An effective “water injection”-assisted method for excision of ovarian endometrioma by laparoscopy

An effective approach for excision of ovarian endometrioma by “water injection”-assisted laparoscopy treatment was introduced to avoid normal ovarian tissue destruction during endometrioma separation.

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Volume 112, Issue 3, Pages 608–609

Authors:

Ning-Ning Zhang, M.D., Tian-Shui Sun, M.D., Qing Yang, Ph.D.

Abstract:

Objective

To introduce an effective approach for excision of ovarian endometrioma by “water injection”-assisted laparoscopy treatment.

Design

Step-by-step video explanation of the surgical procedure with still pictures and surgical video clips to demonstrate the detailed technique, approved by the Shengjing Hospital of China Medical University.

Setting

Hospital.

Patients

A 26-year-old young woman diagnosed with a 6 cm in diameter right ovarian cyst, who endured 5 years of dysmenorrhea.

Interventions

The “water injection”-assisted laparoscopic excision of ovarian endometrioma consists of five steps: rupture the ovarian endometrial cyst and remove the “chocolate fluid;” inject the “water” (diluted vasopressin solution) into the interface between endometrioma and ovarian parenchyma; stop injecting until the solution overflow; separate the endometrioma away from the ovarian parenchyma; and suture the ovary.

Main Outcome Measures

Value and feasibility of “water injection”-assisted laparoscopic excision of ovarian endometrioma.

Results

The “water injection”-assisted laparoscopic excision of ovarian endometrioma was feasible and effective. In the follow-up period, the patient did not report any symptom of dysmenorrhea; and the sex hormone and antimüllerian hormone tests reached to normal levels.

Conclusion

Our surgical approach demonstrated several noteworthy advantages. After “water injection”, the endometrioma and ovarian parenchyma was easily distinguished and separated. The approach avoided normal ovarian tissue destruction during endometrioma separation. The utilization of diluted vasopressin solution might decrease bleeding of ovarian wound. Considering its simplicity of realization, our surgical approach should be promoted to more reproductive-age patients.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

1 Comments

Go to the profile of Kobra Tahermanesh
Kobra Tahermanesh 11 months ago

Dear authors,


We did appreciate the nice video article entitled: An effective "water injection" assisted method for excision of ovarian endometrioma by laparoscopy [1]. We would like to bring to attention two pertinent points:


Despite the excellent effect of vasopressin on reducing bleeding during surgery, normal saline without vasopressin can also be used for hydro dissection of ovarian cysts [2, 3]. The reason for avoiding vasopressin is a concern about its peripheral and local vasoconstriction effects, especially on ovarian vessels [4]. This effect can last 20 to 40 minutes which can lead to temporary ovarian ischemia and probably ovarian function impairment [4, 5].


We also note that the hydro dissection technique is not an efficient removal technique for all types of endometriomas [6]. In our experience, it would be successful when these two conditions are met: 1-There exists some normal ovarian tissue beneath the deepest part of the cyst, in such a way that there is no wide sclerotic attachment to the ovary beyond the floor of the cyst wall. Thick sclerosis would withstand hydrostatic pressure and make it ineffective. 2-In contrast to the benefits of not having sclerotic attachments at the base of the cyst, having some at the opening of endometrioma is useful. Sclerotic adhesion between the cyst wall and cortex in this area provides for a good seal and prevents liquid leakage during hydro dissection. So, it is helpful that the thin sclerotic edges of the opening not be dissected or trimmed before hydro dissection so as to avoid escape of the hydrostatic fluid.



References


1.            Zhang, N.-N., T.-S. Sun, and Q. Yang, An effective “water injection”-assisted method for excision of ovarian endometrioma by laparoscopy. Fertility and sterility, 2019. 112(3): p. 608-609.


2.            Alammari, R. and E. Greenberg, Hydrodissection Technique in Bilateral Ovarian Cystectomy for Dermoid Cysts. Journal of minimally invasive gynecology, 2015. 22(6): p. S144.


3.            Saeki, A., et al., The vasopressin injection technique for laparoscopic excision of ovarian endometrioma: a technique to reduce the use of coagulation. Journal of minimally invasive gynecology, 2010. 17(2): p. 176-179.


4.            Chudnoff, S., S. Glazer, and M. Levie, Review of vasopressin use in gynecologic surgery. Journal of minimally invasive gynecology, 2012. 19(4): p. 422-433.


5.            Kathiresan, A., et al., Vasopressin and tourniquets: a comparison of blood loss in patients undergoing abdominal myomectomies. Fertility and Sterility, 2008. 90: p. S458.


6.            Farrimond, F., et al., Laparoscopic excision of type I and type II endometriomas. Fertility and Sterility, 2017. 108(3): p. e388-e389.