Topic - Ovarian Endometrioma; Lupron and Laparoscopy

Question:
My right ovary is overtaken by endometriosis, in fact my right ovary is 3-4 times larger than my uterus.
My Dr. wants to remove the right ovary. He states that this can not be accomplished through laparoscope. He seems to think I can try the use of Lupron to shrink the ovary for the possibility of taking the ovary with the laparoscope. Do you feel Lupron would be appropriate in this situation? I appreciate any info. you can send my way. Have a great day!

Answer:
The first part of your question is rather to remove the entire ovary or the endometrioma (endometriosis cyst of the ovary). Removal of the ovary eliminates the possibility of endometriosis recurring in the ovary as long as all of the ovarian tissue is removed. (If there are adhesions around the ovary this can be more difficult than it would seem) Often the endometrioma including the cyst wall can be removed and the ovary preserved. The larger the endometrioma, the more difficult it is to preserve some of the ovary. Depending upon your age, desire to have children and the health of your other ovary all play into the decision rather to leave the ovary or take it out. One remaining healthy ovary will usually provide normal hormone production and fertility.

Laparoscopy vs Laparotomy. The most important issue in how to approach the surgery is what happens at the tissue level. In otherwords what is going to give the best chance at removing all of the disease. Some surgeons are more comfortable with Laparotomy, personally I prefer a laparoscopic approach, which with rare exception is the way that I perform the surgery

Some surgeons will use Lupron preoperatively to try to shrink the size of the disease. I personally do not like Lupron. I think it is a fairly crude approach to treatment where the side effects and potential risks outweigh the potential benefits. As discussed elsewhere in this web site endometriosis can produce its own estrogen and is way Lurpron may not work. I would personally like to have the disease active, since it is easier to see. I fell comfortable getting all of the endometriosis out and thus trying to shrink is not a big deal for me. I am concerned that use of Lurpon preoperatively may reduce some color and thus make it harder it see. If this happens I think there is a higher chance of disease being left behind. On the other hand it is not all that unusual for surgeons to use Lupron preoperatively. I just like this approach myself.

In summary, the most important issue is complete removal of disease. Second whether to remove an ovary and whether to do the surgery laparoscopically.