Drilling: medical indications and surgical technique

Drilling: indicações e técnica

Cristina Kallás Hueb João Antônio Dias Júnior Maurício Simões Abrão Elias Kallás Filho About the authors

SUMMARY

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.

Keywords:
clomiphene; laparoscopy; anovulation; polycystic ovary syndrome; percussion drilling

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