This video demonstrate Laparoscopic Removal of Paraovarian Endometrioma, Ovarian cystectomy. Paraovarian cysts (POCs) are remnants of Wolffian duct in the mesosalpinx that do not arise from the ovary. They account for ~10-20% of adnexal masses. Here Intercede is applied to prevent adhesion. Interceed(TC7) is a fabric composed of oxidized, regenerated cellulose that was designed to reduce the formation of postsurgical adhesions.

Endometriosis is a common gynecological condition characterized by the presence of endometrial tissue outside the uterine cavity. One rare form is paraovarian endometrioma, which develops in the paraovarian region, adjacent to the ovary but separate from it. These cystic lesions can cause chronic pelvic pain, infertility, and menstrual irregularities. Minimally invasive surgery, specifically laparoscopy, has become the gold standard for diagnosis and treatment due to its precision, reduced recovery time, and lower postoperative adhesion rates.

Laparoscopic Approach

Laparoscopic excision of paraovarian endometriomas involves the insertion of a camera and specialized instruments through small abdominal incisions. The steps typically include:

1. Patient Preparation: The patient is placed under general anesthesia, and the abdomen is insufflated with CO₂ to create a working space.

2. Identification of Lesion: The paraovarian cyst is identified and carefully dissected from the surrounding structures, including the ovary, fallopian tube, and pelvic peritoneum.

3. Cyst Excision: The cyst wall is meticulously separated, ensuring complete removal while preserving ovarian tissue and avoiding injury to nearby structures.

4. Hemostasis: Any bleeding points are coagulated or sutured to maintain hemostasis.

Application of Interceed
Interceed is an oxidized regenerated cellulose (ORC) barrier used to prevent postoperative adhesions, a common complication after pelvic surgery. Adhesions can lead to chronic pain, infertility, and bowel obstruction.

After the cyst removal:

• The surgical site is irrigated to remove any residual blood or debris.

• Interceed is applied directly over the exposed tissue surfaces where adhesions are likely to form, including the ovarian fossa and pelvic peritoneum.

• The material is gently pressed to ensure full contact with the tissue and left in place as it naturally absorbs over time.

Advantages of Laparoscopic Excision with Interceed

• Minimally invasive: Reduced postoperative pain and faster recovery compared to open surgery.

• Precision: Better visualization allows complete cyst excision with preservation of healthy ovarian tissue.

• Reduced adhesion formation: Interceed minimizes postoperative adhesions, which is critical for maintaining fertility and preventing chronic pain.

• Short hospital stay: Most patients can go home the same day or after 24 hours.

Postoperative Care

• Patients are usually encouraged to ambulate early to reduce the risk of thrombosis.

• Analgesics and anti-inflammatory medications are prescribed as needed.

• Follow-up imaging may be performed to ensure complete resolution and assess ovarian function.

Conclusion
Laparoscopic removal of paraovarian endometriomas combined with the application of Interceed represents a safe and effective approach to managing this rare form of endometriosis. This method not only ensures complete excision of the cyst but also significantly reduces postoperative complications such as adhesion formation, preserving fertility and enhancing patient recovery. With proper surgical technique and adhesion prevention strategies, outcomes for patients undergoing this procedure are excellent.