Surgical treatment of ovarian endometriomas: state of the art?

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Presentation transcript:

Surgical treatment of ovarian endometriomas: state of the art? Pascale Jadoul, M.D., Michio Kitajima, M.D., Ph.D., Olivier Donnez, M.D., Jean Squifflet, M.D., Ph.D., Jacques Donnez, M.D., Ph.D. Fertility and Sterility Volume 98, Issue 3, Pages 556-563 (September 2012) DOI: 10.1016/j.fertnstert.2012.06.023 Copyright © 2012 American Society for Reproductive Medicine Terms and Conditions

Figure 1 Photomicrograph of ovarian cortex. (Masson's trichrome staining.) (A) In this sample obtained from a contralateral healthy ovary, numerous follicles are present. (B) In this sample from an ovary with an endometrioma, cortex-specific stroma have disappeared and been replaced with fibrosis. Follicles are absent in this specimen. Fertility and Sterility 2012 98, 556-563DOI: (10.1016/j.fertnstert.2012.06.023) Copyright © 2012 American Society for Reproductive Medicine Terms and Conditions

Figure 2 Endometrioma cystectomy. The inner lining of the cyst is stripped from the normal ovarian tissue. The arrows shows limit between the ovarian cortex and cyst wall. Fertility and Sterility 2012 98, 556-563DOI: (10.1016/j.fertnstert.2012.06.023) Copyright © 2012 American Society for Reproductive Medicine Terms and Conditions

Figure 3 Laser vaporization of endometrioma wall. The interior wall of the cyst is vaporized with a CO2 laser to destroy the mucosal lining of the cyst. Fertility and Sterility 2012 98, 556-563DOI: (10.1016/j.fertnstert.2012.06.023) Copyright © 2012 American Society for Reproductive Medicine Terms and Conditions

Figure 4 Combined technique. When approaching the hilus, where the ovarian tissue is more functional and the plane of cleavage less visible, resection of the dissected tissue is performed. Fertility and Sterility 2012 98, 556-563DOI: (10.1016/j.fertnstert.2012.06.023) Copyright © 2012 American Society for Reproductive Medicine Terms and Conditions

Figure 5 Combined technique. A CO2 laser is used to vaporize the remaining 10% to 20% of the endometrioma close to the hilus. Fertility and Sterility 2012 98, 556-563DOI: (10.1016/j.fertnstert.2012.06.023) Copyright © 2012 American Society for Reproductive Medicine Terms and Conditions