1. 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 (June 2009)
DOI: /j.fertnstert
Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions

2. 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  , DOI: ( /j.fertnstert )
Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions

3. 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  , DOI: ( /j.fertnstert )
Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions

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

5. 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  , DOI: ( /j.fertnstert )
Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions