Ovarian drilling for PCOS
The operation is indicated for anovulatory infertility due to PCOS, when stimulation with clomiphene/letrozole does not lead to ovulation or causes hyperstimulation, as well as before IVF in patients with a high risk of hyperstimulation syndrome. The surgeon uses a needle monopolar electrode or laser to apply 4-6 point effects on each ovary with a depth of 4-8 mm - minimally so as not to damage the reserve; pipes are checked at the same time. Ovulation is restored within 1–3 months for most, the effect lasts 1–3 years; in the absence of independent ovulation, stimulation after drilling becomes effective. The ovarian reserve does not suffer with gentle techniques.
Indications
- polycystic ovary syndrome with anovulation, resistant to stimulation (cautery/drilling);
- large cysts, tumors, endometriomas with destruction of ovarian tissue (resection);
- benign ovarian tumors in peri- and postmenopausal women, torsion with necrosis, tubo-ovarian abscess (oophorectomy, salpingo-oophorectomy);
- prophylactic removal of appendages for hereditary risk (BRCA), as part of the treatment of breast cancer;
- irreversibly changed appendages due to inflammation.
Scope of surgery and ovarian function
The gynecologist selects the smallest sufficient volume: for PCOS - pinpoint cauterization of the cortex to restore ovulation; for a cyst with preserved tissue - cystectomy; for a tumor replacing the ovary, or in menopause, removal of the ovary (oophorectomy) or along with the tube (salpingo-oophorectomy). One remaining ovary completely provides hormonal function and the possibility of pregnancy. Removal of both ovaries before menopause causes surgical menopause and requires replacement therapy unless contraindicated. All removed tissue undergoes histological examination; if malignancy is suspected, urgent examination is performed during surgery.
Benefits of laparoscopy
Laparoscopy is the standard of modern operative gynecology: magnifying the image by 10–15 times allows you to work more accurately than an open operation and is more gentle on the ovarian tissue and tubes, blood loss is minimal, adhesions form less frequently (important for future pregnancy), the pain after the operation is mild, and the patient gets up on the day of the operation and is discharged on the 1st–3rd day; Instead of a cut, three barely noticeable scars remain. In the clinics below, laparoscopic operations are performed by gynecological surgeons with extensive experience on modern endoscopic stands.
Risks and contraindications
- rare complications: bleeding, injury to neighboring organs, infection, thrombosis - prevention and the experience of the surgeon reduce the risk to a minimum;
- contraindications: severe heart and lung diseases, coagulation disorders, severe adhesions after many operations, large tumors (>15–20 cm) - then laparotomy is chosen;
- Obesity and previous operations are not a contraindication, but require an experienced team.
