Transvaginal endoscopy and small ovarian endometriomas: unravelling the missing link?

S Gordts, Patrick Puttemans, P Puttemans, Sy Gordts, M Valkenburg, Marion Valkenburg, Ivo Brosens, I Brosens, R Campo
Gynecological surgery · 2013 · vol. 11(1) , pp. 3–7 · doi:10.1007/s10397-013-0817-1 · PMID:24611037 · PMC3935096 · W1986399080
article OA: gold CC0 ⤵ 7 in-corpus citations
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Transvaginal hydrolaparoscopy accurately visualizes small ovarian endometriomas, revealing endometrial-like tissue and adhesions that support hypotheses regarding endometriosis and infertility.

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Abstract

The incidence of endometriosis in the infertile female is estimated to be between 20 and 50 %. Although the causal relationship between endometriosis and infertility has not been proven, it is generally accepted that the disease impairs reproductive outcome. Indirect imaging techniques and transvaginal laparoscopy now offer the possibility of an early stage diagnosis. Although it remains debated whether the disease is progressive, treatment in an early stage is recommendable as it carries less risk for ovarian damage, hence premature ovarian failure. Under water, inspection with the technique of transvaginal hydrolaparoscopy (THL) accurately shows the invagination of the ovarian cortex as minimal superficial lesions but with the presence of well-differentiated endometrial like tissue at the base, the lateral walls and especially the inner edges of the small endometrioma. An inflammatory environment is responsible for the formation of connecting adhesions with the broad ligament and lateral wall with invasion of endometrial-like tissue and formation of adenomyotic lesions. In around 50 % of the small endometriomas, adhesiolysis is necessary at the site of invagination with opening of the cyst, to free the chocolate content and hereby recognize the underlying endometrioma. The detailed inspection of these early-stage endometriotic lesions at THL reunites the hypothesis of Sampson with the observation of Hughesdon.

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Condition tags

endometriosisendometriomainfertility

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