Laparoscopic management of endometriomas using a combined technique of excisional (cystectomy) and ablative surgery

Donnez, Jacques; Lousse, Jean-Christophe; Jadoul, Pascale; Donnez, Olivier; Squifflet, Jean

doi:10.1016/j.fertnstert.2009.02.065

Cited by 201 publications

(146 citation statements)

References 21 publications

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“…In order to prevent postoperative ovarian reserve impairment, such as that seen after the treatment of recurrent and bilateral endometriotic cysts, using plasma energy for the ablation of endometrial tissue has been recommended, thus causing minimal damage to the ovarian parenchyma 15. Recently, it was reported that a combined technique, including the vaporization of cysts in close proximity to the hilus and a cystectomy for distant portions, can preserve the ovarian reserve 16. Also recently, the potential contribution of inflammation to follicle burnout in cases of endometriotic cysts was reported17 and the proactive management of endometriotic cysts, including conservative surgery in young women, has been suggested could prevent ovarian dysfunction 18.…”

Section: Discussionmentioning

confidence: 99%

Analyzing the risk factors for a diminished oocyte retrieval rate under controlled ovarian stimulation

Nakamura

Yamashita

Hayashi

et al. 2016

Reprod Medicine & Biology

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AimTo investigate which risk factors contribute to a lower oocyte retrieval ratio in women who are receiving controlled ovarian hyperstimulation.MethodsThe authors retrospectively analyzed 329 in vitro fertilization (IVF) cycles under controlled ovarian hyperstimulation by using a gonadotropin‐releasing hormone antagonist or agonist at Osaka Medical College, Japan. The patients were classified into five groups: advanced age, male infertility, severe endometriosis, tubal infertility, and unexplained infertility. The primary outcomes were the patients’ age, oocyte retrieval ratio, serum basal follicle‐stimulating hormone, total dose of gonadotropin, and the clinical outcome. A secondary outcome was the stepwise multivariate logistic regression analysis to assess the factors associated with the failure of oocyte retrieval.ResultsThe oocyte retrieval ratio declined significantly with the patient's age. The ratio of endometriosis in unsuccessful cases was significantly higher than that in successful cycles. Advanced age and endometriosis were the factors that were significantly associated with a lowered oocyte retrieval rate.ConclusionAdvanced age and endometriosis are high‐risk factors that contribute to oocyte retrieval failure in infertile patients who are receiving IVF treatment.

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Section: Discussionmentioning

confidence: 99%

Analyzing the risk factors for a diminished oocyte retrieval rate under controlled ovarian stimulation

Nakamura

Yamashita

Hayashi

et al. 2016

Reprod Medicine & Biology

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“…Ovarian endometriomas were removed following the technique described by Donnez [7]. Briefly, the ovarian cyst was opened and its content drained, the cleavage plane was found and the pseudo-capsule was separated from the ovarian parenchyma by means of repeated diverging traction applied with atraumatic forceps.…”

Section: Methodsmentioning

confidence: 99%

“…Ovarian cystectomy for endometriomas seems to cause significant damage to ovarian reserve with up to 40 % fall in serum AMH concentration [5,6]. According to Donnez et al, cystectomy may be destructive for the ovary, whereas ablation may be incomplete with a greater risk of recurrence [7]. With the combined technique (excision of a large part of endometrioma wall with vaporization of the remaining 10-20 % of endometrioma wall close to the hilus), we achieve the benefits of stripping on symptoms and recurrence, and a less harmful effect of ablation on ovarian reserve.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of ovarian suspension to round ligament with a resorbable suture to prevent postoperative adhesions in women with ovarian endometrioma: follow-up by transvaginal hydrolaparoscopy

et al. 2014

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The aim of this study was to assess the effect of ovarian suspension to the round ipsilateral ligament with a resorbable suture, performed during laparoscopic surgery for endometrioma, on postoperative ovarian adhesion formation. The tool used to assess this effect was not conventional laparoscopy but outpatient transvaginal hydrolaparoscopy. Fifty women with single ovarian endometrioma were divided in two groups (group A, 24 and group B, 26). All patients underwent laparoscopic ovarian cystectomy for endometriosis. In group A, the ovary was suspended to the ipsilateral round ligament. In group B, ovarian suspension was not performed. All patients underwent transvaginal outpatient hydrolaparoscopy as follow-up. A significantly lower rate of postsurgical ovarian adhesion in group A in comparison with group B (33.3 vs 80.8 %-p=0.001) was observed. Operative time and postoperative pain were similar in both groups. Ovarian suspension to the ipsilateral round ligament with a resorbable suture during surgery for endometrioma is associated with a lower rate of postoperative ovarian adhesion formation.

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“…25 To overcome these problems, Donnez et al described a new mixed technique for the laparoscopic management of endometriomas. 26 Electrosurgical coagulation of the remaining parenchyma after excision of the cyst wall may cause further damage to the ovarian tissue. However, when appropriate techniques are used, small vessels may be identified and coagulated with bipolar forceps that, under these circumstances, may limit thermal damage to less than 0.2 mm.…”

Section: Fenestration and Ablation (Fulguration Or Vaporization)mentioning

confidence: 99%

A review article on ovarian cystectomy in endometriomas by laparoscopy

Yadav

Patel

2017

Int J Reprod Contracept Obstet Gynecol

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Endometrioma is one of the most frequent adnexal masses in the reproductive population. Medical therapy is inefficient and cannot be recommended in the management of ovarian endometriomas. The general consensus is that ovarian endometriomas larger than 4 cm should be removed, both to reduce pain and to improve spontaneous conception rates. The removal of ovarian endometriomas can be difficult, as the capsule is often densely adherent. While the surgical treatment of choice is surgical laparoscopy, for conservative treatment, the preferred method is modified combined cystectomy. Cystectomy can be destructive for the ovary, whereas ablation may be incomplete, with a greater risk of recurrence.

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Laparoscopic management of endometriomas using a combined technique of excisional (cystectomy) and ablative surgery

Cited by 201 publications

References 21 publications

Analyzing the risk factors for a diminished oocyte retrieval rate under controlled ovarian stimulation

Analyzing the risk factors for a diminished oocyte retrieval rate under controlled ovarian stimulation

Efficacy of ovarian suspension to round ligament with a resorbable suture to prevent postoperative adhesions in women with ovarian endometrioma: follow-up by transvaginal hydrolaparoscopy

A review article on ovarian cystectomy in endometriomas by laparoscopy

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