Recommendations for the surgical treatment of endometriosis—part 1: ovarian endometrioma

Working group of ESGE, ESHRE, and WES, Ertan Sarıdoğan, Ertan Saridogan, Christian M Becker, Anis Feki, Anis Féki, Grigoris Grimbizis, Grigoris F Grimbizis, Lone Hummelshøj, Lone Hummelshoj, Joerg Keckstein, J. Keckstein, Michelle Nisolle, Vasilios Tanos, U. Ulrich, Uwe A Ulrich, Nathalie Vermeulen, Rudy Leon De Wilde
Gynecological surgery · 2017 · vol. 14(1) , pp. 27 · doi:10.1186/s10397-017-1029-x · PMID:29285022 · W2781273140
article OA: hybrid CC0 ⤵ 78 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This document provides recommendations for the surgical treatment of ovarian endometriomas, detailing techniques such as cystectomy, laser ablation, and electrocoagulation.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This ESGE/ESHRE/WES working group paper provides technical recommendations for surgical management of ovarian endometriomas in women of reproductive age, describing and comparing approaches including cystectomy, ablation by laser or plasma energy, electrocoagulation, and combinations or staged use of these techniques. It bases most recommendations on expert clinical opinion due to limited evidence, and emphasizes preoperative assessment of disease extent and anatomic considerations such as adhesions, possible ureteral involvement/hydronephrosis, hydrosalpinx, ovarian blood supply to limit bleeding and follicle loss, and ovarian reserve testing when fertility is a concern, with serum tumor markers considered when malignancy is suspected. The paper highlights the surgical aim of eliminating endometriotic tissue while preserving normal ovarian tissue, noting that surgery is associated with measurable reductions in ovarian reserve (e.g., AMH or antral follicle count). This paper is centrally about endometriosis — it focuses specifically on technical recommendations for surgery of ovarian endometriomas.

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Abstract

STUDY QUESTION: What does this document on the surgical treatment of endometriosis jointly prepared by the European Society for Gynaecological Endoscopy (ESGE), ESHRE, and the World Endometriosis Society (WES) provide? SUMMARY ANSWER: This document provides recommendations covering technical aspects of different methods of surgery for endometriomas in women of reproductive age. WHAT IS ALREADY KNOWN: Endometriomas (ovarian endometriotic cysts) are a commonly diagnosed form of endometriosis, owing to the relative ease and accuracy of ultrasound diagnosis. They frequently present a clinical dilemma as to whether and how to treat them when found during imaging or incidentally during surgery. Previously published guidelines have provided recommendations based on the best available evidence, but without technical details on the management of endometriosis. STUDY DESIGN SIZE DURATION: A working group of ESGE, ESHRE and WES collaborated on writing recommendations on the practical aspects of endometrioma surgery. PARTICIPANTS/MATERIALS SETTING METHODS: This document focused on endometrioma surgery. Further documents in this series will provide recommendations for surgery of deep and peritoneal endometriosis. MAIN RESULTS AND THE ROLE OF CHANCE: The document presents general recommendations for surgery of endometrioma, and specific recommendations for cystectomy, ablation by laser or by plasma energy, electrocoagulation and a combination of these techniques applied together or with an interval between them. LIMITATIONS REASONS FOR CAUTION: Owing to the limited evidence available, recommendations are mostly based on clinical expertise. WIDER IMPLICATIONS OF THE FINDINGS: These recommendations complement previous guidelines on the management of endometriosis. STUDY FUNDING/COMPETING INTERESTS: The meetings of the working group were funded by ESGE, ESHRE and WES. C.B. declares to be a member of the independent data monitoring committee for a clinical study by ObsEva, and receiving research grants from Bayer, Roche Diagnostics, MDNA Life Sciences, and Volition. E.S. received honoraria for provision of training to healthcare professionals from Ethicon, Olympus and Gedeon Richter. The other authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER: NA.

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endometriosisendometrioma

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