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Rev Assoc Med Bras (1992). 2015 Nov-Dec;61(6):530-5. doi: 10.1590/1806-9282.61.06.530.

Drilling: medical indications and surgical technique.

Author information

1
Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
2
Hospital Sírio Libanês, São Paulo, SP, Brazil.
3
Faculdade de Direito do Sul de Minas, Pouso Alegre, MG, Brazil.

Abstract

INTRODUCTION:

anovulation is a major cause of female infertility, and polycystic ovary syndrome (PCOS) is the leading cause of anovulation. While undergoing drug-induced ovulation, women with PCOS usually have a satisfactory response recruiting follicles, but some are unable to recruit follicles or often produce an excessive number of follicles, which can result in ovarian hyper-stimulation syndrome and/or multiple pregnancy. Surgical laparoscopy with ovarian "drilling" may prevent or reduce the need for drug-induced ovulation.

OBJECTIVE:

to identify the current indications of laparoscopic ovarian drilling and the best surgical technique.

METHOD:

a review of the medical literature based on systematic search in the Medline, Lilacs and Cochrane databases, using as keywords laparoscopy, polycystic ovary syndrome, and drilling.

RESULTS:

we found 105 articles in the literature, 27 of these highly relevant, describing findings on ovarian drilling.

CONCLUSION:

laparoscopic drilling is indicated for patients with polycystic ovary syndrome with ovulatory resistance to the use of clomiphene citrate, body mass index less than 30 kg/m2 and preoperative luteinizing hormone above 10 IU/L. The preferred surgical technique should be the realization of 5 to 10 perforations on the surface of each ovary bilaterally using monopolar energy.

PMID:
26841163
DOI:
10.1590/1806-9282.61.06.530
[Indexed for MEDLINE]
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