ABSTRACT
There is considerable controversy over the pathogenesis as well as the surgical management of ovarian endometriomas.1 In 1957 Hughesdon suggested that bleeding from endometriotic implants on the posterior surface of the ovary caused the ovary to adhere to the peritoneum of the ovarian fossa.2 Subsequent bleeding into the space enclosed by the adhesions prevents the escape of the blood and results in the invagination of the ovarian cortex as the endometrioma enlarges (Figures 14.1 and 14.2). If this hypothesis is correct, the endometrioma is a pseudocyst which can be mobilized, fenestrated, and then the pseudo-
cyst capsule ablated using a KTP (potassium titanyl phosphate) laser. The KTP laser penetrates tissue to a depth of between 70 and 200 lm and therefore does not damage the underlying follicles in the ovarian cortex.
