The presence of living endometrial cells in ovarian endometriotic cyst fluid may contribute to the recurrence of endometriosis after surgical excision of endometriomas

Xu, Xinxin; Chen, Yi‐Chen; Yu, Qin; Wang, Jianzhang; Xu, Ping; Zhu, Libo; Xu, Qian; Zhang, Jing; Cui, Shuling; Yu, Kewen; Li, Tiantian; Guo, Xinyue; Zhang, Xinmei

doi:10.1186/s13048-022-01018-9

Cited by 10 publications

(3 citation statements)

References 55 publications

(58 reference statements)

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“…A recent study suggested that the presence of living endometrial cells in ovarian endometriotic cyst fluid may contribute to the recurrence of endometriosis after surgical excision of OMAs [ 13 ]. We recommend that adhesiolysis (which requires excellent vision) is more easily performed with the OMA intact (rather than deflated); however, the risk of rupturing the pathology during adhesiolysis needs to be balanced.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Cystectomy for a 20-Centimetre Ovarian Endometrioma in a Subfertile Patient: Α Case Report

Grigoriadis,

Lazaridis,

Smith

et al. 2024

Cureus

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Large ovarian endometriomas may cause severe pressure symptoms and often require surgical management. The laparoscopic approach, although challenging, is feasible and safe when performed by surgeons with advanced minimal access skills, provided that certain rules are respected. We report a case of a 40-year-old, nulliparous patient with a history of endometriosis, low ovarian reserve, and subfertility who presented with a 20-cm left ovarian endometrioma and associated symptoms, managed successfully by laparoscopic cystectomy. Compared to non-excisional surgical methods, endometrioma cystectomy likely causes a more profound decline in post-operative ovarian reserve, which is particularly important in the context of subfertility. We discuss the technical aspects of this challenging procedure, potential alternative approaches, and clinical decision-making as to why cystectomy was preferred.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Cystectomy for a 20-Centimetre Ovarian Endometrioma in a Subfertile Patient: Α Case Report

Grigoriadis,

Lazaridis,

Smith

et al. 2024

Cureus

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“…All types of endometriotic lesions have a high rate of recurrence after conservative surgery. It has been proposed that recurrence rates of endometriosis after surgery occur due to cyst fluid leakage of ovarian endometriotic cyst fluid, which contains living endometrial cells with high adhesion ability, which may contribute to the recurrence of endometriosis after surgical excision [60]. This poses a significant further strain on the management of endometriosis.…”

Section: Surgical Techniques That May Help To Reduce Ovarian Damage I...mentioning

confidence: 99%

Oocyte Cryopreservation in Women with Ovarian Endometriosis

Mifsud,

Pellegrini,

Cozzolino

2023

JCM

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Ovarian endometriosis is a gynecological condition that is closely associated with infertility—from its pathogenesis to treatment modalities, this condition presents a challenge both for patients and clinicians alike when seeking conception, due to low AMH levels, peritoneal inflammation, and the inadvertent removal of healthy ovarian parenchyma at surgery. In fact, around half of endometriosis patients seeking fertility require tertiary-level assisted reproduction techniques to achieve a live birth. Oocyte cryopreservation, a procedure initially designed for oncology patients, has emerged over recent years as a very promising treatment strategy for patients who have been diagnosed with ovarian endometriosis in order to preserve their fertility and obtain a live birth at a later stage in their lives. Counseling patients about oocyte preservation techniques at an early stage in the diagnosis, ideally before the age of 35 and especially prior to any surgical treatment, provides an excellent opportunity to discuss future fertility and the benefits associated with oocyte cryopreservation.

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“…An ovarian cyst, a common tumor of the female reproductive system, is caused by an abnormal endocrine system or genetic factors ( 1 , 2 ). It has an incidence rate of 1.3–24.0%, with more than 90% being benign tumors ( 3 , 4 ).…”

Section: Introductionmentioning

confidence: 99%

Transvaginal natural orifice endoscopic surgery for ovarian cystectomy: a more suitable surgical approach for the day-care procedure

Xie

Huang

et al. 2023

Front. Med.

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IntroductionAlthough previous studies have shown that vaginal natural orifice transluminal endoscopic surgery (vNOTES) has the advantages of causing less pain, faster recovery, and better concealment of surgical incisions, which aligns with the concept of the day-care procedure, this approach poses a greater risk of damaging adjacent organs (i. e., rectum and bladder) due to its anatomical specificity. Moreover, the day-care procedure may lead to relatively less preoperative evaluation and postoperative care. Hence, it is necessary to explore the safety and effectiveness of vNOTES for ovarian cystectomy in the day-care procedure, to provide a theoretical basis for the wider development of vNOTES surgery.Materials and methodsThis retrospective study included 131 patients at our hospital who underwent ovarian cystectomy from September 2021 to October 2022. Based on the surgical approach, patients were classified into transumbilical laparoendoscopic single-site surgery (LESS) and vNOTES groups. The patients' demographic characteristics and follow-up data were collected during the perioperative period and 1-month postoperatively.ResultsVaginal natural orifice transluminal endoscopic surgery has less postoperative exhaust time, a lower postoperative 6-hour pain score, and a lower incidence of analgesic drug use, with higher surgical conversion incidence. Multiple linear regression analysis showed that the surgical conversion, chocolate cyst, bilateral cyst, and pelvic adhesion increased the operation duration by ~43 (95% CI: 10.309, 68.152, p < 0.001), 15 (95% CI: 6.342, 45.961, p = 0.036), 10 (95% CI: 3.07, 40.166, p = 0.019), and 8 (95% CI: 4.555, 26.779, p = 0.035) min, respectively. Interestingly, vNOTES decreased the operation duration by ~8.5 min (95% CI: −18.313, −2.699, p = 0.033).ConclusionVaginal natural orifice transluminal endoscopic surgery was equally safe and effective for ovarian cystectomy compared to LESS. vNOTES aligned with the concept of the day-care procedure due to its reduced postoperative pain, shorter exhaust time, and absence of scarring. However, surgeons should conduct a comprehensive preoperative evaluation and exclude patients suspected to have severe pelvic adhesions.

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The presence of living endometrial cells in ovarian endometriotic cyst fluid may contribute to the recurrence of endometriosis after surgical excision of endometriomas

Cited by 10 publications

References 55 publications

Laparoscopic Cystectomy for a 20-Centimetre Ovarian Endometrioma in a Subfertile Patient: Α Case Report

Laparoscopic Cystectomy for a 20-Centimetre Ovarian Endometrioma in a Subfertile Patient: Α Case Report

Oocyte Cryopreservation in Women with Ovarian Endometriosis

Transvaginal natural orifice endoscopic surgery for ovarian cystectomy: a more suitable surgical approach for the day-care procedure

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