Laparoscopic Management of Bilateral Endometrioma with Frozen Pelvis at World Laparoscopy Hospital

https://www.laparoscopyhospital.com/SERV01.HTM

Endometriosis is a debilitating condition characterized by the presence of endometrial-like tissue outside the uterus, often resulting in chronic pain, infertility, and the formation of ovarian cysts known as endometriomas. When these cysts occur bilaterally and are accompanied by a frozen pelvis—a condition where dense adhesions immobilize pelvic organs—surgical management becomes significantly more challenging. At World Laparoscopy Hospital, we specialize in advanced laparoscopic techniques to manage these complex cases, providing patients with the highest standards of care.

Preoperative Assessment
Clinical Evaluation:

Detailed patient history and comprehensive physical examination to understand the extent of symptoms, such as severe dysmenorrhea, chronic pelvic pain, and infertility.
Pelvic examination to assess the degree of adhesions and organ involvement.
Imaging Studies:

Transvaginal ultrasound (TVUS) as the initial imaging modality to evaluate the presence and size of endometriomas.
Magnetic Resonance Imaging (MRI) for detailed anatomical mapping, crucial for surgical planning.
Laboratory Tests:

Measurement of CA-125 levels to support the diagnosis, although not specific to endometriosis.
Surgical Planning
Multidisciplinary Approach:

Collaboration with specialists including gynecologic oncologists, colorectal surgeons, and urologists to address complex adhesions and involvement of multiple pelvic organs.
Detailed preoperative discussion with the patient regarding the surgical plan, potential risks, benefits, and expected outcomes.
Patient Preparation:

Bowel preparation to enhance intraoperative visualization and reduce the risk of bowel injuries.
Preoperative counseling to set realistic expectations and discuss postoperative recovery.
Surgical Technique
Port Placement:

Utilization of a supraumbilical port as the primary entry point to provide optimal access and visualization of the pelvic cavity.
Placement of additional ports under direct vision to avoid injury to surrounding structures.
Adhesiolysis:

Initial focus on meticulous dissection and separation of adhesions using blunt and sharp techniques, combined with advanced energy devices to minimize tissue damage.