Surgical management of endometrioma for ovarian safety

ABSTRACTObjectives: The effect of laparoscopic surgery for endometrioma on ovarian function is debated and controversial. The aim of the study was to address the impact of preoperative parameters and surgical technique for the removal of endometrioma on the ovarian reserve.Methods: This was a retrospective cohort study of outpatient women referred to the Fertility Center of the University of Campania “Luigi Vanvitelli” in Naples undergoing laparoscopy for enucleation of endometriotic cysts. The evaluation of the ovarian reserve was performed before the intervention and at the third month after the intervention by the count of antral follicles (AFC), FSH and AMH dosage. Surgery was performed by operative laparoscopy by stripping technique and ablation. Hemostasis was performed with two kinds of bipolar forceps, according to the feasibility of self-regulating coagulation.Results: 46 patients were analyzed. The data showed a greater impact of the surgical technique on the ovarian reserve of patients in advanced reproductive age or with a recurrent endometrioma (<0.05). Patients undergone surgery with the use of forceps without self-regulation showed a statistically signifi cant impairment (p<0.05) of AFC, FSH, and AMH. Conclusions: Our data showed equal hemostatic effectiveness for the two forceps, but a lower impact on the ovarian reserve with the one with self-regulating coagulation (p<0.05). However, more studies with a longer follow-up period are required to clarify the fertility outcome better.