A laparoscopic approach to Nuck’s duct endometriosis Jesus S. Jiménez, M.D., Patricia Barbero, M.D., Alvaro Tejerizo, M.D., Carmen Guillén, M.D., Carol Strate, M.D.  Fertility and Sterility  Volume 96, Issue 2, Pages e103-e105 (August 2011) DOI: 10.1016/j.fertnstert.2011.05.083 Copyright © 2011 American Society for Reproductive Medicine Terms and Conditions

Figure 1 CT performed with intravenous portal contrast. A cystic lesion, which measures 55 mm at its larger axis, is shown. The lesion is located in the upper area of the right groin. The CT image suggests a Nuck’s duct cyst, but other cystic lesions such as lymphangioma cannot be excluded. Parietal peritoneum defect above the internal inguinal ring. This is an indirect hernia form, which courses parallel to the round ligament and develops toward the labia majora. Fertility and Sterility 2011 96, e103-e105DOI: (10.1016/j.fertnstert.2011.05.083) Copyright © 2011 American Society for Reproductive Medicine Terms and Conditions

Figure 2 Cystic structure beginning in the inguinal duct through a defect of the parietal peritoneum in the inguinal internal ring area. Dissection of the internal inguinal ring was performed with bipolar grasper and scissors. Once the duct was opened, the cyst was removed and placed in an extraction bag for its extraction through the hole of the principal trocar (umbilicus level). The extraction is usually performed at the end of the surgery after verification of hemostasis. Fertility and Sterility 2011 96, e103-e105DOI: (10.1016/j.fertnstert.2011.05.083) Copyright © 2011 American Society for Reproductive Medicine Terms and Conditions

Figure 3 After dissection and identification of the abdominal wall structures, the defect of the parietal peritoneum was repaired and a polyurethane mesh placed to reinforce the inguinal internal ring area. The mesh was fixed to the abdominal wall by intracorporeal suturing. Fertility and Sterility 2011 96, e103-e105DOI: (10.1016/j.fertnstert.2011.05.083) Copyright © 2011 American Society for Reproductive Medicine Terms and Conditions