laparoskopi pada kasus kista endometriotic bilateral

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Laparoskopi Pada Kasus Kista Endometriotic Bilateral



LAPAROSCOPIC TREATMENT OF BILATERAL ENDOMETRIOTIC CYSTSPowerpoint TemplatesPage #Ultrasound (USG)Presence of diffuse, low level internal echoesHyperechogenic foci in the wallKissing ovaries

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Powerpoint TemplatesPage #Confirmed diagnoseVia laparoscopy and histology

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Powerpoint TemplatesPage #Management of endometriomasHormonal treatmentSurgery IVF - ETPowerpoint TemplatesPage #Surgical approach of ovarian endometriosisSurgical approach has to be chosen :Coagulation of the site of eversionEndometrioma Fenestration and vaporizationOvarian CystectomyCombined = Cystectomy and vaporizationPowerpoint TemplatesPage #

Powerpoint TemplatesPage #Ovarian cystectomy by laparoscopyBy Michel CanisAvoid the opening of the cysts from the anterior part of the ovaryOpening the cysts must be performed at the attachment site zone of the cysts which located between the ovary and the broad ligament

Powerpoint TemplatesPage #1st step : via adhesiolysis (the separation of the ovary from the broad ligament). During the adhesiolysis, the cysts will be opened and you will be entered the cysts.2nd step : performing the opening of the cysts. During cystectomy, it will be easier to grasp the ovarian cortex.Make sure both plane of cleavage and blood vassel were visible. Use coagulate and apply traction and contratraction to avoid severe bleeding

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Powerpoint TemplatesPage #Surgery and ovarian reserveRisk of removal normal ovarian tissue and ovocytes as endometrioma is surrounded by a fibrotic capsule (which is an ovarian tissue reaction)By plane of cleavage can determined the difference in macroscopic and microscopic levelsPowerpoint TemplatesPage #

Powerpoint TemplatesPage #Surgical approach of ovarian endometriosisEndometrioma fenestration and ablationEnergyBipolar coagulationCO2 laserPlasma In one step or three stepsPowerpoint TemplatesPage #Ablation Cyst wall vaporization = destroyed only the endometriotic glands and the stromaPowerpoint TemplatesPage #

Powerpoint TemplatesPage #3 steps treatment for large endometriomaAdhesiolysisAspiration of chocolate fluidVaporization of peritoneal lessionsMedical therapy GnRHaSecond look laparoscopyPowerpoint TemplatesPage #Combined excision and ablationRecommended for very large cysts in bilateral endometriotic cysts.Partial cystectomy + ablation of the deepest part of the cystsOne step therapy

Powerpoint TemplatesPage #Excision + ablation : The StepsIdentified the ovaryThe opening of the attachment between the ovary and the broad ligamentAfter the separetion from the broad ligaments, performed cystectomy by grasping the cystsusing traction and contratraction technique to partially removed the cystsAfter the cystectomy, performed ablation from the deepest part of the cysts using CO2 laser Powerpoint TemplatesPage #

Powerpoint TemplatesPage #Endometriotic cysts : recommandationsPreoperative treatmentPelvic pain : yesInfertility : no effect on endometrioma sizeLaparoscopyCystectomy or ablation or combinedHemostasis : selective bipolar coagulationAssociated lessions : to be treatedAnti adhesion : antacid or dialobaryPost operative treatmentInfertility : GnRH-analog before IVFPelvic pain or no desire for pregnancy : OC pill to avoid the recurrencePowerpoint TemplatesPage #

Powerpoint TemplatesPage #Results of surgery?Pregnancy rate : 60% of patiens obtain spontaneous pregnancy after 9 12 months post opRisk of recurrence cystectomy = 5 8 %ablation = 12 -22 %

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Powerpoint TemplatesPage #Cystectomy (excisional) vs ablativeExcisional surgery provides more favourable outcome than albation with regard to the :Recurrence of endometrioma and symptoms related to previous problemsSubsequent spontaneous pregnancyPowerpoint TemplatesPage #Surgery and ovarian reserveBased on numerous research, indicates :Statistically significant AMH decrease after ovarian cystectomyOvarian reserve is injured by surgeryMore reduction of ovarian reserve in women operated for bilateral cysts

Powerpoint TemplatesPage #IVF outcomes after surgeryIncreased number of cancelled cyclesDecreased number of follicles, oocytes and embryosConclusion = IVF outcome significantly impaired after surgery

Powerpoint TemplatesPage #Surgery in infertility associated to endometriosisIn infertile women with AFS stage I/II endometriosis, clinicans should perform operative laparoscopy (excision or ablation), rather than performing diagnostic laparoscopy only increase ongoing pregnancy ratesClinicans may consider CO2 laser vaporization of endometriosis compared to monopolar electrocoagulation higher cumulative spontaneous pregnancy ratesPowerpoint TemplatesPage #Clinicans should perform excision of the endometrioma capsule, instead of drainage and electrocoagulation of the endometrioma wall increase spontaneous pregnancy ratesIn infertiloe women with endometriosis, clinians should not prescribe adjunctive hormonal treatment before or after surgery may decrease spontaneous pregnancy ratesPowerpoint TemplatesPage #Thats all folks, thank you for your attentionany questions?Powerpoint TemplatesPage #