Ovarian Endometrioma Surgery

The ovarian localization of endometriosis is most frequently called endometrioma. Surgical removal of endometriomas – in case of symptoms or in case of infertility – is one of the standard procedures for the treatment of ovarian endometriosis recommended in national and international guidelines such as Dunselman et al. The most frequent indications for surgery are cyst-related symptoms, mainly pain. There are serious arguments for and against surgical removal of endometriomas. Removal of an endometrioma may not only reduce pain but may also impair the integrity of primordial and antral follicles. Major obstacles for endometriosis patients trying to conceive are the parameters “ovarian reserve” and the quality of germ cells. The ureter is to be visualized where it crosses the iliac vessels, approximately at the level of the sacral promontory. The preoperative risk factors observed as having significant predictive value for the presence of pain and dysmenorrhea were younger age, previous laparoscopic surgery of ovarian endometrioma, and nulliparity.