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Laparoscopic sclerotherapy for an endometrioma in 10 steps
Adrien Crestani1, Benjamin Merlot1, Thomas Dennis1
1IFEMEndo, Clinique Tivoli-Ducos, Bordeaux, France.
Objective:
To present 10 consecutive, standardized, and reproducible surgical steps for laparoscopic sclerotherapy of an endometrioma.
Design:
Step-by-step video demonstration of the technique. Local institutional review board approval was not required for this video because patients cannot be identified.
Setting:
Endometriosis Center.
Patient(S):
Women with an endometrioma >50 mm with deep endometriosis lesions, symptomatic, and wishing to conceive.
Intervention(S):
Ethanol sclerotherapy for an endometrioma may be performed following 10 steps. Step 1 takes place preoperatively and consists of a rigorous selection of the patient to eliminate malignant tumors. Step 2 consists of the preparation of the material by preparing the required volume of alcohol. Step 3 consists of an exploration of the peritoneal cavity to eliminate the presence of peritoneal carcinosis. Step 4 is the puncture of the cyst, which may be direct via a 5 mm trocar or after the intraabdominal opening of the cyst; then aspiration of its contents in Step 5. Step 6 is flushing the cyst with a Ringer's lactate solution. In Step 7, the surgeon fills the cavity with a 96% alcohol solution. Step 8 consists of exposure for 10 to 15 minutes while the surgeon continues to operate. In Step 9, the surgeon extracts out all the alcohol from the cyst and cleans the peritoneal cavity. Step 10 consists of removal of the area not exposed to alcohol to treat this portion and obtain a histologic diagnosis.
Main Outcome Measure(S):
Description of 10 successive surgical steps.
Result(S):
A video presenting 10 surgical steps to perform sclerotherapy of an endometrioma during endometriosis surgery.
Conclusion(S):
Laparoscopic sclerotherapy for an endometrioma is a rapid and accessible method. The standardization of this technique by this 10-step video should allow the surgeon to consider it as an alternative to cystectomy to preserve the ovarian reserve.
