Laparoscopic management of endometrioma following ovarian transposition during radical hysterectomy

Copyright © 2025 Jeju National University Institute for Medical Science Articles published in JMLS are Open Access, distributed under the terms of the Creative Commons Attribution-Noncommercial License (https://creativecommons.org/ licenses/by-nc/4.0/). eISSN: 2671-4922 Journal of Medicine and Life Science Vol. 22, No. 1, 28-29, January 2025 https://doi.org/10.22730/jmls.2025.22.1.28 Laparoscopic management of endometrioma following ovarian transposition during radical hysterectomy Chul Min Park Department of Obstetrics & Gynecology, Jeju National University College of Medicine, Jeju, Republic of Korea Key words:Ovary; Transposition; Endometriosis Received : August 12, 2024 Revised : October 24, 2024 Accepted : October 28, 2024 Correspondence to Chul Min Park Department of Obstetrics & Gynecology, Jeju National University College of Medicine, 15 Aran 13-gil, Jeju 63241, Republic of Korea Tel: 82-64-754-8169 Fax: 82-64-717-1131 E-mail: [email protected] LetterJournal of Medicine and Life Science Ovarian transposition is typically performed during rad - ical hysterectomy in young premenopausal patients with cervical cancer to prevent ovarian damage caused by adju - vant radiotherapy. 1-3 Some patients may experience pain at the site of ovarian transposition because of functional cysts or benign tumors. A prospective study reported that two patients who underwent ovarian transposition developed benign ovarian cysts that subsequently required oophorec - tomy. 4 However, predisposing factors for the development of ovarian tumors at previous ovarian transposition sites remain unknown. I encountered a case in which an endome- trioma developed at the site of ovarian transposition during a radical hysterectomy. Therefore, I would like to share my experience with laparoscopic surgery for managing endo - metriomas that develop after ovarian transposition. In January 2023, I performed laparoscopic radical hys - terectomy and transposition of both ovaries in a 41-year-old patient with stage IB1 cervical cancer. After 6 months, the patient complained of pain on the right side of the ovarian transposition site. In August 2023, abdominopelvic comput- ed tomography (APCT) revealed a 5.3 cm cystic lesion ante- rior to the cecum, possibly associated with ovarian transpo- sition. In September 2023, the patient visited the emergency room with the sudden development of right abdominal pain and was admitted for further evaluation and pain control. APCT showed the newly developed fluid collection in the pelvic cavity and around the cystic lesion anterior to the cecum, raising concerns about the hemoperitoneum asso - ciated with the rupture of a hemorrhagic cyst at the ovarian transposition site. After supportive care, the patient’s pain improved, and she was discharged. In December 2023, she revisited the emergency room because of the sudden development of severe acute abdom- inal pain. APCT revealed an increased 7.6 cm cyst with Ovary transposition 29 https://medsci.jejunu.ac.kr/ Chul Min Park e-jmls.org septations in the right ovary, raising the suspicion of ovar - ian cyst torsion or a malignant cystic neoplasm. This led to a decision to perform laparoscopic surgery. During the procedure, I encountered severe adhesions around the right ovarian transposition site and discovered a 7-8 cm endome- trioma containing partially ruptured fluid. Consequently, a right oophorectomy was performed following adhesiolysis. Additionally, an appendectomy was performed to prevent the need for reoperation (Supplementary Video 1). The final histological diagnosis confirmed an endometriotic cyst in the right ovary, along with chronic inflammation and fi - brosis in the appendix. After surgery, her pain disappeared without the need for further medication such as dienogest or other oral contraceptives. Surgery is uncommon in patients with tumors at the site of ovarian transposition during radical hysterectomy. Addi- tionally, dense adhesions are unavoidable because the ova - ry is firmly fixed in its extrapelvic position. However, we found that laparoscopic surgery for endometriomas at the site of ovarian transposition was feasible. We believe that adhesion barrier products may help prevent adhesions after ovarian transposition. I hope that the video will be of great help to you (IRB No. 2024-07-031). CONFLICT OF INTEREST The author reports no conflict of interest. FUNDING This work was supported by the 2024 education, research and student guidance grant funded by Jeju National University. ORCID Chul Min Park, https://orcid.org/0000-0001-9338-9972 REFERENCES 1. Covens AL, van der Putten HW, Fyles AW, Leung PM, O'Brien PF, Murphy KJ, et al. Laparoscopic ovarian transposition. Eur J Gynae- col Oncol 1996;17:177-82. 2. Bisharah M, Tulandi T. Laparoscopic preservation of ovarian function: an underused procedure. Am J Obstet Gynecol 2003;188:367-70. 3. Moawad NS, Santamaria E, Rhoton-Vlasak A, Lightsey JL. Lapa- roscopic ovarian transposition before pelvic cancer treatment: ovar- ian function and fertility preservation. J Minim Invasive Gynecol 2017;24:28-35. 4. Pahisa J, Martínez-Román S, Martínez-Zamora MA, Torné A, Cap- arrós X, Sanjuán A, et al. Laparoscopic ovarian transposition in patients with early cervical cancer. Int J Gynecol Cancer 2008;18:584-9.