Ovarian cauterization is one of the forms of therapeutic management of patients suffering from polycystic ovary syndrome (PCOS). During ovarian cauterization, electrocoagulation (high temperature) is used to remove pathological cysts in the ovaries.
Ovarian cauterizationis a therapeutic procedure used primarily in the treatment of polycystic ovary syndrome (PCOS). The etiology of the syndrome has not been fully defined.
Genetic predisposition is of great importance. The diagnosis of the disease can be made on the basis of the so-called Rotterdam criteria (min 2 out of 3):
- menstrual disorders in the form of rare or complete absent periods
- hirsutism - abnormal hair appearing in places unusual for women, an example may be the hair above the upper lip or in an advanced form of the disorder - androgenic alopecia, i.e. male pattern baldness. Hirsutism is a manifestation of hyperandrogenization, an excessive amount of androgens - male hormones. Sometimes the concentration of androgens is elevated, but hirsutism is not observed. Therefore, in some situations, hyperandrogenisation may be considered one of the Rotterdam criteria, but without the coexistence of abnormal hair.
- characteristic ultrasound image of the ovaries - numerous enlarged ovaries - over 12. Under normal conditions, during each menstrual cycle, several ovarian follicles are stimulated, but only one of them reaches the largest size, then ruptures and the egg is released. In the case of PCOS, several follicles are stimulated at the same time, but none of them rupture, which means that ovulation does not occur.
In addition to the above-mentioned clinical characteristics of polycystic ovary syndrome, many women suffer from obesity associated with tissue resistance to insulin (in medical terms - insulin resistance), and consequently leading to type 2 diabetes. Due to the anovulatory cycles, there is a problem with fertility. Getting pregnant is very difficult but not impossible. It requires the use of complex therapy - hyperandrogenization can be eliminated through the supply of appropriatemedications, and the overgrown follicles are removed during the cauterization procedure.
How is ovarian cauterization going?
Cauterization of the ovaries does not require opening the abdominal cavity in the first place. It is a minimally invasive method, more and more often performed using the laparoscopic technique.
From the patient's point of view, it is much less traumatizing the tissues and faster convalescence, while for the center performing the procedure, it is much more profitable.
The final cosmetic effect is extremely important. The scars after laparoscopic surgery are small and sometimes imperceptible, which increases the comfort of women, and additionally does not reduce the initial low self-esteem of the patient.
The first stage of the procedure is a standard element of every laparoscopic procedure. To increase the space in the abdominal cavity, pump almost 5 liters of carbon dioxide with a special tube (cannula) inserted around the navel.
Then two symmetrical incisions are made around each of the hip pits.
One of the holes is for introducing the camera, and the other is for mounting the appropriate tool (coagulator) used during the procedure. To expose the surgical field, in this case slide the intestines, place the patient in the Trendelenburg position, so that the pelvis is slightly raised.
This allows the gut loops and net fragments to slide down towards the chest. The actual cauterization procedure involves making small incisions on the surface of the ovary in the immediate vicinity of enlarged ovarian follicles.
Then, using a coagulator operating on the basis of a very high temperature, the procedure of permanent destruction of the bubbles is performed, without the possibility of their re-creation.
Safety of ovarian cauterization
Cauterization of the ovaries performed by laparoscopy is not associated with a high risk of complications. Small tissue traumatization, quick convalescence and a good cosmetic effect are just some of the advantages of laparoscopy, which has recently gained more and more supporters.
Unfortunately, the procedure of permanent thermal destruction of ovarian follicles is associated with faster decay of ovarian function. Sometimes the repeated destruction of ovarian follicles quickly reduces their initial pool, and colloquially speaking, they wear out.
This is probably due to the low precision of the procedure - the coagulator usually does not destroy only pathologically oversized follicles, but in many cases also the adjacent ones, whose growth is completely normal.
Taking theIn turn, the rare complications of the laparoscopic procedure itself include the perforation of the intestinal wall, usually when performing the procedure of inserting the first carbon dioxide cannula, which is done blindly.
Puncture of the intestinal wall leads to intra-abdominal hemorrhage, as well as the evacuation of intestinal bacteria from the intestine, which in turn is associated with bacterial peritonitis, which is a direct life-threatening condition.
Although bleeding during laparoscopy is usually small, it is more difficult to re-arrange the site than in conventional surgery. It requires a great deal of skill and experience of the doctor in handling tools.