Surgeon Subspecialty and Ovarian Preservation in Endometrioma Surgery: A Retrospective Cohort Study

OBJECTIVE: To evaluate variation in ovarian preservation and excision of extra-ovarian endometriosis during endometrioma surgery across gynecologic subspecialties. DESIGN: Retrospective cohort study. SETTING: One tertiary academic medical center and four regional hospitals within a single health system. PARTICIPANTS: Individuals aged 18 to 45 years who underwent surgery for pathology-confirmed ovarian endometrioma between 2012 and 2024. Exclusion criteria included hereditary cancer syndromes, prior malignancy, malignancy on final pathology, nongynecologic surgeons, and incomplete documentation. The final cohort comprised 351 patients. INTERVENTIONS: Surgical management was assessed across four gynecologic subspecialties: general obstetrics and gynecology (OB/GYN), minimally invasive gynecologic surgery (MIGS), reproductive endocrinology and infertility (REI), and gynecologic oncology. The primary outcome was ovarian-sparing surgery, defined as cystectomy without oophorectomy. The secondary outcome was excision of extra-ovarian endometriosis among patients with advanced-stage disease (revised American Society for Reproductive Medicine stage III or IV). Multivariable logistic regression was used to adjust for clinical and surgical factors. RESULTS: Ovarian-sparing surgery was performed in 66% of cases and varied by surgeon subspecialty. Compared with OB/GYN surgeons, MIGS and REI surgeons had higher odds of ovarian-sparing surgery (adjusted odds ratio [aOR] 8.46, 95% confidence interval [CI] 3.07-23.29 and aOR 8.44, 95% CI 2.71-26.27, respectively; both p < .001). Among patients with advanced-stage disease, excision of extra-ovarian endometriosis also differed by subspecialty, with MIGS and REI surgeons demonstrating higher odds of extra-ovarian excision compared with OB/GYN surgeons (aOR 23.18, 95% CI 8.18-65.72 and aOR 13.09, 95% CI 4.44-38.63, respectively; both p < .001). CONCLUSION: Surgical management of ovarian endometriomas varied across gynecologic subspecialties. Compared with OB/GYN and gynecologic oncology surgeons, MIGS and REI surgeons were more likely to perform ovarian-sparing surgery and excise extra-ovarian endometriosis.