Ovarian endometrioma ablation using plasma energy versus cystectomy: a step toward better preservation of the ovarian parenchyma in women wishing to conceive

OBJECTIVE: To use postoperative examination by three-dimensional (3D) ultrasound to compare loss of ovarian parenchyma after ovarian endometrioma ablation with the use of plasma energy versus cystectomy. DESIGN: Retrospective "before and after" comparative study. SETTING: University tertiary referral center. PATIENT(S): Thirty women with no previous history of ovarian surgery managed for unilateral ovarian endometrioma >30 mm in diameter. INTERVENTION(S): Endometrioma ablation using plasma energy and ovarian tissue-sparing cystectomy. MAIN OUTCOME MEASURE(S): 3D ultrasound assessment of postoperative reduction in ovarian volume and antral follicle count (AFC). RESULT(S): Fifteen women with comparable baseline characteristics were managed by each technique. Those who underwent cystectomy showed a statistically significant reduction in ovarian volume and AFC when compared with women who underwent ablation using plasma energy. Multivariate analysis showed that the relationship between the decrease in ovarian volume and AFC and the use of cystectomy remained statistically significant after adjustment for age, previous pregnancy, and cyst diameter. CONCLUSION(S): When compared with plasma energy ablation, cystectomy is responsible for a statistically significant decrease in ovarian volume and a statistically significant reduction in AFC. This data should be taken into account in therapeutic decision-making concerning women attempting pregnancy, especially where there are other risk factors for postoperative ovarian failure.