Direct proportional relationship between endometrioma size and ovarian parenchyma inadvertently removed during cystectomy, and its implication on the management of enlarged endometriomas

Abstract

background: The aim of this study was to estimate whether or not the size of an endometrioma is related to the thickness of the ovarian parenchyma inadvertently excised along with the cyst wall.methods: We performed a retrospective study including 35 women who had undergone endometrioma cystectomy, using an ovarian tissue sparing procedure. In total 38 specimens were studied by three pathologists as three women presented bilateral localizations, and all cyst diameters measured at least 30 mm. For each endometrioma, serial sections were performed, and on each section four different sites were randomly chosen to measure the thickness of glandular epithelium and stroma, of subjacent fibrosis, depending on the cyst, and of the ovarian parenchyma removed with the cyst. The diameter of the ovary was measured preoperatively either by MRI or ultrasound, and the area of the internal wall was then calculated. The relationships between the mean thickness of ovarian parenchyma removed and the variables were estimated and a multiple regression model identified independent predictors for ovarian parenchyma thickness.results: Adjacent ovarian tissue was found in 37 cases (97%). The mean thickness of ovarian tissue removed was 1173 + 711 mm and that of the cyst wall was 851 + 499 mm. The thickness of the ovarian parenchyma removed presented a direct proportional relationship with cyst diameter (P ¼ 0.015), and consequently with cyst wall area (P ¼ 0.032). This relationship with cyst diameter was independent after adjustment on other variables (P ¼ 0.032).conclusion: Endometrioma cystectomy even though performed with an accurate surgical technique leads to significant ovarian tissue removal, the thickness of which increases proportionally with cyst diameter.

Ovarian endometrioma ablation using plasma energy versus cystectomy: a step toward better preservation of the ovarian parenchyma in women wishing to conceive

“…Both surgical procedures have previously been described elsewhere (2,(10)(11)(12). Neither requires antimesial incision of the ovarian parenchyma, as they can be performed through a small area of the cyst, free of ovarian tissue, which corresponds to the primary invagination spot of the cyst (13)(14)(15).…”

“…Recent data suggest that excising endometriomas by ovarian tissue-sparing cystectomy does not avoid inadvertent removal of ovarian parenchyma surrounding the cyst (1)(2)(3), particularly in enlarged cysts (2). Although several investigators have questioned whether the ovarian parenchyma immediately surrounding the cyst may still be functional (4), there is little doubt that postoperative fertility could be significantly impaired (5,6) by loss of ovarian cortex; this provokes the question as to whether pregnancy should be initiated before performing a cystectomy, whenever this scenario is possible.…”

The role of fertility preservation in patients with endometriosis

“…Surgery Severe ovarian damage and extensive follicle loss have been reported after cystectomy for endometriomas [11] resulting in a shorter reproductive life span [20,21], or even immediate ovarian failure as reported in few cases [19]. Table 1 shows the effect of surgery on ovarian reserve markers.…”

Effects of low dose oral contraceptive pill containing drospirenone/ethinylestradiol in patients with endometrioma

“…Nevertheless, it has also been shown that the endometrioma per se may cause damage to ovarian reserve and function. The thickness of ovarian tissue removed surgically seems to increase proportionally with cyst diameter [26]. Therefore, the reduction in volume of the endometrioma by low dose OCPs is crucial to preserve fecundity.…”