Laparoscopy for ovarian endometriomas

Thanks to advances in endoscopic technique and instrumentation, it is possible to remove endometrial cysts by laparoscopy, including total ablation of the cyst capsules. It is difficult to make a clear diagnosis laparoscopically, because some of pathologies have the same appearance (e.g., luteal cysts, follicular cysts). Macroscopically, endometroid cysts are round or elongated. The external surface may be whitish or rust-colored, smooth or covered by adhesions. We analyzed 103 laparoscopic endometrioma resections performed from 1993 to 1995. Laparoscopies consisted of dissection of the ovarian cortex above the cyst, evacuation of cyst contents, cystoscopy, total ablation of its capsule, and bipolar coagulation of its site. Histologically we found endometriosis in 70% of cases, luteal cysts with blood effusion in 20%, follicular cysts in 4%, cysts deprived of epithelial lining in 2%, and serosal cysts in 4%. Unilateral endometriomas were found in 60.9%, and were bilateral in 39.1%. Each patient with a histologically proved diagnosis received danazol 400 to 600 mg/day for 6 to 8 months, and we performed 21 second-look laparoscopies among infertile women after therapy. No adhesion formation was seen. Follow-up was 12 to 14 months after laparoscopy and included vaginal sonography, which showed one (1.28%) recurrence of the ovarian endometrioma.