Laparoscopic management of endometrioma following ovarian transposition during radical hysterectomy
Article information
Ovarian transposition is typically performed during radical hysterectomy in young premenopausal patients with cervical cancer to prevent ovarian damage caused by adjuvant radiotherapy [1-3]. Some patients may experience pain at the site of ovarian transposition because of functional cysts or benign tumors. A prospective study reported that two patients who underwent ovarian transposition developed benign ovarian cysts that subsequently required oophorectomy [4]. However, predisposing factors for the development of ovarian tumors at previous ovarian transposition sites remain unknown. I encountered a case in which an endometrioma developed at the site of ovarian transposition during a radical hysterectomy. Therefore, I would like to share my experience with laparoscopic surgery for managing endometriomas that develop after ovarian transposition.
In January 2023, I performed laparoscopic radical hysterectomy and transposition of both ovaries in a 41-year-old patient with stage IB1 cervical cancer. After 6 months, the patient complained of pain on the right side of the ovarian transposition site. In August 2023, abdominopelvic computed tomography (APCT) revealed a 5.3 cm cystic lesion anterior to the cecum, possibly associated with ovarian transposition. In September 2023, the patient visited the emergency room with the sudden development of right abdominal pain and was admitted for further evaluation and pain control. APCT showed the newly developed fluid collection in the pelvic cavity and around the cystic lesion anterior to the cecum, raising concerns about the hemoperitoneum associated with the rupture of a hemorrhagic cyst at the ovarian transposition site. After supportive care, the patient’s pain improved, and she was discharged.
In December 2023, she revisited the emergency room because of the sudden development of severe acute abdominal pain. APCT revealed an increased 7.6 cm cyst with septations in the right ovary, raising the suspicion of ovarian cyst torsion or a malignant cystic neoplasm. This led to a decision to perform laparoscopic surgery. During the procedure, I encountered severe adhesions around the right ovarian transposition site and discovered a 7-8 cm endometrioma containing partially ruptured fluid. Consequently, a right oophorectomy was performed following adhesiolysis. Additionally, an appendectomy was performed to prevent the need for reoperation (Supplementary Video 1). The final histological diagnosis confirmed an endometriotic cyst in the right ovary, along with chronic inflammation and fibrosis in the appendix. After surgery, her pain disappeared without the need for further medication such as dienogest or other oral contraceptives.
Surgery is uncommon in patients with tumors at the site of ovarian transposition during radical hysterectomy. Additionally, dense adhesions are unavoidable because the ovary is firmly fixed in its extrapelvic position. However, we found that laparoscopic surgery for endometriomas at the site of ovarian transposition was feasible. We believe that adhesion barrier products may help prevent adhesions after ovarian transposition. I hope that the video will be of great help to you (IRB No. 2024-07-031).
Supplementary Material
Supplementary Video 1.
Laparoscopic management of endometrioma following ovarian transposition.
Notes
CONFLICT OF INTEREST
The author reports no conflict of interest.
FUNDING
This work was supported by the 2024 education, research and student guidance grant funded by Jeju National University.