{"paper_id":"453b049c-cf0b-4044-a235-10ce9846acd1","body_text":"OBJECTIVE\nThe objective of this study was to demonstrate effective surgical methods to facilitate laparoscopic salpingo-oophorectomy for tubo-ovarian abscess (TOA) in a patient with a frozen pelvis.\nDESIGN\nThis video article demonstrates various laparoscopic surgical techniques: (1) Blunt dissection using suction-irrigator apparatus and (2) proper use of bipolar electrosurgery devices for dissection and hemostatic applications.\nSETTING\nA sexually inexperienced patient developed a TOA 5 to 6 weeks after she underwent a (hysteroscopic) transcervical resection of endometrial polyp.\nINTERVENTIONS\nA 42-year-old, nulligravid, with no coital experience, developed sudden-onset lower abdominal pain accompanied by fever, 1 week following a hysteroscopic procedure. She endured the symptoms for 6 weeks until finally deciding to seek a consult. A magnetic resonance scan showed a thick-walled left adnexal cyst with marked diffusion restriction and fat stranding. This was signed out as pelvic inflammatory disease (PID) with a left TOA. A broad-spectrum course of antibiotics was given, without any improvement in her symptoms. A sonographic follow-up scan showed no decrease in the lesion size, hence surgical intervention was performed.\nShe underwent laparoscopic adhesiolysis, left salpingo-oophorectomy, appendectomy, and myomectomy [Figure 1 and Video]. The histopathological report showed an ovarian abscess with chronic inflammation of the fallopian tube, myoma uteri, and normal appendix. There were no postoperative complications after this surgery.\nDISCUSSION\nA TOA is a complex infectious mass of the adnexa that most commonly affects sexually active women. It is usually a consequence of PID.[] A TOA may form as an untoward consequence of a hysteroscopic procedure. This adverse outcome is rare, with an incidence rate of about only 0.2%.[]\nIn this case, the patient was sexually inexperienced. Her pelvic abscess was most likely a complication of the hysteroscopic procedure.\nThe decision to perform laparoscopic surgery on this patient versus an open procedure, was based on the following merits of minimally invasive surgery (MIS): (1) Decreased intraoperative blood loss, and consequently, blood transfusions, (2) shorter hospital stay, and (3) faster duration of the surgical procedure.[] With these clear advantages, in mind, we pursued the less invasive surgical route.\nCONCLUSION\nGynecologists who perform hysteroscopy should be aware that there is a real possibility that a patient could develop postprocedural TOA or PID.\nEffective management with antibiotics followed by mandatory surgery prevents the potential risk of morbidity and mortality associated with delayed treatment.\nThere is a clear advantage of MIS over open procedures such as decreased blood loss and transfusion rate, shorter operative times, and decreased length of hospital stay, and as such should be made the first choice in surgically managing TOA cases.\nFinancial support and sponsorship\nNil.\nConflicts of interest\nProf. Kuan-Gen Huang and Dr. Chyi-Long Lee, the editorial board members at Gynecology and Minimally Invasive Therapy, had no roles in the peer review process of or decision to publish this article. The other authors declared no conflicts of interest in writing this paper.\nREFERENCES\n1.\nKairys N, Roepke C. Tubo-ovarian abscess. StatPearls. Treasure Island (FL): StatPearls Publishing; 2022 Available from: https://www.ncbi.nlm.nih.gov/books/NBK448125/. [Last updated on 2022 Jun 21].2.\nSilva F, Silva J, Rocha I, Brito T, Paredes E, Ramalho G, et al. Surgical approach of tubo-ovarian abscesses from theory to our minimally invasive practice. Gynecol Minim Invasive Ther 2015;4:72–5.3.\nTanaka T, Ota Y, Sano R, Shimoya K, Moriya T, Shiota M. Diagnostic laparoscopy for ovarian tumor due to salmonella infection. Gynecol Minim Invasive Ther 2022;11:61–3.4.\nMuzii L, Donato VD, Tucci CD, Pinto AD, Cascialli G, Monti M, et al. Efficacy of antibiotic prophylaxis for hysteroscopy:A meta-analysis of randomized trials. J Minim Invasive Gynecol 2020;27:29–37.5.\nShigemi D, Matsui H, Fushimi K, Yasunaga H. Laparoscopic compared with open surgery for severe pelvic inflammatory disease and Tubo-ovarian abscess. Obstet Gynecol 2019;133:1224–30.6.\nLin CH, Long CY, Huang KH, Lo TS, Wu MP. Surgical trend and volume effect on the choice of hysterectomy benign gynecologic conditions. Gynecol Minim Invasive Ther 2021;10:1–9.7.\nLee CL. Minimally invasive therapy for cancer:It is time to take actions for training system in minimally invasive therapy After LACC report. Gynecol Minim Invasive Ther 2019;8:1–3.8.\nKinay T, Kizilkaya Y, Altinbas SK, Tapisiz OL, Ustun YE. Feasibility and safety of laparoscopic surgery in large ovarian masses. Gynecol Minim Invasive Ther 2022;11:215–20.","source_license":"CC0","license_restricted":false}