Surgical Excision Versus Ablation for Superficial Endometriosis-Associated Pain: A Randomized Controlled Trial

Riley, Kathleen; Benton, Andrea; Deimling, T.; Kunselman, Allen R.; Harkins, Gerald

doi:10.1097/ogx.0000000000000672

Cited by 5 publications

(30 citation statements)

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“…Reduction in VAS Scores for Dyschezia Data pooled from Healey et al and Riley et al [28,30] regarding the reduction in VAS scores for dyschezia from baseline before surgery and at 12 months postoperatively showed no significant difference between excision and ablation (MD 0.46; 95% CI, −1.09 to 2.02; p = .56). There was no significant heterogeneity in effects between the studies (I 2 = 46%; x 2 = 1.86; p = .17) (Fig.…”

Section: Secondary Outcome Measuresmentioning

confidence: 93%

“…2. Overall, the Healey et al [28] study was of good quality because it had the least amount of bias, whereas the Radosa et al [29] study was of poor quality because it had the most bias, and the Riley et al [30] study was determined to be of fair quality because it was determined to have intermediate bias.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The sample size of the analyzed participants ranged from 24 to 170 in these studies. Two studies, Wright et al [27] and Riley et al [30], performed follow-up at 6 months for a total of 97 participants. At the 6-month mark, 68 participants out of the 97 (70%) completed their postoperative follow-up: 34 of the 48 (71%) women in the ablation arm and 34 of the 49 (69%) in the excision arm.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…At the 6-month mark, 68 participants out of the 97 (70%) completed their postoperative follow-up: 34 of the 48 (71%) women in the ablation arm and 34 of the 49 (69%) in the excision arm. Three studies-Healey et al [28], Radosa et al [29], and Riley et al [30]-performed follow-up at 12 months or more for a total of 322 participants. At this time point after surgery, 227 out of the 322 participants (70%) completed their follow-up: 108 out of the 157 (69%) women in the ablation arm compared with 119 out of the 165 (72%) in the excision arm.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…In all 3 of the included RCTs, randomization occurred intraoperatively after the surgeons made the diagnosis of mild endometriosis. Two RCTs were double blinded, meaning both patients and clinicians were blinded to the treatment at follow-up [27,28], as opposed to the final included RCT in which the patients were blinded, but the clinicians were not [30].…”

Section: Study Characteristicsmentioning

confidence: 99%

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Excision versus Ablation for Management of Minimal to Mild Endometriosis: A Systematic Review and Meta-analysis

Burks

Lee

DeSarno

et al. 2021

Journal of Minimally Invasive Gynecology

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The aim of this systematic review and meta-analysis was to perform an updated analysis of the literature in regard to the surgical management of minimal to mild endometriosis. This study evaluated women of reproductive age with superficial endometriosis to determine if the results of surgical excision compared with those of ablation in improved pain scores postoperatively. Data Sources: The following databases were searched from inception to May 2020 for relevant studies: Cochrane Central Register of Controlled Trials, PubMed (MEDLINE), Ovid (MEDLINE), Scopus, and Web of Science. Methods of Study Selection: From our literature search, a total of 2633 articles were identified and screened. Ultimately, 4 randomized controlled trials were selected and included in our systematic review. The combined total number of subjects was 346 from these 4 studies, with sample sizes ranging from 24 to 170 participants. Data from 3 of the included studies were able to be compared and analyzed for a meta-analysis. The primary outcome was reduction in the visual analog scale (VAS) score for endometriosis-associated pain (dysmenorrhea, dyschezia, and dyspareunia), with follow-up time ranging from 6 to 60 months postoperatively. Tabulation, Integration, and Results: Data extracted from each study included the mean reduction in the VAS score from baseline. A random-effects model was used owing to significant heterogeneity across the studies. Statistical analyses were performed using Review Manager 5.3 software (Cochrane Collaboration, London, United Kingdom). The meta-analyses showed no significant differences between the excision and ablation groups in the mean reduction in VAS scores from baseline to 12 months postoperatively for dysmenorrhea (mean difference [MD] −0.03; 95% confidence interval [CI], −1.27 to 1.22; p = .97), dyschezia (MD 0.46; 95% CI, −1.09 to 2.02; p = .56), and dyspareunia (MD 0.10; 95% CI, −2.36 to 2.56; p = .94). In addition, there were no significant differences between the excision and ablation groups in mean VAS scores at the 12-month follow-up and beyond for dysmenorrhea (MD −0.11; 95% CI, −2.14 to 1.93; p = .92), dyschezia (MD 0.01; 95% CI, −0.70 to 0.72; p = .99), and dyspareunia (MD 0.34; 95% CI, −1.61 to 2.30; p = .73). Conclusion: On the basis of the data from our systematic review and pooled meta-analysis, no significant difference between laparoscopic excision and ablation was noted in regard to improving pain from minimal to mild endometriosis. However, to make definitive conclusions on this topic, larger randomized controlled trials are needed with longer followup.

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Section: Secondary Outcome Measuresmentioning

confidence: 93%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 3 more Smart Citations

Excision versus Ablation for Management of Minimal to Mild Endometriosis: A Systematic Review and Meta-analysis

Burks

Lee

DeSarno

et al. 2021

Journal of Minimally Invasive Gynecology

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Clinical practice guidelines for endometriosis in Japan (The 3rd edition)

Harada

Taniguchi

Kitajima

et al. 2022

J of Obstet and Gynaecol

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with detailed flow charts. The clinical questions (CQs) in the latter half of this edition are intended as a useful guide for decision-making in clinical practice. The authors are all physicians working tirelessly at the frontiers of endometriosis research in Japan, and this edition has undergone multiple generous revisions amid their busy schedules. Integration of the overall structure, revision of inconsistencies and duplication among CQs, and other onerous editing tasks were undertaken with tremendous dedication by the secretaries on the Japan Society of Endometriosis, Drs.

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Robotic versus laparoscopic surgery for severe deep endometriosis: protocol for a randomised controlled trial (ROBEndo trial)

et al. 2022

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IntroductionEndometriosis is a common gynaecological disease affecting around 10% of fertile-aged women, causing severe pain symptoms. Deep endometriosis is defined as endometriotic implants that infiltrate the underlying organs more than 5 mm in depth. Surgery for deep endometriosis requires advanced multidisciplinary surgical technique, often in very difficult surgical conditions, with increased risks of complications. Robotic surgery offers a high-definition three-dimensional view and articulating instruments that may allow more precise dissection than conventional laparoscopy in the pelvic area. The superiority of robotic surgery has not, however, been provedin randomised controlled studies, and there is a lack of long-term outcome data. Advanced endometriosis surgery offers an excellent platform to study the feasibility and long-term outcomes of robotic surgery compared with conventional laparoscopy.Methods and analysisROBEndo is a prospective, randomised, controlled clinical trial in a single-centre setting. Patients with deep endometriosis verified by MRI needing surgery at Oulu University Hospital (Oulu, Finland) will be considered eligible. 70 patients will be allocated 1:1 to receive either robotic-assisted or conventional laparoscopic surgery in two strata: radical surgery (with the removal of the uterus and adnexae) and gynaecological organ-sparing surgery. The primary outcome will be the surgical outcome as regards to pain symptoms measured on numeric rating scale (NRS) questionnaires at 24 hours and 6, 12 and 24 months postoperatively. As secondary outcomes, intraoperative measures, enhanced recovery after surgery factors, complications, cost and long-term quality of life measured with Endometriosis Health Profile-30 (EHP-30), Female Sexual Function Index (FSFI) and 15-dimensional (15D) questionnaires will be compared.Ethics and disseminationThis study has been approved by the Northern Ostrobothnian Hospital District Ethical Committee at Oulu University Hospital (212/2021). Informed consent will be obtained during the preoperative check-up by the operating gynaecologist. The results will be published in peer-reviewed international journals.Trial registration numberNCT05179109.

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Surgical Excision Versus Ablation for Superficial Endometriosis-Associated Pain: A Randomized Controlled Trial

Abstract: (Abstracted from J Minim Invasive Gynecol 2019;26:71–77) The primary sequelae of endometriosis are infertility and chronic pelvic pain (CPP). Nearly 40% of women with endometriosis are infertile, and 71% to 87% have CPP.

Cited by 5 publications

References 0 publications

Excision versus Ablation for Management of Minimal to Mild Endometriosis: A Systematic Review and Meta-analysis

Excision versus Ablation for Management of Minimal to Mild Endometriosis: A Systematic Review and Meta-analysis

Clinical practice guidelines for endometriosis in Japan (The 3rd edition)

Robotic versus laparoscopic surgery for severe deep endometriosis: protocol for a randomised controlled trial (ROBEndo trial)

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