Laparoscopic cystectomy of endometrioma: Good surgical technique does not adversely affect ovarian reserve

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.

Predictors for Successful Pregnancy Following Hystro-Laparoscopic Intervention among Infertile Females: A Cohort Study

Background: Infertility is a major medical and sociopsychological problem that impacts a couple's life. Investigations help guide therapeutic intervention by exploring underlying causes. Hysteroscopy can identify and treat intrauterine pathologies such as adhesion, septum, and endometrial polyps. Laparoscopy has a diagnostic and therapeutic role in the pelvic cavity, including tubal blockage, pelvic adhesions, endometriosis, and polycystic ovaries. Objective: To evaluate the value of combined hystro-laparoscopic interventions in managing female infertility and to explore predictors for a successful pregnancy. Methods: A retrospective cohort study enrolled (142) eligible females who underwent hystro-laparoscopy. Participants' demographic criteria were recorded. Additionally, intraoperative interventions (hysteroscopic removal of the polyp and septum) and laparoscopic removal of pelvic adhesions, removal of the chocolate cyst, ovarian drilling and laparoscopic chromotubation). All patients were followed up for six months. Logistic regression and odd ratio were used to assess the intervention's reliability in predicting pregnancy. Results: Clinical pregnancy was reported in 48/142, with a success rate of 33.8%. Pregnant women had significantly lower ages and lived in urban areas. Laparoscopic adhesion removal and tubal block correction reliably predicted clinical pregnancy, with adjusted odds ratios (AOR) of 0.25; 95% CI (0.08–0.78) and 0.40; 95% CI (0.16-0.98), respectively. None of the hysteroscopic interventions was statistically significant. Conclusions: Because hystero-laparoscopic procedures improve the chances of getting pregnant and are minimally invasive, they are an important part of fertility workups and can be used to diagnose and treat fertility problems.

Ovarian Loss in Laparoscopic and Robotic Cystectomy Compared Using Artificial Intelligence Pathology

A Comparison of Ovarian Loss Following Laparoscopic versus Robotic Cystectomy As Analyzed by Artificial Intelligence-Powered Pathology Software.

Background and Objective

To compare the area of ovarian tissue and follicular loss in the excised cystectomy specimen of endometrioma performed by laparoscopic or robotic technique.

Methods

Prospective observational study performed between April 2023 to August 2023. There were 14 patients each in Laparoscopic group (LC) and Robotic group (RC). Excised cyst wall sent was for to the pathologist who was blinded to the technique used for cystectomy. The pathological assessment was done by artificial intelligence-Whole Slide Imaging (WSI) software.

Results

The age was significantly lower in LC group; the rest of demographic results were comparable. The mean of the median ovarian area loss [Mean Rank, LC group (9.1 ± 15.1); RC (8.1 ± 12.4)] was higher in LC group. The mean of the median total follicular loss was higher in LC group (8.9 ± 9.2) when compared to RC group (6.3 ± 8.9) and was not significant. The area of ovarian loss in bilateral endometrioma was significantly higher in LC group (mean rank 7.5) as compared to RC group (mean rank 3) - (P = .016) despite more cases of bilateral disease in RC group. With increasing cyst size the LC group showed increased median loss of follicles when compared to RC group (strong correlation coefficient 0.347) but not statistically significant (P = .225). AAGL (American Association of Gynecologic Laparoscopists) score did not have any impact on the two techniques.

Conclusion

Robotic assistance reduces the area of ovarian and follicular loss during cystectomy of endometrioma especially in bilateral disease and increasing cyst size. It should be considered over the laparoscopic approach if available.

Analysis of Risk Factors for Negative Emotions in the Perioperative Period in Patients with Benign Ovarian Cysts Treated Laparoscopically and Their Impact on Prognosis: A Retrospective Cohort Study

Background

Ovarian cysts are common diseases among women. They might affect reproductive function in severe cases, and thus, patients with ovarian cysts often have negative emotions.

Purpose

In this study, we elucidated the risk factors for negative emotions in patients with ovarian cysts during the perioperative period and their impact on prognosis.

Methods

From August 2019 to August 2021, we retrospectively included 330 female patients with pathologically diagnosed benign ovarian cysts as potential participants in this study. Based on the established inclusion and exclusion criteria, 308 patients were finally included. We performed the t-test and Chi-squared test to analyze the relationship between the negative emotions of the patients and prognosis. Binary logistic regression and linear regression were used to assess independent risk factors for negative patient mood and prognosis.Based on SAS and SDS scores, patients with anxiety and/or depression are considered to combined negative emotions.

Results

In total, 47 patients (15.3%) had negative emotions during the perioperative period. The results of the binary logistic regression analysis showed that the menstrual status (OR = 3.099, P = 0.028), intraoperative blood loss (OR = 1.043, P = 0.029), recurrence (OR = 3.691, P = 0.047), and several other factors were independent risk factors for negative emotions. The results of the linear regression analysis showed that the presence of combined negative affect (P = 0.000), recurrence (P = 0.010), postoperative IL-2 (P = 0.035), and several other factors were independent risk factors for patient prognosis.

Conclusion

In clinical work, identifying the independent risk factors for negative emotions and enhancing their behavioral awareness and self-efficacy is necessary to improve their quality of life after surgery. Meanwhile, we will continue our exploration of the causes of negative emotions in patients in the future.

Surgical Management of Ovarian Endometrioma: Impact on Ovarian Reserve Parameters and Reproductive Outcomes

Ovarian endometriomas have a negative impact on a patient's reproductive potential and are likely to cause a reduction in ovarian reserve. The most commonly employed ovarian reserve parameters are anti-Müllerian hormone (AMH) and antral follicular count (AFC). Surgical management options of endometrioma include cystectomy, ablative methods, ethanol sclerotherapy and combined techniques. The optimal surgical approach remains a matter of debate. Our review aimed to summarize the literature on the impact of surgical management of endometrioma on AMH, AFC and fertility outcomes. Cystectomy may reduce recurrence rates and increase chances of spontaneous conception. However, a postoperative reduction in AMH is to be anticipated, despite there being evidence of recovery during follow-up. The reduction in ovarian reserve is likely multi-factorial. Cystectomy does not appear to significantly reduce, and may even increase, AFC. Ablative methods achieve an ovarian-tissue-sparing effect, and improved ovarian reserve, compared to cystectomy, has been demonstrated. A single study reported on AMH and AFC post sclerotherapy, and both were significantly reduced. AMH levels may be useful in predicting the chances of conception postoperatively. None of the aforementioned approaches has a clearly demonstrated superiority in terms of overall chances of conception. Surgical management of endometrioma may, overall, improve the probability of pregnancy. Evidence on its value before medically assisted reproduction (MAR) is conflicting; however, a combination of surgery followed by MAR may achieve the optimal fertility outcome. In view of the complexity of available evidence, individualization of care, combined with optimal surgical technique, is highly recommended.

Effect of laparoscopic cystectomy on ovarian reserve in patients with ovarian cyst

OBJECTIVE

This study aimed to evaluate the effect of laparoscopic cystectomy on ovarian reserve in patients with ovarian cysts.

MATERIAL AND METHODS

This prospective study was performed on 113 women with ovarian cysts in a tertiary referral teaching hospital. All patients underwent laparoscopic cystectomy. Serum levels of antimüllerian hormone (AMH) were measured pre-and, 3 months postoperatively. The primary outcome of the study was to assess the effect of laparoscopic cystectomy on ovarian reserve based on alterations in serum AMH levels. The secondary outcome of the present study was to evaluate the impact of the number of cauterizations, size and type of cysts, bilaterality (bilateral or unilateral), age, and body mass index (BMI) on the ovarian reserve after laparoscopic excision.

RESULTS

Laparoscopic cystectomy reduced the serum AMH levels preoperatively (1.32 ± 4.48 ng/ml) to postoperatively (3.2 ± 1.93 ng/ml) and the difference (- 1.28 ng/ml) was statistically different (0.001 >P). There was a negative significant relationship between the number of cauterizations used and postoperative serum AMH levels (p ≤ 0.001). There was a significant relationship between the location (p ≤ 0.01), type of cyst (p ≤ 0.001) and the serum AMH levels reduction.

CONCLUSION

The number of cauterizations used during surgery, the type of cyst, and bilaterality can affect AMH levels that need to be addressed.

Surgery for endometriomas within the context of infertility treatment

BACKGROUND

The presence of an endometrioma can often be accompanied by a clinical dilemma during the course of fertility treatment. The aim of this study was to evaluate anti-Müllerian hormone (AMH) levels and spontaneous pregnancy rate in infertility patients with endometriomas depending of initial AMH levels and cyst type.

METHODS

This prospective cohort study included infertility patients with unilateral endometrioma (3-5 s m in diameter) aged 25-35. A total of them underwent laparoscopic cystectomy. All patients were divided into two groups due to AMH levels and cyst type during surgery. We investigated AMH levels and spontaneous pregnancy rate in 1,3 and 12 months after surgery.

RESULTS

The majority of patients with normal AMH level had type II endometriomas (70%) compared with low AMH level group (30%). There were no significant differences between AMH levels in all the patients with type II endometriomas after surgery. AMH level decreased significantly at 1 month in patients with normal AMH level and type I endometriomas (P = 0.018). But at 3 months the AMH level was compared with initial parameters. Women with low AMH levels before surgery and type I cysts had a significant decrease of AMH level at 1 and at 3 months after surgery. All patients with a time interval of 6 months after surgery had the best outcomes with significantly higher pregnancy rate (PR) in patients with normal AMH level and type II cysts (P = 0.036) and with AMH less than 2 ng/ml and type I cysts (P = 0.021). The group with normal AMH level and type II endometriomas had a significantly higher ongoing cumulative PR than others (59.4%).

CONCLUSIONS

Our data suggest that laparoscopic surgery could affect ovarian reserve in case of initial low AMH levels and type I of endometriomas. We believe that the good surgical technique helps to increase pregnancy rate in infertility patients with endometriomas. Good prognosis group are the infertility patients with normal AMH level and type II endometriomas.

Effect of two laparoscopic techniques for treatment of ovarian endometrioma on ovarian reserve

Introduction:

Operative laparoscopy is the most common used technique for treatment of patients with ovarian endometriomas, because of many positive effects in comparison with laparotomy. There are many laparoscopic techniques, but most used are cystectomy and puncture with endocoagulation (ablation) of the cyst’s capsule. The aim of this study was to evaluate the effect of two laparoscopic techniques for treatment of ovarian endometriomas on ovarian reserve. We used two ultrasonographic markers for ovarian reserve: ovarian volume and antral follicle count (AFC).

Materials and Methods:

Sixty patients in reproductive age (18-42 years) were treated for a chronic pelvic pain or infertility in a tertiary hospital (University Clinic for Gynecology and Obstetrics in Skopje, R. Macedonia). The study was prospective and two laparoscopic techniques were used. All patients were with confirmed ultrasound diagnosis for ovarian endometriomas with diameter between 3 and 8 cm. Complete cystectomy was done in 30 patients (group A) and puncture with endocoagulation was done in other 30 patients (group B). Ovarian reserve was analyzed before surgery and was controlled one and three months after laparoscopic surgery.

Results:

In group A (operated with cystectomy) ovarian volume was 53.46±29.97 cm³ before surgery, which fell to 13.06±7.34 cm³ after one month, and 13.28±7.17 cm³ after three months. Statistical analysis showed a significant reduction in ovarian volume one and three months after surgery (p≤0.01). In group B (operated with puncture and endocoagulation) the ovarian volume was 58.34±37.99 cm³ before surgery, which fell to 18.96±7.90 cm³ one month and 17.38±6.86 cm³ three months after surgery. In both groups there was a significant reduction in ovarian volume one and three months postoperatively (p≤0.01). In the first group AFC was 3.03±1.27 before surgery, 4.8±1.30 one month after surgery and 6.23±1.57 after three months. Statistical analysis showed a significant increase in AFC after laparoscopic cystectomy (p≤0.01). In the second group AFC was 3.07±1.05 before surgery, 5.33±1.60 after one month and 7.0±1.62 after three months. The comparison of AFC showed high statistically significant difference (p≤0.001), e.g. increase of AFC after one and three months in comparison with AFC before surgery.

Conclusions:

Ovarian reserve decreases after laparoscopic surgery using both laparoscopic techniques. But, this decrease was more frequent using cystectomy in comparison with ablation of the endometriotic cyst.