11658 Fertility Preservation in Patients With a Large Endometrioma: Combined Laparoscopic Technique

Document Type

Conference Proceeding

Publication Date

11-14-2024

Publication Title

J Minim Invasive Gynecol

Abstract

Study Objective: To demonstrate a combined technique of partial excision of endometrioma cyst wall and CO2 laser ablation of the remaining cyst wall that was adhered to the hilum. Design: Case Report. Setting: Fertility Center - Teaching Hospital. Patients or Participants: The patient is a 36y/o G0P0 female with primary infertility of one-half years duration with no significant surgical or medical history. Her infertility work up was normal except for possible endometriosis. After laparoscopic left salpingo-ovariolysis and right ovariolysis, we utilized a combined technique of endometrioma wall excision, utilizing blunt dissection, and CO2 ablation of the remaining part of the cyst wall. This was followed by temporary suspension of the right ovary and left fallopian tube to the fascia of the anterior abdominal wall to reduce risk of abdominal adhesions. Interventions: Conservative laparoscopic surgery for stage IV endometriosis. Measurements and Main Results: Postoperative course was uneventful. After the surgery, the patient started her period within 2 weeks and conceived during her subsequent cycle. The pregnancy is ongoing and she is currently at 20 week-gestation. Conclusion: Combined surgical technique allows the patient to receive benefits of both excision and ablation approaches. This can help achieve excellent pregnancy outcomes in some patients. Further investigation to assess the recurrence rate of endometriomas and effect on ovarian reserve with this combined surgical approach is needed.

Volume

31

Issue

11

First Page

S99

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