Endocoagulation of endometrioid heterotopia - Causes, symptoms and treatment. MF.

Endokoagulyatsiya - a method of thermal destruction of foci of endometriosis is used as an independent method for treating external genital endometriosis or as a step in combination with hormonal treatment: combined estrogen-progestational drugs, gestagenic, antigonadotropic drugs.

The safest and most gentle method of thermal destruction of endometrioid heterotopia is endocoagulation by the method of Zemma, carried out at a temperature of 90-100 ° C.

To endocoagulation of the foci of endometriosis should be started after a thorough examination of all available surface of the pelvic organs and parietal peritoneum, detection and fixation of all visible foci of endometriosis and all suspicious areas, determining the extent of endometrial transmission.

The optimal days of the menstrual cycle for endoscopic diagnosis of external genital endometriosis is the late luteal phase and the first days after the end of menstruation.

When performing laparoscopy on other days of the menstrual cycle, when the foci of endometriosis are not so clearly visible, and also in doubtful cases, it is recommended to perform a so-called "thermo-color test".Heated to 100 ° C the working end of the endocoagulant is slowly carried out in suspicious areas. In this case, the healthy peritoneum acquires a white color as a result of the burn, and endometriotic heterotopies become brown or black due to the content of hemosiderin and other products of hemoglobin degradation. Fresh hemorrhages remain red, only the intensity of the color changes. Before the beginning of the procedure of endocoagulation, it is necessary to clarify the depth of the lesion, how much the foci of endometrioid growths located on the parietal peritoneum and the peritoneum covering the bottom of the bladder and other organs are soldered to the underlying tissues, especially in the areas of the projection of large vessels and ureters. To do this, Zemma biopsy forceps or atraumatic forceps grab a fold of the peritoneum next to the affected area and, lifting it, is displaced in different directions. With the germination of the underlying tissues, the affected areas almost do not move relative to the subperitoneal tissue and are raised with it.

With endometriosis of the ureter wall, endocoagulation of these areas should not be performed.

Coagulation of the foci of endometriosis, located on the wall of the intestine, should also be refrained, since endometriotic growths of this localization tend to germinate the muscular layer of the intestinal wall very early.

It should be remembered that a biopsy of the endometriosis foci for the purpose of histological confirmation of the diagnosis should be made only in doubtful cases, since it is established that the visual endoscopic picture is sufficient for the diagnosis of external genital endometriosis.

A biopsy of the foci of external genital endometriosis is performed with the help of two instruments as follows:

The atma traumatic forceps or biopsy Forceps grasp the peritoneum in the immediate vicinity of the lesion and raise it so that a fold of the peritoneum forms. At the top of the fold, a scar with endometrial overgrowth will be located. Introduced through the second operating trocar, Frankenheim biopsy forceps grab the apex of the peritoneum containing the endometriosis focus in such a way as to capture all the layers of the endometrioid formation and bite off. The edges of the formed peritoneum defect with the purpose of destruction of the remaining endometrioid tissue are carefully coagulated with a point coagulator at a temperature of 100-120 ° C.

In order to destroy all visible endometriotic lesions, endocoagulation of the endometriosis foci is produced successively in all areas of the peritoneum, From the anteromed space, clockwise. It is best to perform destruction using a point endocoagulant. Coagulation is carried out tightly touching the lesion focus with the coagulator on. Slowly stroking the working part of the endocoagulant, coagulate the affected surface on the entire area of ​​the heterotopy and receding 2-3 mm beyond its limits. It should be remembered that at a temperature of 100-120 ° C for 10 seconds, tissue coagulation occurs at a depth of about 1 mm. Endometrioid lesions of the uterosacral ligaments often penetrate into tissues to a considerable depth. Considering this, it is necessary to produce endocoagulation of the growths to their full depth. If it is impossible to penetrate the end of the point endocoagulant into the hearth, the surface layer can be cut with scissors.

In paracervical or retrocervical location of endometrioid heterotopia with a large number of deep-lying tumoral formations, it is recommended to excise these formations in a vaginal way under the control of a laparoscope, which almost completely eliminates trauma to the rectum.

The removal of endometrioid ovarian cysts is technically performed as well as the removal of other retention cysts and is described in the section "Enucleation of ovarian cysts".

Surgical treatment of endometrioid lesions of the wall of the small or large intestine, appendix is ​​carried out by laparotomy in the presence of indications for surgical treatment.