Laser CO2 Ablation of Endometrioma
When is this procedure indicated?
Laser CO2 ablation of ovarian endometriomas can be perfomed as a valid alternative for the treatement of ovarian endometriotic cysts. This procedure is usually preferred in young women as it is considered a tissue and fertility-sparing procedure. Rather than cystcystectomy which consists in the surgical removal of the endometriosis cyst, the laser CO2 ablation aim to vaporise only the endometriotic cyst lining without a deep damage on the ovarian tissue.
How is it performed?
Throught an operative Laparoscopy, the endometrioma containing ovary is carefully separated from the pelvic side wall often determining the endometriosis cyst rupture . When the ovary was not adherent, an incision over the thinnest part of the ovarian endometriotic surface or on the antimesenteric border is made.
Accurate inspection, drainage, irrigation and aspiration of the cyst cavity is then performed to check for hemostasis and to remove the remaining cyst fluid or blood clots.
After that, the cyst is everted to expose the inner cystic wall completely, which is than completely vaporized with the CO2 fiber laser starting from the center to the periphery in a radial way. A power setting of 13-15 W/cm2 is usually used. Vaporization continues until hemosiderin pigment stained-tissue is no longer visible. No suture is usually placed after vaporization.
Recovery from laser CO2 ablation of ovarian endometriosis is usually short. Patients are dismissed from the hospital in two to three days and are suggested to home rest for more or less a week.