Awareness of surgical techniques and fertility among early-career gynecologists performing total laparoscopic cystectomy for ovarian mature cystic teratoma

Hiroaki Hiraga, Zen Watanabe, Naomi Shiga, Emi Yokoyama, Yuri Takahashi, Jumpei Toratani, Takeki Sato, Yutaka Takahashi, Masahito Tachibana
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2025 · vol. 41(1) , pp. 94–102 · doi:10.5180/jsgoe.41.1_94 · W4412835105
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This survey examined early-career gynecologists' awareness of surgical techniques and fertility implications when performing total laparoscopic cystectomy for ovarian mature cystic teratoma.

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This study surveyed early-career gynecologists in Japan to assess their awareness of surgical technique and fertility considerations when performing total laparoscopic cystectomy for ovarian mature cystic teratoma, using a questionnaire distributed to doctors affiliated with the authors’ program. Among 31 respondents (84%), 97% agreed that TLC-MCT quality can affect fertility and recurrence, yet after two years of experience 73% reported little confidence in their ability to perform the procedure. The most difficult components were initial ovarian incision, layer recognition, and dissection (60%), along with surgical field control (47%) and communication with assistants (40%). The paper concludes that although fertility-relevant precision is recognized, practical proficiency for inexperienced laparoscopists remains challenging and only notes forceps dexterity, visual/cognitive training, and expert observation, without stating any explicit limitations of the survey methods. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Objective: In Japan, total laparoscopic cystectomy for ovarian mature cystic teratoma (TLC-MCT) is commonly performed by early-career laparoscopists. However, some experienced gynecological surgeons view TLC-MCT as a technically demanding surgery that requires surgical proficiency. Additionally, postoperative ovarian reserve directly affects fertility potential in assisted reproductive technology. This poses a contradiction: inexperienced laparoscopists perform proficiency-dependent procedures with substantial impacts on fertility. While developing expert skills from the outset is unrealistic, supervising and junior gynecologists should focus on optimizing the learning curve. Thus, we surveyed early-career gynecologists on their awareness of surgical techniques and fertility considerations in TLC-MCT.
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Objective

In Japan, total laparoscopic cystectomy for ovarian mature cystic teratoma (TLC-MCT) is commonly performed by early-career laparoscopists. However, some experienced gynecological surgeons view TLC-MCT as a technically demanding surgery that requires surgical proficiency. Additionally, postoperative ovarian reserve directly affects fertility potential in assisted reproductive technology. This poses a contradiction: inexperienced laparoscopists perform proficiency-dependent procedures with substantial impacts on fertility. While developing expert skills from the outset is unrealistic, supervising and junior gynecologists should focus on optimizing the learning curve. Thus, we surveyed early-career gynecologists on their awareness of surgical techniques and fertility considerations in TLC-MCT.

Methods

A questionnaire about TLC-MCT was distributed to early-career gynecologists who are or have been affiliated with our program.

Results

Thirty-one doctors (84%) responded. Among them, 97% agreed that TLC-MCT quality may impact fertility and recurrence. By their second year, 98% had performed TLC-MCT, but 73% responded little confidence in their ability to perform the procedure. The most challenging aspects were “initial ovarian incision,” “layer recognition,” and “dissection” (60%), “surgical field control” (47%), and “communication with assistants” (40%).

Conclusions

Early-career gynecologists are generally aware of the impact of technique on fertility. Surgery must be precise to preserve fertility, but inexperienced laparoscopists struggle with aspects of the procedure. To enhance patient outcomes, they must acquire skills without extensive case experience. Besides forceps dexterity training (dry box training), improving layer recognition and strategy by observing expert-led surgeries and videos (visual and cognitive training) is essential. © 2025 日本産科婦人科内視鏡学会

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