Operative transvaginal hydrolaparoscopy of a large ovarian endometrioma

Objectives The purpose of this case report is to describe the feasibility of transvaginal underwater surgery for reconstruction of the ovary with a large endometrioma. Design Descriptive study. Setting Tertiary referral centre for reproductive medicine. Interventions Transvaginal hydrolaparoscopy and bipolar surgery were used as the techniques for access and surgery of a large ovarian endometrioma. Results A two-step procedure was performed with the first step under general anaesthesia and the second under conscious sedation. Transvaginal hydrolaparoscopy allowed easy access, bloodless dissection of the adhesions and marsupialization and coagulation of the endometrioma. Conclusions The report proves the feasibility of reconstruction of the ovary with a large endometrioma using the new technique of transvaginal hydrolaparoscopy. The technique has the advantage of easy access to the endometrioma and accurate dissection and coagulation of adhesions. The low morbidity makes a two-step technique more acceptable to the patient.