Laparoscopic Ovarian Wedge Resection and Ovarian Drilling - Dr. R.K. Mishra

Laparoscopic Ovarian Wedge Resection and Ovarian Drilling

Drilling of the polycystic ovary is a common procedure performed laparoscopically. Polycystic disease of the ovary has various manifestations but its hallmark is chronic anovulation. Ovarian wedge resection is advocated for these enlarged ovaries. However, there is a chance of returning to previous inoculators state is quite high after several months. There is also an increased risk of adhesion formation after laparoscopic ovarian wedge resection.

As with ovarian wedge resection, laparoscopic laser drilling eliminates a portion of the central or stroma of the ovary. And while it can be effective, several studies have shown that the burning of the surface of the ovary with the laser leads to adhesion formation.

Laparoscopic Ovarian Wedge Resection and Ovarian Drilling
Laparoscopic Ovarian Wedge Resection and Ovarian Drilling

Availability of ovulation-inducing medicines clomiphene citrate around the 1970s has offered nonsurgical management of this disease. Initially, wedge resection of the polycystic ovary was tried but later laparoscopic ovarian drilling appears to be associated with comparable rates of ovulation and conception.

Theoretically wedge resection of the ovary and ovarian drilling work by reducing androgen production by ovarian stroma. Ideal patient of ovarian wedge resection or ovarian drilling are women who fail to ovulate after 3 to 4 months treatment with clomiphene citrate. The laparoscopic technique uses a 5 mm or 10 mm umbilical port for telescope and 5 mm port in the left iliac fossa or suprapubic region.

With the help of one atraumatic grasper, one ovary is kept held by a utero-ovarian ligament. At laparoscopy, multiple symmetrically placed holes are made over subcapsular follicular cystic stroma. Polycystic drilling generally does not bleed like physiological follicular cyst following incision. Each ovary is treated symmetrically and cysts are vaporized. The ovaries are irrigated and hemostasis is obtained by the help of bipolar forceps.

If aspiration needle is used for monopolar drilling 30 to 40-watt current is used in a cutting mode. The power is activated just before touching the ovary and it should be penetrated at 4 to 8 sites at a depth of 4 mm.

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