Endometrioma surgery: Hit with your best shot (But know when to stop)

Umberto Perrone, Simone Ferrero, Irene Gazzo, Alberto Izzotti, Umberto Leone Roberti Maggiore, Claudio Gustavino, Marcello Ceccaroni, Stefano Bogliolo, Fabio Barra
Best practice & research. Clinical obstetrics & gynaecology · 2024 · vol. 96 , pp. 102528 · doi:10.1016/j.bpobgyn.2024.102528 · PMID:38977389 · W4400270448
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This paper discusses the debated surgical management of ovarian endometriomas, considering their impact on fertility, ovarian reserve, and potential for malignancy, and reviews various surgical techniques for hemostasis.

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Abstract

Ovarian endometriomas (OEs) are commonly detected by ultrasound in individuals affected by endometriosis. Although surgery was widely regarded in the past as the gold standard for treating OEs, especially in the case of large cysts, the surgical management of OEs remains debated. Firstly, OEs often represent the "tip of the iceberg" of underlying deep endometriosis, and this should be considered when treating OEs to ameliorate patients' pain for focusing on the surgical objectives and providing better patient counseling. In the context of fertility care, OEs may have a detrimental effect on ovarian reserve through structural alterations, inflammatory responses, and oocyte reserve depletion. Conversely, the surgical approach may exacerbate the decline within the same ovarian reserve. While evidence suggests no improvement in in-vitro fertilization (IVF) outcomes following OE surgery, further studies are needed to understand the impact of OE surgery on spontaneous fertility. Therefore, optimal management of OEs is based on individual patient and fertility characteristics such as the woman's age, length of infertility, results of ovarian reserve tests, and surgical background. Among the available surgical approaches, cystectomy appears advantageous in terms of reduced recurrence rates, and traditionally, bipolar coagulation has been used to achieve hemostasis following this approach. Driven by concerns about the negative impact on ovarian reserve, alternative methods to obtain hemostasis include suturing the cyst bed, and novel methodologies such as CO2 laser and plasma energy have emerged as viable surgical options for OEs. In instances where sonographic OE features are non-reassuring, surgery should be contemplated to obtain tissue for histological diagnosis and rule out eventual ovarian malignancy.

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Condition tags

mesh:D004715endometriosisendometriomainfertility

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Ovarian Diseases Ovarian Diseases Ovarian Diseases Ovarian Diseases Ovarian Diseases Ovarian Diseases Ovarian Diseases Ovarian Diseases

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (100)

Cited by (8)

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europepmc
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License: CC0 · commercial use OK