Reconstruction of the ovary containing large endometriomas by an extraovarian endosurgical technique

Objective: To describe and evaluate the surgical treatment of large ovarian endometriomas by an extraovarian endosurgical technique. Design: Prospective case series study. Setting: University center and tertiary referral center for endoscopic surgery. Patients: Patients with large ovarian endometriomas. Intervention: A two-step endosurgical procedure: the first step is a combined diagnostic and operative procedure confirming the diagnosis and preparing the involution of the pseudocyst and the second step includes adhesiolysis and superficial coagulation of the inverted cortex. Main Outcome Measures: Operative findings and recurrence of endometriomas in the operated ovaries. Results: Sixteen patients presenting with 20 large typical ovarian endometriomas were operated using the two-step endosurgical technique. Both steps were performed on 18 endometriomas. One patient with bilateral endometriomas refused the second endoscopic procedure. The long-term follow-up showed no recurrence in the 18 ovaries that were treated by the two-step endoscopic technique. Conclusions: The two-step extraovarian endosurgical technique can be applied in large typical endometriomas to reconstruct the ovary without excision and is followed by a low recurrence rate.