Stephan Gordts, M. D. , Sylvie Gordts, M. D. , Patrick Puttemans, M. D

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Transvaginal hydrolaparoscopy in the treatment of polycystic ovary syndrome Stephan Gordts, M.D., Sylvie Gordts, M.D., Patrick Puttemans, M.D., Marion Valkenburg, M.D., Rudi Campo, M.D., Ivo Brosens, M.D., Ph.D. Fertility and Sterility Volume 91, Issue 6, Pages 2520-2526 (June 2009) DOI: 10.1016/j.fertnstert.2008.04.020 Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions

Figure 1 (A) The specially developed needle–trocar system consists of three parts: a spring load needle, a dilating trocar, and an outer trocar that allows the passage of the optic once the trocar is in place. The spring-load system allows quick access to the pouch of Douglas (K. Storz, Tüttlingen, Germany); (B) the 2.9-mm, 30° endoscope; (C) the metal obturator that allows one to replace the diagnostic trocar by the operative trocar; (D) the operative trocar with a 5 Fr working channel and an outer diameter of 5.6 mm; (E) the 5 Fr bipolar cutting and coagulation needle (K. Storz) with a diameter of 0.19–0.20 mm and a free (noninsulated) length of 8 mm (see insert). Fertility and Sterility 2009 91, 2520-2526DOI: (10.1016/j.fertnstert.2008.04.020) Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions

Figure 2 Technique of drilling the ovarian capsule via transvaginal laparoscopy with a 5 Fr bipolar needle. (A) Positioning of the bipolar needle perpendicular to the ovarian surface; (B) entering the ovarian capsule by a short burst of cutting power, after stopping the flow of saline and without any mechanical force; (C) coagulating the underlying stroma during 10–15 seconds; (D) end result of the capsule drilling. Fertility and Sterility 2009 91, 2520-2526DOI: (10.1016/j.fertnstert.2008.04.020) Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions

Figure 3 Flow sheet of the treatments. Fertility and Sterility 2009 91, 2520-2526DOI: (10.1016/j.fertnstert.2008.04.020) Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions

Figure 4 Second-look transvaginal laparoscopic images of ovaries that were drilled 8 months earlier: only filmy nonconnecting adhesions are seen that cover the ovarian surface only locally, with some neovascularization inside the adhesions. Fertility and Sterility 2009 91, 2520-2526DOI: (10.1016/j.fertnstert.2008.04.020) Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions