Laparoscopic Salpingo-oophorectomy for Recurrent Endometrioma: A Comprehensive Video Overview скачать в хорошем качестве

Laparoscopic Salpingo-oophorectomy for Recurrent Endometrioma: A Comprehensive Video Overview

Introduction Endometriosis is a chronic gynecological condition characterized by the presence of endometrial-like tissue outside the uterus, often leading to the formation of endometriomas, particularly in the ovaries. Recurrent endometriomas can cause significant pain, infertility, and diminished quality of life for affected women. Salpingo-oophorectomy, the surgical removal of one or both ovaries and fallopian tubes, is a definitive treatment option for recurrent endometriomas, especially when other treatments have failed. Indications for Salpingo-oophorectomy Salpingo-oophorectomy is typically considered for patients with recurrent endometriomas under the following circumstances: Persistent or Severe Pain: When conservative management, including medical therapy and less invasive surgeries, fails to alleviate pain. Infertility: In cases where recurrent endometriomas impair fertility and other fertility-preserving options are not viable. Risk of Malignancy: Although rare, there is a slight risk of malignant transformation in long-standing endometriomas. Patient Choice: Women who have completed their families and prefer a definitive solution to recurrent endometriomas. Preoperative Evaluation A thorough preoperative evaluation is crucial for optimal outcomes. This includes: Detailed History and Physical Examination: Assessing the extent of symptoms, previous treatments, and surgeries. Imaging Studies: Ultrasound and MRI to evaluate the size, location, and extent of endometriomas and to rule out malignancy. Laboratory Tests: Including CA-125 levels, although not specific, can provide additional information. Counseling: Discussing the benefits, risks, and implications of the surgery, including the potential need for hormone replacement therapy (HRT) if bilateral oophorectomy is performed. Surgical Technique Salpingo-oophorectomy for recurrent endometrioma can be performed via laparoscopic or robotic-assisted techniques, both offering minimally invasive approaches with quicker recovery times compared to open surgery. Laparoscopic Salpingo-oophorectomy Anesthesia and Positioning: General anesthesia is administered, and the patient is positioned in a dorsal lithotomy position. Port Placement: Typically, a supraumbilical port is used for the camera, along with additional ports for the instruments. Adhesiolysis: Careful dissection to free the ovaries and fallopian tubes from adhesions, which are common in endometriosis. Ovary and Tube Removal: The affected ovary and tube are mobilized, ligated, and removed using an endoscopic retrieval bag to prevent spillage. Hemostasis and Inspection: Ensuring adequate hemostasis and inspecting the pelvic cavity for any remaining endometriotic lesions. Robotic-Assisted Salpingo-oophorectomy Robotic assistance can enhance precision, particularly in complex cases with extensive adhesions. The steps are similar to the laparoscopic approach, with the added advantage of improved dexterity and visualization provided by the robotic system. Postoperative Care Postoperative care includes pain management, early ambulation, and monitoring for complications such as infection or bleeding. If bilateral oophorectomy is performed, HRT may be initiated to manage menopausal symptoms, unless contraindicated. Outcomes and Prognosis Salpingo-oophorectomy generally provides significant relief from pain and other symptoms associated with recurrent endometriomas. However, it is important to consider the long-term implications, particularly the impact on hormonal balance and potential need for HRT. Fertility preservation discussions should be held with reproductive-age women before surgery. Conclusion Salpingo-oophorectomy is a valuable option for managing recurrent endometriomas, offering definitive relief from symptoms when other treatments fail. A multidisciplinary approach, thorough preoperative evaluation, and meticulous surgical technique are essential for optimal outcomes. Patient education and counseling play a crucial role in decision-making, ensuring that women are fully informed about the benefits and risks of the procedure. References Nezhat, C., et al. (2020). "Surgical treatment of endometriosis: a global perspective." Best Practice & Research Clinical Obstetrics & Gynaecology. Johnson, N. P., & Hummelshoj, L. (2013). "Consensus on current management of endometriosis." Human Reproduction. Contact us World Laparoscopy Hospital Cyber City, Gurugram NCR Delhi, India World Laparoscopy Training Institute Bld.No: 27, DHCC, Dubai, UAE World Laparoscopy Training Institute 5401 S Kirkman Rd Suite 340 Orlando, FL 32819, USA