Ovarian Endometriomas Research Articles

Effect of Vasopressin Injection Technique in Laparoscopic Excision of Bilateral Ovarian Endometriomas on Ovarian Reserve: Prospective Randomized Study

Study ObjectiveTo evaluate the effects of vasopressin injection technique in laparoscopic cystectomy on ovarian reserve in patients with bilateral endometriomas. DesignRandomized prospective study (Canadian Task Force classification I). SettingUniversity hospital. PatientsEighty-six women with bilateral endometriomas. InterventionsLaparoscopic cystectomy of bilateral endometriomas was performed using different techniques including laparoscopic cystectomy by stripping without injection (control group), laparoscopic cystectomy by stripping with injection of saline solution (saline group), and laparoscopic cystectomy by stripping with vasopressin injection technique (VIT group). Measurements and Main ResultsThe number of coagulation events on the ovarian cortex for hemostasis was counted in different groups, and the thickness of ovarian tissues removed was measured. The basal follicle-stimulating hormone (FSH) level was determined before surgery and at 3-, 6-, and 12-month follow-up after laparoscopic cystectomy in the different groups. In the saline group, fewer coagulation events were required to achieve hemostasis, less ovarian tissues were removed, and lower preoperative FSH levels were detected than in the control group (p < .01). In the VIT group, even fewer coagulation events (p < .01) and lower preoperative FSH levels (p < .01) were detected than in the saline group. There was no significant difference in the thickness of ovarian tissues removed in the 2 groups (p > .05). Basal FSH levels were significantly different before and after surgery in the control and saline groups (p < .01) but not in the VIT group (p > .05). ConclusionVasopressin injection is an ideal procedure to reduce damage from usual laparoscopic cystectomy of bilateral ovarian endometriomas to protect ovarian reserve.

Hemostasis by Bipolar Coagulation Versus Suture After Surgical Stripping of Bilateral Ovarian Endometriomas: A Randomized Controlled Trial

Study objectiveTo estimate whether the suture of the ovary is superior to bipolar coagulation in preserving ovarian reserve in infertile women undergoing laparoscopic stripping of bilateral endometriomas. DesignRandomized controlled trial (Canadian Task Force classification I). SettingUniversity teaching hospital. Patients100 patients with bilateral endometriomas. InterventionsPatients underwent stripping of bilateral endometriomas and were randomized to undergo hemostasis by use of either laparoscopic suturing (LS group) or bipolar coagulation (BC group). Changes in ovarian reserve were investigated by measuring the levels of anti-Mullerian hormone (AMH) and basal follicle-stimulating hormone (FSH) before surgery and at 3, 6 and 12 months from surgery. Measurements and Main ResultsAt 3-month, 6-month, and 12-month follow-up, in both study groups, postsurgical AMH levels were significantly lower and basal FSH levels were significantly higher than before surgery. There was no significant difference in the mean percentage decrease of AMH levels in the BC group and LS group at 3-, 6-, and 12-month follow-up. The mean percentage increase in basal FSH was higher in the BC group than in the LS group at both 3-month (p = .023) and 6-month follow-up (p = .029), but not at 12-month follow-up. Pregnancy rate, time to conception, and rate of endometrioma recurrence was similar in the 2 study groups. ConclusionLaparoscopic stripping of ovarian endometriotic cyst significantly decreases serum AMH levels and increases basal FSH levels independent from the method used to obtain hemostasis on the ovarian tissue.

Villar’s Nodule: Umbilical Endometriosis in a Patient With Stage IV Endometriosis and Previous Umbilical Hernia Repair

J Obstet Gynaecol Can 2012;34(2):123 A 45-year-old woman was brought to the operating room for surgical management of bilateral ovarian endometriomas and fibroid uterus. A lesion arising from her umbilicus had been previously thought to be a keloid from a remote umbilical hernia repair (Figure 1). This lesion was excised during the midline laparotomy, and the final pathology revealed seborrheic keratosis infiltrated by endometriosis (Figure 2). The patient underwent an abdominal hysterectomy and bilateral salpingooophorectomy for severe endometriosis.

Bilateral Ovarian Endometriomas Presenting as Nonprogress of Labor: First Case Report in the Literature Is Concomitant Surgical Excision during Cesarean Section Advisable?

Objective. To report the first case of bilateral ovarian endometriomas, leading to nonprogress of labour, successfully excised during cesarean section. Design. Case report. Setting. Department of Obstetrics & Gynecology of Dr. RPGMC Tanda, Kangra, India. Patients. A primigravida in labour at term gestation. Interventions. Surgical management. Main Outcome Measures. Description and treatment of a pregnant woman with bilateral ovarian endometriomas during cesarean section. Results. Successful excision of ovarian endometriomas and reconstruction of the ovaries during cesarean section. Conclusion. Management of incidentally detected endometriomas during cesarean section should be individualized, taking into account the symptoms, size, bilaterality, and adhesion with adjacent organs.

Case Reports: Two Successful Pregnancies Following Robotic Resection of Stage IV Endometriosis

Successful term pregnancies following surgical management of Stage IV endometriosis is reported between 4-10%. PubMed and the Cochrane Review showed no publications on successful pregnancies following robotic enhanced pelviscopy for the treatment of Stage IV endometriosis. Case reports of 2 patients. Patients of a solo private practice with surgery at a community hospital. MS is a 20 year old G0 diagnosed laparoscopically with stage 1 endometriosis that was ablated. KW is a 29 year old G2P1Ab1 diagnosed laparoscopically with Stage IV endometriosis and no operative management performed. MS was started on OCs but developed worsening pelvic pain and bilateral ovarian complex masses. Repeat laparoscopy demonstrated Stage IV endometriosis with appendiceal involvement. She later consented to daVinci assisted pelviscopy with resection of bilateral ovarian endometriomas, and obliterated cul-de-sac and appendectomy. KW was treated with 6 months of Depot Lupron with no change in the size of the endometriomas and pelvic pain continued. Pelviscopy was done with drainage of bilateral ovarian endometriomas and limited pelvic adhesiolysis due to the obliterated cul-de-sacs. She was retreated with 6 more months of Depot Lupron. Two years later, she still had not conceived, her pelvic pain increased, and the endometriomas returned. KW then underwent daVinci assisted resection of the obliterated cul-de-sac and bilateral ovarian endometriomas. Also performed were lysis of bilateral peritubal adhesions, a left neosalpingotomy, and uterine suspension. MS conceived 3 months postoperatively and delivered at term. KW used OCs for 6 months, then conceived 1 year postoperatively and then delivered at term. With robotics, the superior optics and maneuverability allow for more extensive and thorough dissection with minimal morbidity; and a better way of helping patients cope with the difficulties of endometriosis and achieving pregnancies.

Effects of ovarian endometrioma on embryo quality

The proportions of good, fair, and poor embryos in 13 women with bilateral endometriomas were compared with those of 39 women without endometriomas and were found to be similar (47.2% vs. 41.1%, 28.3% vs. 32.8%, and 24.3% vs. 26.0%, respectively). Therefore, it appears that the presence of bilateral endometriomas during IVF treatment is not associated with reduced embryo quality.

Intrapartum uterine rupture associated with a scarred cervix because of a previous rupture of cystic cervical endometriosis

Endometriosis is defined as the growth of ectopic endometrial tissue beyond the uterine cavity. The incidence of endometriosis has been reported to range from 4% to 17% in all women of reproductive age. The most commonly reported presentations of endometriosis are dysmenorrhea, dyspareunia, pelvic pain, and infertility. Most endometrial deposits are confined to the pelvis but extrapelvic endometriosis has also been occasionally documented in the literature [1]. Cervical endometriosis is an uncommon and generally asymptomatic condition. We report an extremely rare case of intrapartum uterine rupture through the scar of the previously ruptured cystic cervical endometriosis. A 33-year-old nulliparous woman visited our clinic in 2003 because of lower abdominal pain. She had a history of laparoscopic cystectomy because of bilateral ovarian endometriomas in 2000. Dysmenorrhea recurred 2 years after the operation. Transvaginal sonography at our clinic revealed a homogeneous cyst measuring approximately 3 cm 4 cm over the posterior endocervix (Fig. 1). Abdominal sonography showed a fluidfilled cervical cyst. The patient presented at our emergency department a few hours after her initial visit to our clinic because of lower abdominal pain and persistent vaginal bleeding. She denied having undergone sexual intercourse or trauma before the vaginal bleeding began. Speculum examination revealed a ruptured cystic lesion approximately 2 cm 2 cm with active bleeding over the posterior lip of the cervix (5-o’clock direction) near the vaginocervical junction without extending to the external orifice of the cervix. Chocolate-like fluid also flowed out from the wound, and cervical endometriosis was suspected. We removed the fragile cyst wall

Bilateral Herniation of the Ovaries into the Anterior Compartment of the Pelvis

A 41-year-old woman had a 6-month history of pelvic pain and heavy periods. She had no significant gynecologic or surgical history. Pelvic ultrasonography revealed a large complex cyst measuring 5.1 ! 5.4 ! 5.4 cm within the right adnexa (Fig. 1). CA 125 was minimally increased at 44. During laparoscopy, both ovaries were found to have herniated through the broad ligament into the anterior compartment. The round and ovarian ligaments had their usual attachments to the uterus. Bilateral ovarian cysts were observed, both approximately 5 cm in greatest diameter. The right ovary was densely adherent to the pelvic side wall. No other pelvic or upper abdominal disease was noted. A perioperative diagnosis of bilateral ovarian endometrioma was made. Laparoscopic right salpingo-oophorectomy and left ovarian cystectomy were performed with the ovaries in their abnormal location. Histologic analysis confirmed endometriotic cyst in the right ovary and hemorrhagic corpus luteum in the left ovary. Defects in the broad ligament can be congenital or acquired. Acquired defects can result from pelvic surgery, pregnancy, or pelvic inflammatory disease. Although herniation of bowel through the broad ligament has been described [1–4], to our knowledge, there are no reports of bilateral ovarian herniation through defects of the broad ligament.

Vaporization of ovarian endometrioma using plasma energy: histologic findings of a pilot study

In ten ovarian endometriomas of diameter exceeding 30 mm, managed by complete vaporization of the inner surface using plasma energy followed by cystectomy, we performed histologic evaluation of the depth of necrosis and the effectiveness of endometrial tissue ablation. We observed that plasma energy allows the ablation of endometrial tissue with minimal damage to the ovarian parenchyma, which suggests that this technique might be of particular interest for women with risk factors of postoperative ovarian reserve impairment, such as recurrent and bilateral endometriomas.

Successful Laparoscopic Resection of Noncommunicating Rudimentary Uterine Horn and Bilateral Ovarian Endometrioma with Severe Adhesion

Successful Laparoscopic Resection of Noncommunicating Rudimentary Uterine Horn and Bilateral Ovarian Endometrioma with Severe Adhesion

Tubo-Ovarian Abscess (TOA) Due to Bilateral Ovarian Endometriomas: Conservative Treatment to Retain Fertility-A Case Report

Objective: To report a case of TOA from bilateral ovarian endometriomas and discuss how fertility may be preserved.Case: A 37-year-old gravida 1/para 0 female underwent treatment for infertility for seven years. Her initial laparoscopy, at age 31, disclosed bilateral ovarian endometriomas (stage IV endometriosis according to the revised classification of the American Society for Reproductive Medicine [r-ASRM]). Ultrasound-guided transvaginal endometrioma aspirations were done on four occasions, and more than 10 attempts at intrauterine insemination (IUI) failed. At age 35, she also developed pelvic inflammatory disease (PID) two days following an IUI procedure. Antibiotics were given and the infected ovarian cysts aspirated. However, the condition became episodic, so laparoscopic intervention with transvaginal ultra-sound guided aspiration was elected to withdraw pus. Once recovered, 10 poststimulatory eggs were harvested. She subsequently conceived with in vitro fertilization (IVF), and a healthy baby was finally delivered vaginally.Conclusions: Up to 25% of infertility patients have ovarian endometriomas. If PID develops, antibiotics are clearly indicated; but surgical drainage of pus may still be needed. We routinely give preservation of fertility high priority, using minimally invasive laparoscopy and transvaginal, ultrasound-guided aspiration. Ovarian function was thus retained for this patient, despite TOA and repeated endometrioma infections.

Ovarian Endometrioma Associated with Very High Serum CA-125 Levels

The magnitude of the elevation is important and levels &gt; 200 U/ml are potentially associated with ovarian malignancies, whereas slight increases in levels were associated with benign gynecologic conditions. However, serum CA-125 levels &gt; 1000 U/ml have also been reported in patients with endometriosis. Herein, the authors report an additional case of high levels of CA-125 in large unruptured endometrioma. We present a patient with moderate sized bilateral ovarian endometrioma who was undergoing laparotomy and who had CA-125 levels of 3782 U/mL. Our case further emphasizes that very high levels of CA-125 are not always associated with malignant disease and no critical cutoff value for CA-125 is diagnostic of malignancy.

Pain and ovarian endometrioma recurrence after laparoscopic treatment of endometriosis: a long-term prospective study

To identify prognostic factors for pain and endometrioma recurrence after complete laparoscopic excision of endometrioma(s). Prospective observational study. Tertiary care university hospital. One-hundred sixty-six consecutive women affected by uni- or bilateral ovarian endometrioma(s). Laparoscopic conservative treatment of endometriosis. Patient demographic characteristics, surgical findings, and surgical results were prospectively recorded. Postoperative follow-ups were carried out every 3 months to identify pain and/or endometrioma recurrence for a minimum of 3 years. Dysmenorrheal, dyspareunia, and chronic pelvic pain recurred in 14.5%, 6%, and 5.4% of women, respectively. Prior surgery for endometriosis, adhesion extension, and use of ovarian stimulation drugs (OSD) were unfavorable prognostic factors for pain symptoms. Ovarian endometrioma recurred in 9.6% of cases; negative factors were prior surgery for endometriosis, OSD, pelvic adhesions, and high American Society for Reproductive Medicine disease scores. Postoperative pregnancy showed a significant protective effect on pain and disease recurrences. Prior surgery, presence of adhesions, and ovulation drugs are negative prognostic factors. Pregnancy has a protective effect on disease and pain recurrence.

IVF-ICSI outcome in women operated on for bilateral endometriomas

The influence of previous conservative surgery for endometriomas on IVF-ICSI outcome is debated. Conflicting information emerging from the literature may be consequent to the fact that endometriomas are mostly monolateral. The contralateral intact ovary may adequately supply for the reduced function of the affected one. To clarify this point, we assess IVF-ICSI outcome in women operated on for bilateral endometriomas. Women selected for IVF-ICSI cycles who previously underwent bilateral endometriomas cystectomy were matched (1:2) for age and study period with patients who did not undergo prior ovarian surgery. Sixty-eight cases and 136 controls were recruited. Women operated on for bilateral endometriotic ovarian cysts had a higher withdrawal rate for poor response (P < 0.001). In these patients, despite the use of higher doses of gonadotrophins, the number of follicles (P = 0.006), oocytes retrieved (P = 0.024) and embryos obtained (P = 0.024) were significantly lower. The clinical pregnancy rate per started cycle in cases and controls was 7% and 19% (P = 0.037) and the delivery rate per started cycle was 4% and 17%, respectively (P = 0.013). IVF outcome is significantly impaired in women operated on for bilateral ovarian endometriomas.

Laparoscopic neurolysis of the pelvic sciatic nerve in a case of catamenial footdrop

Isolated cases of cyclic sciatica associated with endometriosis have been reported since the 1940s. Surgical intervention, either by laparoscopy for lesions within the pelvis or by open procedures for extrapelvic lesions, has usually been performed. A 37-year-old woman with catamenial footdrop and pain of the right thigh came to our observation. Previously, she underwent laparoscopy for bilateral ovarian endometriomas. In a second laparoscopy, we removed her uterosacral right ligament and recto-vaginal endometriotic nodules. After a temporary improvement, a third surgical procedure was necessary: laparoscopic neurolysis to free the sciatic nerve from fibrotic tissue. Then the patient was treated with gonadotropin-releasing hormone analogs for 6 months, and she is free of symptoms 2 years after last surgery. This is the first described case of laparoscopic neurolysis of the proximal sciatic nerve. The procedure has been successful in treating a patient with endometriosis in whom the cause of the syndrome was probably due to entrapment of the nerve in fibrous tissue.

Rupture of a noncommunicating rudimentary uterine horn pregnancy with a combined intrauterine pregnancy

The second known case is documented of a combined intrauterine pregnancy and ruptured noncommunicating rudimentary uterine horn pregnancy. the patient was a 37-year old gravida 2 para 1 with unremarkable obstetric history except for preterm delivery of her previous pregnancy. At her first visit at 13 weeks gestation the ultrasound scan showed a twin pregnancy compatible with dates in 2 separated uterine cavities and a left ovarian cyst 4 cm in diameter. Hematocrit was 35.7%. She was followed in the high risk antenatal clinic. At 15 weeks she had severe pelvic pain and epigastric distress. On exam she was restless and markedly pale with cold extremities a blood pressure of 60/p and pulse of 120. Her abdomen was markedly distended with guarding and rigidity. Her cervix was normal her uterus was not palpable and the cul-de-sac was bulging. Hematocrit was 24%. On laparotomy the peritoneum contained 4000 ml fluid and a ruptured right noncommunicating rudimentary uterine born pregnancy of 6 x 6 cm was attached to the right hemi-uterus by a pedicle. A 90 gm fetus was free in the abdominal cavity. She also had bilateral ovarian endometriomas of 3 and 4 cm in diameter. After hysterectomy and bilateral ovarian cystectomy she recovered uneventfully. Rupture of a blind uterine born usually occurs in the second trimester causing fetal death and high maternal morbidity or mortality if not extirpated immediately.