Objective: To assess the attributes and feasibility of conservative laparoscopic surgery for patients with ruptured ovarian endometrioma.
Design: Retrospective analysis.
Setting: University medical center.
Patient(s): Eighteen patients undergoing laparoscopic surgery at our institution between January, 2005 and December, 2008 for presumed ovarian endometrioma rupture.
Intervention: Laparoscopy.
Measurements and Key Findings: Of 792 patients undergoing laparoscopic surgery for ovarian endometrioma, rupture occurred preoperatively in 18 (2.3%), with a median age of 32 years. Eight were right-sided lesions and 10 were left-sided. Five patients were actively menstruating, four were in follicular phase, and six were in luteal phase. Rupture followed GnRH agonist treatment in three instances. Laparoscopic surgery was performed within 24 hours for most, with exception of one patient who received a six-month course of GnRH agonist, postponing surgical intervention. Concurrent cystectomy was elected in 16 patients to preserve fertility. In the other two, treatment was limited to irrigation only (due to severe inflammation), with the option of delayed cystectomy following medical (GnRH agonist) management.
Conclusions: Rupture of ovarian endometrioma is an infrequent event, requiring emergency surgery, but conservative laparoscopic intervention is a viable approach for preservation of fertility.

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Objective: To evaluate the identification of influential factors for physician's choice of laparoscopic and open surgery against benign ovarian tumor during pregnancy.
Design: We conducted the retrospective comparative analysis of 10 laparoscopic and 7 open surgeries for ovarian tumors performed during pregnancy in our hospital between April 2003 and March 2010 by clinical records. The laparoscopic surgery was performed under general anesthesia, either with intra-peritoneal or trans-peritoneal technique.
Results: Statistical analysis revealed the following factors were significantly different between laparoscopic surgery and open surgery (p<0.05): gestational date, operation time, surgeon type (specialist for laparoscopy vs. no specialist), anesthesia technique, post operative hospitalization, and post operative pain. No patient encountered complications during the intra- and post-operative periods. All outcome of the pregnancy was normal.
Conclusion: We confirmed that the laparoscopic surgery for ovarian tumor is useful and safe even during pregnancy. For elective laparoscopic surgery, we recommend to perform the operation around 12-week gestation for its easy feasibility and the safety for gravid uterus and fetus.

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