Impact on ovarian reserve and fertility using carbon dioxide laser for endometriosis treatment: a systematic review

Andrea Giannini, Tebache L, Linda Tebache, Giacomo Noti, Noti G, Giulia Cosimi, Cosimi G, Michelle Nisolle, Nisolle M, Simoncini T, Tommaso Simoncini
Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology · 2022 · vol. 38(8) , pp. 617–622 · doi:10.1080/09513590.2022.2087218 · PMID:35822466 · W4285086347
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This systematic review found that CO2 laser treatment for endometriosis may cause less ovarian tissue damage than bipolar energy but robust data indicate excisional techniques are superior, with fertility outcomes remaining inconclusive.

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Abstract

BackgroundThe application of carbon dioxide (CO2) laser for laparoscopic gynecologic surgery was introduced in 1979 and spread after improving instrumentation, due to the versatility of the CO2 laser technology and the parallel increase of laparoscopic use. In a gynecologic setting, laser laparoscopy has been demonstrated to be effective in treating infertility and pain associated with mild to severe endometriosis.Aim and methods: This document aims at conducting a systematic review to provide a comprehensive literature overview regarding the rationale, indications, safety, and efficacy of CO2 laser treatment of endometriosis and related outcomes on ovarian reserve and fertility.ResultsCO2 laser seems to lead to lower heat damage in the ovarian tissue than bipolar energy during endometriomas treatment. Moreover, several reports have pointed out that laser vaporization allows to selectively destroy the endometrioma wall's internal surface, preserving the pericystic fibrotic capsule or the adjacent healthy ovarian cortex. Despite this, robust data we have so far indicates that the most effective laparoscopic approach for managing endometriomas is the traditional excisional technique providing better postoperative outcomes than drainage and electrocoagulation, and laser treatment. Data about fertility after treatment of deep infiltrating endometriosis (DIE) using dioxide laser are emerging but very poor.ConclusionsCurrent scientific evidence in this field is inconclusive, and the debate about the safety and efficacy of the CO2 laser on fertility outcomes is still ongoing. Further randomized case-control studies are mandatory to attain more consistent evidence.

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Condition tags

endometriosisdie_deep_infiltratingendometriomainfertility

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

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 (30)

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