Endoscopic treatment of advanced endometriosis with large endometriomata. Surgical technique

Abstract

Advanced endometriosis is a common cause of infertility. It has traditionally been treated surgically by laparotomy. The surgeon had to cope mainly with adhesions, endometriotic implants and, quite often, endometriotic cysts of various diameters. In this study, we report our laparoscopic technique for treating advanced endometriosis with large endometriomata, using conventional instrumentation, and we discuss our main problems and our results.

The study population consisted of 68 subfertile patients with large endometriomata who underwent laparoscopic removal of the cysts.

The Infertility Clinic at the Alexandra Maternity Hospital, Athens, Greece, between January 1990 and October 1997.

Laparoscopic excision of endometriotic cysts in subfertile women.

Success of treatment modality; postoperative complications; postoperative cumulative pregnancy rates.

The technique is described. Postoperative complications were minimal. Of the patients, 32 (47%) became pregnant during the 2-year postoperative follow-up period. The estimated cumulative pregnancy rates at 6, 12, 18 and 24 months were 22%, 35%, 45% and 47%, respectively.

Our experience favours the use of traditional laparoscopic tools over laser treatment for the management of extensive endometriosis with endometriomata, since the results are similar to those observed after laser treatment, and the training of a larger number of physicians and availability of equipment are more readily achieved for the former method. Postoperative pregnancy rates are high.