An effective "water injection"-assisted method for excision of ovarian endometrioma by laparoscopy.

OBJECTIVE: To introduce an effective approach for excision of ovarian endometrioma by "water injection"-assisted laparoscopy treatment. DESIGN: Step-by-step video explanation of the surgical procedure with still pictures and surgical video clips to demonstrate the detailed technique, approved by the Shengjing Hospital of China Medical University. SETTING: Hospital. PATIENTS: A 26-year-old young woman diagnosed with a 6 cm in diameter right ovarian cyst, who endured 5 years of dysmenorrhea. INTERVENTIONS: The "water injection"-assisted laparoscopic excision of ovarian endometrioma consists of five steps: rupture the ovarian endometrial cyst and remove the "chocolate fluid;" inject the "water" (diluted vasopressin solution) into the interface between endometrioma and ovarian parenchyma; stop injecting until the solution overflow; separate the endometrioma away from the ovarian parenchyma; and suture the ovary. MAIN OUTCOME MEASURES: Value and feasibility of "water injection"-assisted laparoscopic excision of ovarian endometrioma. RESULTS: The "water injection"-assisted laparoscopic excision of ovarian endometrioma was feasible and effective. In the follow-up period, the patient did not report any symptom of dysmenorrhea; and the sex hormone and antimüllerian hormone tests reached to normal levels. CONCLUSION: Our surgical approach demonstrated several noteworthy advantages. After "water injection", the endometrioma and ovarian parenchyma was easily distinguished and separated. The approach avoided normal ovarian tissue destruction during endometrioma separation. The utilization of diluted vasopressin solution might decrease bleeding of ovarian wound. Considering its simplicity of realization, our surgical approach should be promoted to more reproductive-age patients.