LAPAROSKOPI PADA KASUS KISTA ENDOMETRIOSIS BILATERAL
LAPAROSCOPIC TREATMENT OF BILATERAL ENDOMETRIOTIC
CYSTSPowerpoint TemplatesPage #Ultrasound (USG)Presence of diffuse,
low level internal echoesHyperechogenic foci in the wallKissing
ovaries
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Powerpoint TemplatesPage #Confirmed diagnoseVia laparoscopy and
histology
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Powerpoint TemplatesPage #Management of endometriomasHormonal
treatmentSurgery IVF - ETPowerpoint TemplatesPage #Surgical
approach of ovarian endometriosisSurgical approach has to be chosen
:Coagulation of the site of eversionEndometrioma Fenestration and
vaporizationOvarian CystectomyCombined = Cystectomy and
vaporizationPowerpoint TemplatesPage #
Powerpoint TemplatesPage #Ovarian cystectomy by laparoscopyBy
Michel CanisAvoid the opening of the cysts from the anterior part
of the ovaryOpening the cysts must be performed at the attachment
site zone of the cysts which located between the ovary and the
broad ligament
Powerpoint TemplatesPage #1st step : via adhesiolysis (the
separation of the ovary from the broad ligament). During the
adhesiolysis, the cysts will be opened and you will be entered the
cysts.2nd step : performing the opening of the cysts. During
cystectomy, it will be easier to grasp the ovarian cortex.Make sure
both plane of cleavage and blood vassel were visible. Use coagulate
and apply traction and contratraction to avoid severe bleeding
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Powerpoint TemplatesPage #Surgery and ovarian reserveRisk of
removal normal ovarian tissue and ovocytes as endometrioma is
surrounded by a fibrotic capsule (which is an ovarian tissue
reaction)By plane of cleavage can determined the difference in
macroscopic and microscopic levelsPowerpoint TemplatesPage #
Powerpoint TemplatesPage #Surgical approach of ovarian
endometriosisEndometrioma fenestration and ablationEnergyBipolar
coagulationCO2 laserPlasma In one step or three stepsPowerpoint
TemplatesPage #Ablation Cyst wall vaporization = destroyed only the
endometriotic glands and the stromaPowerpoint TemplatesPage #
Powerpoint TemplatesPage #3 steps treatment for large
endometriomaAdhesiolysisAspiration of chocolate fluidVaporization
of peritoneal lessionsMedical therapy GnRHaSecond look
laparoscopyPowerpoint TemplatesPage #Combined excision and
ablationRecommended for very large cysts in bilateral endometriotic
cysts.Partial cystectomy + ablation of the deepest part of the
cystsOne step therapy
Powerpoint TemplatesPage #Excision + ablation : The
StepsIdentified the ovaryThe opening of the attachment between the
ovary and the broad ligamentAfter the separetion from the broad
ligaments, performed cystectomy by grasping the cystsusing traction
and contratraction technique to partially removed the cystsAfter
the cystectomy, performed ablation from the deepest part of the
cysts using CO2 laser Powerpoint TemplatesPage #
Powerpoint TemplatesPage #Endometriotic cysts :
recommandationsPreoperative treatmentPelvic pain : yesInfertility :
no effect on endometrioma sizeLaparoscopyCystectomy or ablation or
combinedHemostasis : selective bipolar coagulationAssociated
lessions : to be treatedAnti adhesion : antacid or dialobaryPost
operative treatmentInfertility : GnRH-analog before IVFPelvic pain
or no desire for pregnancy : OC pill to avoid the
recurrencePowerpoint TemplatesPage #
Powerpoint TemplatesPage #Results of surgery?Pregnancy rate :
60% of patiens obtain spontaneous pregnancy after 9 12 months post
opRisk of recurrence cystectomy = 5 8 %ablation = 12 -22 %
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Powerpoint TemplatesPage #Cystectomy (excisional) vs
ablativeExcisional surgery provides more favourable outcome than
albation with regard to the :Recurrence of endometrioma and
symptoms related to previous problemsSubsequent spontaneous
pregnancyPowerpoint TemplatesPage #Surgery and ovarian reserveBased
on numerous research, indicates :Statistically significant AMH
decrease after ovarian cystectomyOvarian reserve is injured by
surgeryMore reduction of ovarian reserve in women operated for
bilateral cysts
Powerpoint TemplatesPage #IVF outcomes after surgeryIncreased
number of cancelled cyclesDecreased number of follicles, oocytes
and embryosConclusion = IVF outcome significantly impaired after
surgery
Powerpoint TemplatesPage #Surgery in infertility associated to
endometriosisIn infertile women with AFS stage I/II endometriosis,
clinicans should perform operative laparoscopy (excision or
ablation), rather than performing diagnostic laparoscopy only
increase ongoing pregnancy ratesClinicans may consider CO2 laser
vaporization of endometriosis compared to monopolar
electrocoagulation higher cumulative spontaneous pregnancy
ratesPowerpoint TemplatesPage #Clinicans should perform excision of
the endometrioma capsule, instead of drainage and
electrocoagulation of the endometrioma wall increase spontaneous
pregnancy ratesIn infertiloe women with endometriosis, clinians
should not prescribe adjunctive hormonal treatment before or after
surgery may decrease spontaneous pregnancy ratesPowerpoint
TemplatesPage #Thats all folks, thank you for your attentionany
questions?Powerpoint TemplatesPage #
