Minimally invasive surgery for ovarian endometriosis as a mean of improving fertility: Cystectomy vs. CO2 fiber laser ablation what do we know so far?

Comparison of Surgical Interventions for Endometrioma: A Systematic Review of Their Efficacy in Addressing Infertility

Background: Endometriosis is characterized by the presence of endometrial tissue outside the uterus. Beyond medical treatment, surgical intervention is also a viable consideration. However, current guidelines do not clearly indicate whether laparoscopic cystectomy, ablative methods (CO2 laser vaporization, plasma energy), or sclerotherapy is the preferred option. Methods: We conducted searches in two databases (PubMed and Europe PMC) to retrieve articles containing the keywords 'surgical intervention for Endometrioma, ovarian reserve, pregnancy rates, fertility', published between 1 January 2000 and 31 December 2023. We included articles presenting information on surgical intervention for endometrioma and its correlation with infertility parameters. Articles describing conservative treatment were excluded. Data were extracted by two authors using predefined criteria. Results: The initial database search produced 1376 articles, which were narrowed down to 41 relevant articles meeting the eligibility criteria. Conclusions: Laparoscopic cystectomy appears to impact postoperative anti-mullerian hormone levels, showing a stronger correlation with larger cysts and individual factors. CO2 laser vaporization demonstrates favorable results compared to traditional cystectomy. Combining GnRH agonist treatment with assisted reproduction treatment after cystectomy could be considered an alternative method. Plasma energy causes less damage to ovarian function, with pregnancy outcomes comparable to cystectomy. Sclerotherapy shows promising results for ovarian reserve preservation, recurrence rates, and safety. Further studies comparing these techniques are necessary to provide guidance to clinicians.

A Comprehensive Review of Advanced Diagnostic Techniques for Endometriosis: New Approaches to Improving Women's Well-Being

According to the World Health Organization (WHO), endometriosis affects roughly 10% (190 million) of reproductive-age women and girls in the world (2023). The diagnostic challenge in endometriosis lies in the limited value of clinical tools, making it crucial to address diagnostic complexities in patients with suggestive symptoms and inconclusive clinical or imaging findings. Saliva micro ribonucleic acid (miRNA) signature, nanotechnologies, and artificial intelligence (AI) have opened up new perspectives on endometriosis diagnosis. The aim of this article is to review innovations at the intersection of new technology and AI when diagnosing endometriosis. Aberrant epigenetic regulation, such as DNA methylation in endometriotic cells (ECs), is associated with the pathogenesis and development of endometriosis. By leveraging nano-sized sensors, biomarkers specific to endometriosis can be detected with high sensitivity and specificity. A chemotherapeutic agent with an LDL-like nano-emulsion targets rapidly dividing cells in patients with endometriosis. The developed sensor demonstrated effective carbohydrate antigen 19-9 detection within the normal physiological range. Researchers have developed magnetic iron oxide nanoparticles composed of iron oxide. As novel methods continue to emerge at the forefront of endometriosis diagnostic research, it becomes imperative to explore the impact of nanotechnology and AI on the development of innovative diagnostic solutions.

Surgical Technique and Fertility Outcomes: A Comprehensive Review of Open and Laparoscopic Cystectomy in Women of Reproductive Age

Cystectomy, the surgical removal of ovarian tissue, is commonly performed in women of reproductive age to address conditions such as ovarian cysts, endometriosis, and tumors. The choice of surgical technique, open versus laparoscopic, has significant implications for postoperative recovery and long-term fertility outcomes. This comprehensive review aims to evaluate the current literature on the effects of these two surgical approaches on fertility in women of reproductive age. Open cystectomy, while effective, is associated with larger incisions, increased trauma to surrounding reproductive structures, and a higher incidence of postoperative complications, which may negatively impact future fertility. In contrast, laparoscopic cystectomy offers a minimally invasive option that generally results in less postoperative pain, quicker recovery, and potentially improved fertility outcomes due to reduced damage to surrounding tissues. However, the literature reveals a complex interplay between surgical technique, underlying medical conditions, and individual patient factors that can influence reproductive potential. This review synthesizes key studies comparing the fertility outcomes of both surgical methods, highlighting the need for individualized surgical planning based on each patient's unique circumstances and reproductive goals. Additionally, it discusses the importance of preoperative counseling and multidisciplinary approaches to optimize patient outcomes. Future research is essential to further clarify the long-term fertility implications of open and laparoscopic cystectomy and to refine surgical techniques to enhance reproductive health. This review contributes to the growing body of evidence guiding clinicians in making informed decisions that prioritize the effective treatment of ovarian pathology and fertility preservation.

An algorithm for the pre-operative differentiation of benign ovarian tumours based on magnetic resonance imaging interpretation in a regional core hospital: A retrospective study

Objective

For selecting minimally invasive surgery (i.e. laparoscopic ovarian cystectomy) for treating ovarian tumours (OTs) in premenopausal patients, the pre-operative differentiation of benign ovarian tumours (Be-OTs) based on magnetic resonance imaging (MRI) interpretation is important. This paper describes the authors' 8-year experience of approximately 1000 OT cases, and provides information about a diagnostic algorithm to help other hospitals.

Study design

The medical records of 901 patients aged < 50 years with OTs from 1 January 2015-31 March 31 2023 were reviewed. First, the accuracy of pre-operative differentiation between Be-OTs and borderline/malignant ovarian tumours (Bo/Ma-OTs) was compared in each type of OT. Second, to identify the factors influencing differentiation between Be-OTs and Bo/Ma-OTs in 164 serous/mucinous ovarian tumours (SM-OTs), a multi-variate logistic regression analysis was performed to assess the effect of 13 factors, including MRI findings, OT size and tumour markers.

Results

In the comparison of diagnostic accuracy of pre-operative MRI for each OT type, accuracy was found to be notably high for ovarian endometrial cyst (OEC) (n = 409), ovarian mature cystic teratoma (OMCT) (n = 308), ovarian endometrioid adenocarcinoma (OEA) (n = 6) and ovarian clear cell adenocarcinoma (OCCA) (n = 14). On the other hand, discrepancies between MRI and pathological findings often occurred in SM-OTs, including ovarian serous cystadenoma (n = 86), ovarian mucinous adenocarcinoma (n = 61), ovarian serous adenocarcinoma (n = 12) and ovarian mucinous adenocarcinoma (n = 5). In the multi-variate logistic regression analysis of the latter 164 patients, in addition to MRI findings, OT size and carbohydrate antigen 125 also had an effect to some extent. The combination of MRI interpretation and OT size may enhance differentiation of Be-OTs and Bo/Ma-OTs.

Conclusions

Among four types of OTs (OEC, OMCT, OEA and OCCA), MRI interpretation was able to differentiate between Be-OTs and Bo/Ma-OTs almost perfectly. Additionally, to mitigate the difficulty in differentiating SM-OTs, OT size may be useful in combination with MRI findings, although further accumulation and analysis of OT cases is needed.

Microbiota in Irritable Bowel Syndrome and Endometriosis: Birds of a Feather Flock Together-A Review

Endometriosis and irritable bowel syndrome (IBS) are chronic conditions affecting up to 10% of the global population, imposing significant burdens on healthcare systems and patient quality of life. Interestingly, around 20% of endometriosis patients also present with symptoms indicative of IBS. The pathogenesis of both these multifactorial conditions remains to be fully elucidated, but connections to gut microbiota are becoming more apparent. Emerging research underscores significant differences in the gut microbiota composition between healthy individuals and those suffering from either endometriosis or IBS. Intestinal dysbiosis appears pivotal in both conditions, exerting an influence via similar mechanisms. It impacts intestinal permeability, triggers inflammatory reactions, and initiates immune responses. Furthermore, it is entwined in a bidirectional relationship with the brain, as part of the gut-brain axis, whereby dysbiosis influences and is influenced by mental health and pain perception. Recent years have witnessed the development of microbiota-focused therapies, such as low FODMAP diets, prebiotics, probiotics, antibiotics, and fecal microbiota transplantation, designed to tackle dysbiosis and relieve symptoms. While promising, these treatments present inconsistent data, highlighting the need for further research. This review explores the evidence of gut dysbiosis in IBS and endometriosis, underscoring the similar role of microbiota in both conditions. A deeper understanding of this common mechanism may enable enhanced diagnostics and therapeutic advancements.