Factors for Removal of Normal Ovarian Tissue During Laparoscopic Cystectomy
Factors for Removal of Normal Ovarian Tissue During Laparoscopic Cystectomy
Background: The aim of this study was to identify risk factors for the removal of normal ovarian tissue during laparoscopic cystectomy for endometriosis.
Methods: A total of 121 patients who had histologically confirmed ovarian endometriosis and 56 control patients who had other histologically confirmed benign cysts were included for the present analysis. The blocks of removed tissue were sectioned at 120 µm intervals and a total of five sections were analyzed for each ovarian cyst. Eight variables (age, pre-operative medical treatment, previous surgery for ovarian endometriosis, single or multiple cysts, size of the largest cyst, side of cyst, co-existence of deep endometriosis, revised American Society for Reproductive Medicine classification) were evaluated using a generalized linear modeling analysis to identify major factors associated with the removal of normal ovarian tissue.
Results: Normal ovarian tissue adjacent to the cyst wall was detected in 71 patients (58.7%) with endometriosis, whereas normal ovarian tissue was removed from only three patients (5.4%) with other benign cysts. A significant factor that was independently associated with the removal of normal ovarian tissue with ovarian endometriosis was pre-operative medical treatment.
Conclusions: The present retrospective, controlled study suggests that pre-operative medical treatment might be a risk factor for the removal of normal ovarian tissue during laparoscopic cystectomy for ovarian endometriosis.
Laparoscopic surgery has become the gold standard for treatment of ovarian endometriosis (Canis et al., 2003). A Cochrane review concluded that excisional surgery of ovarian endometriosis results in a more favorable outcome than drainage and ablation with regard to recurrence, pain symptoms and subsequent spontaneous pregnancy in women who were previously subfertile (Hart et al., 2008). Consequently, excisional surgery for ovarian endometriosis should be the preferred surgical approach (Hart et al., 2008). However, both excision and ablation may damage normal ovarian cortex. The current technique of ovarian endometrioma capsule excision may lead to the removal of normal ovarian tissue, causing loss of follicles (Hachisuga and Kawarabayashi, 2002). On the other hand, capsule ablation may lead to thermal (heat) damage to the underlying ovarian cortex (Maouris and Brett, 2002). Ovarian endometriosis is found almost exclusively in women of reproductive age, and many women intend to conceive after endometriosis surgery (Chapron et al., 2002; Vercellini et al., 2003). Therefore, surgeons would benefit from knowing which factors, if any, predispose a patient to losing normal ovarian tissue during laparoscopic cystectomy for ovarian endometriosis (Chapron et al., 2002; Vercellini et al., 2003).
The goal of this study was to identify these factors. As controls, we included patients who underwent laparoscopic cystectomy for other benign cysts. The findings from this study could aid in the development of improved surgical cystectomy techniques designed to spare normal ovarian tissue.
Abstract and Introduction
Abstract
Background: The aim of this study was to identify risk factors for the removal of normal ovarian tissue during laparoscopic cystectomy for endometriosis.
Methods: A total of 121 patients who had histologically confirmed ovarian endometriosis and 56 control patients who had other histologically confirmed benign cysts were included for the present analysis. The blocks of removed tissue were sectioned at 120 µm intervals and a total of five sections were analyzed for each ovarian cyst. Eight variables (age, pre-operative medical treatment, previous surgery for ovarian endometriosis, single or multiple cysts, size of the largest cyst, side of cyst, co-existence of deep endometriosis, revised American Society for Reproductive Medicine classification) were evaluated using a generalized linear modeling analysis to identify major factors associated with the removal of normal ovarian tissue.
Results: Normal ovarian tissue adjacent to the cyst wall was detected in 71 patients (58.7%) with endometriosis, whereas normal ovarian tissue was removed from only three patients (5.4%) with other benign cysts. A significant factor that was independently associated with the removal of normal ovarian tissue with ovarian endometriosis was pre-operative medical treatment.
Conclusions: The present retrospective, controlled study suggests that pre-operative medical treatment might be a risk factor for the removal of normal ovarian tissue during laparoscopic cystectomy for ovarian endometriosis.
Introduction
Laparoscopic surgery has become the gold standard for treatment of ovarian endometriosis (Canis et al., 2003). A Cochrane review concluded that excisional surgery of ovarian endometriosis results in a more favorable outcome than drainage and ablation with regard to recurrence, pain symptoms and subsequent spontaneous pregnancy in women who were previously subfertile (Hart et al., 2008). Consequently, excisional surgery for ovarian endometriosis should be the preferred surgical approach (Hart et al., 2008). However, both excision and ablation may damage normal ovarian cortex. The current technique of ovarian endometrioma capsule excision may lead to the removal of normal ovarian tissue, causing loss of follicles (Hachisuga and Kawarabayashi, 2002). On the other hand, capsule ablation may lead to thermal (heat) damage to the underlying ovarian cortex (Maouris and Brett, 2002). Ovarian endometriosis is found almost exclusively in women of reproductive age, and many women intend to conceive after endometriosis surgery (Chapron et al., 2002; Vercellini et al., 2003). Therefore, surgeons would benefit from knowing which factors, if any, predispose a patient to losing normal ovarian tissue during laparoscopic cystectomy for ovarian endometriosis (Chapron et al., 2002; Vercellini et al., 2003).
The goal of this study was to identify these factors. As controls, we included patients who underwent laparoscopic cystectomy for other benign cysts. The findings from this study could aid in the development of improved surgical cystectomy techniques designed to spare normal ovarian tissue.
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