Design: Case Report
Setting: Fertility Center - Teaching Hospital
Patients or Participants: The patient is a 36y/o G0P0 female with primary infertility of one-half years duration with no significant surgical or medical history. Her infertility work up was normal except for possible endometriosis. After laparoscopic left salpingo-ovariolysis and right ovariolysis, we utilized a combined technique of endometrioma wall excision, utilizing blunt dissection, and CO2 ablation of the remaining part of the cyst wall. This was followed by temporary suspension of the right ovary and left fallopian tube to the fascia of the anterior abdominal wall to reduce risk of abdominal adhesions.
Interventions: Conservative laparoscopic surgery for stage IV endometriosis
Measurements and Main Results: Postoperative course was uneventful. After the surgery, the patient started her period within 2 weeks and conceived during her subsequent cycle. The pregnancy is ongoing and she is currently at 20 week-gestation.
Conclusion: Combined surgical technique allows the patient to receive benefits of both excision and ablation approaches. This can help achieve excellent pregnancy outcomes in some patients. Further investigation to assess the recurrence rate of endometriomas and effect on ovarian reserve with this combined surgical approach is needed.
Thawani, N*. Women's Health Services, Henry Ford Health, Detroit, MI, Merida, MA. Obstetrics and Gynecology, Hurley Medical Center - Michigan State University College of Medicine, Flint, MI, Joseph, SK. Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates, Youssef, Y. Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, Maimonides Medical Center, Brooklyn, NY, Abuzeid, MI. Department of Women’s Health Services, Henry Ford Health, Center for Reproductive Medicine, Rochester Hills, MI
