To describe a laparoscopic technique for ovarian tissue biopsy (OTB) for fertility preservation. In the last years, the demand for fertility preservation has grown because of the increasing survival rates among patients with cancer and the rising awareness of the importance of quality of life after gonadotoxic therapy. Among fertility-sparing approaches, ovarian tissue cryopreservation is a valid strategy to preserve ovarian endocrine and reproductive function in prepubertal and postpubertal women who will undergo gonadotoxic cancer treatments. Currently, there is no universal consensus regarding ovarian tissue retrieval technique for fertility preservation. Step-by-step description of the surgical technique with narrated video footage. Academic tertiary hospital. Patients with a high risk of premature ovarian insufficiency, usually due to gonadotoxic treatments, who undergo OTB for fertility preservation were included in the study. In this video, we present the clinical case of a 28-year-old patient affected by Hodgkin lymphoma who underwent laparoscopy for OTB before chemotherapy. After exposing the chosen ovary, an incision at the tubal pole of the ovary is made with scissors. Through section and dissection, a large cortical biopsy of the ovary is performed without removing and avoiding any damage to the medulla. At the end of the procedure, hemostasis was achieved with selective coagulation using bipolar coagulation. Step by step educational video. The post-operative course was uneventful and the patient was discharge 24 hours after surgery. Standardization of a step-by-step laparoscopic technique can provide an effective method to optimize ovarian tissue removal while minimizing tissue injury. Medulla-sparing ovarian biopsy allows retrieval of only the cortical part of the ovary, maximizing the number of primordial follicles obtained without damaging the vascular supply of the ovary contained within the medulla. Primordial follicles are resistant to cryoinjury owing to their relatively inactive metabolism, and they are usually found at approximately 0.8 mm below the surface of the cortex. This technique could also reduce the back-table processing time of the ovarian tissue before cryopreservation. One disadvantage could be the difficulty of the technique compared to an oophorectomy because it requires a skilled surgeon that can easily find the cleavage plane between the medulla and the cortex, even in patients submitted to previous chemoradiotherapy or during gonadotropin-releasing hormone analogue therapy.

中文翻译：

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腹腔镜保留髓质卵巢组织活检用于冷冻保存：分步手术技术

描述用于保存生育力的卵巢组织活检 (OTB) 的腹腔镜技术。在过去的几年里，由于癌症患者生存率的提高以及人们对性腺毒性治疗后生活质量重要性的认识不断提高，对保留生育能力的需求不断增长。在保留生育能力的方法中，卵巢组织冷冻保存是保护即将接受性腺毒性癌症治疗的青春期前和青春期后女性卵巢内分泌和生殖功能的有效策略。目前，对于保留生育力的卵巢组织取出技术尚未达成普遍共识。通过解说视频逐步描述手术技术。学术型三级医院。该研究纳入了卵巢早衰风险较高的患者（通常是由于性腺毒性治疗而导致），他们接受 OTB 来保留生育能力。在本视频中，我们介绍了一名 28 岁霍奇金淋巴瘤患者的临床病例，该患者在化疗前接受了腹腔镜 OTB 治疗。暴露选定的卵巢后，用剪刀在卵巢的输卵管极处切开一个切口。通过切片和解剖，对卵巢进行大型皮质活检，无需切除髓质，避免对髓质造成任何损伤。手术结束时，使用双极凝固进行选择性凝固来实现止血。一步一步的教育视频。术后过程很顺利，患者在术后24小时就出院了。逐步腹腔镜技术的标准化可以提供一种有效的方法来优化卵巢组织切除，同时最大限度地减少组织损伤。保留髓质的卵巢活检可以仅取出卵巢的皮质部分，从而最大限度地获得原始卵泡的数量，而不会损害髓质内卵巢的血管供应。原始卵泡由于其代谢相对不活跃而能够抵抗冷冻损伤，并且它们通常位于皮质表面以下约 0.8 毫米处。该技术还可以减少冷冻保存前卵巢组织的后台处理时间。与卵巢切除术相比，该技术的一个缺点可能是该技术的难度，因为它需要熟练的外科医生才能轻松找到髓质和皮质之间的裂隙平面，即使对于之前接受过放化疗或促性腺激素释放激素类似物治疗的患者也是如此。