Endometriosis Clinical Trial
Official title:
Combined Mini Laparotomy With Laparoscopy Appraoch for Management of Endometrioma
Under general anaesthesia, the patient is placed in the modified dorsal lithotomy position a
10-mm umbilical trocar is inserted. A panoramic view of the pelvis was obtained together with
full assessment of the ovarian mass(es).
Aspiration of the cyst:
Veress needle is inserted in the midline 2 cm above the symphysis pubis to aspirate the cyst
under laparoscopic guidance (to guide the entry of the needle into the cyst wall & to confirm
complete aspiration).
Delivery of affected ovary outside the abdominal cavity:
Classic ovarian cystectomy will be done using microsurgical techniques in which the cyst wall
will be dissected gently and carefully from the healthy ovarian tissue followed by perfect
haemostasis and re-fashioning of the remaining ovarian tissue using Vicryl (3-0) sutures.
Re-introduction of the ovary to inside the abdominal cavity:
The stitched ovary is pushed gently inside the abdominal cavity and the minilaparotomy is
re-covered by the rubber shield (to allow re-inflation of the abdominal cavity). The ovary is
reassessed under laparoscopic guidance to ensure perfect haemostasis and normal position of
the ovary. Pelvic irrigation is done if needed.
Under general anaesthesia, the patient is placed in themodified dorsal lithotomy position (to
ensure lax anterior abdominal wall). The patient is thenprepped and draped in the usual
fashion for an abdominaland vaginal procedure. In non- virgin patients, vaginal speculum is
inserted into thevagina to expose the cervix, a uterine manipulator is inserted in the cervix
followed by placement of a Foley's catheter in thebladder. As regards port placement, a 10-mm
umbilical trocar is inserted. A panoramic view of the pelvis was obtained together with full
assessment of the ovarian mass(es).
Aspiration of the cyst:
Veress needle is inserted in the midline 2 cm above the symphysis pubis to aspirate the cyst
under laparoscopic guidance (to guide the entry of the needle into the cyst wall & to confirm
complete aspiration).
Delivery of affected ovary outside the abdominal cavity:
A transverse mini-laparotomy is done (2-3 cm) in the midline 2 cm above the symphysis pubis.
A long shanks artery forceps is introduced inside the abdominal cavity (to grasp the affected
ovary) under laparoscopic guidance. Then, the artery is pulled gently to the outside to
deliver the ovary at the minilaparotomy skin incision. Careful handling and traction is
applied to avoid injury of both the ovarian tissue or/andinfundibulopelvic ligament.
Following the delivery of the ovary, the abdominal incision is temporary closed using
(Eshaped 10 x 10 cm) rubbershield (to avoid any soiling of abdominal cavity with blood or
cystic fluid & give the chance to reinflate the abdominal cavity later on).
Ovarian cystectomy:
Classic ovarian cystectomy will be done using microsurgical techniques in which the cyst wall
will be dissected gently and carefully from the healthy ovarian tissue followed by perfect
haemostasis and re-fashioning of the remaining ovarian tissue using Vicryl (3-0) sutures.The
stitched ovary is pushed gently inside the abdominal cavity and the minilaparotomy is
re-covered by the rubber shield (to allow re-inflation of the abdominal cavity). The ovary is
reassessed under laparoscopic guidance to ensure perfect haemostasis and normal position of
the ovary. Pelvic irrigation is done if needed
;
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