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Tanos et al. Mini-invasive Surg 2020;4:39 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2019.59

Original Article Open Access

Endometrioma surgery and possibilities of early
disease control

Vasilios Tanos , Elsie Sowah 3
1,2
1 University of Nicosia Medical School, Nicosia 2408, Cyprus.
2 Department of Obstetrics and Gynaecology, Aretaieo Hospital, Strovolos, Nicosia 2024, Cyprus.
3 St. George’s, University of London, London, SW17 ORE United Kingdom

Correspondence to: Prof. Vasilios Tanos, Aretaieo Hospital, 55-57 Andreas Avraamides, Strovolos, 2024, Nicosia, Cyprus.
E-mail: v.tanos@aretaeio.com
How to cite this article: Tanos V, Sowah E. Endometrioma surgery and possibilities of early disease control. Mini-invasive Surg
2020;4:39. http://dx.doi.org/10.20517/2574-1225.2019.59
Received: 15 Dec 2019 First Decision: 24 Feb 2020 Revised: 13 Apr 2020 Accepted: 29 Apr 2020 Published: 24 Jun 2020

Science Editor: Simone Ferrero Copy Editor: Jing-Wen Zhang Production Editor: Jing Yu

Abstract
Aim: The purpose of this study is to investigate the efficacy of surgical management in ovarian endometrioma for
early disease control and long-term fertility preservation in adolescents and women of very young age. A history
of cyclic pains in adolescents is highly associated with endometriosis. Sonography enables the diagnosis of small
endometriomas 1-2 cm in diameter. Although it is obvious that the risk of damage to normal ovarian tissue is
diminished when operating and removing a 2 cm endometrioma, it is not approved since there are currently no
tools available to identify at-risk patients. Additionally, performing laparoscopic surgery with 5 mm instruments in
patients with small endometriomas will likely cause more harm than benefit.

Methods: A literature review was performed using key words for endometrioma surgery, in vitro fertilization
(IVF), implantation rate, pregnancy rate and adolescents. The pros and cons of surgical removal prior to
assisted reproductive therapy (ART), outcomes of endometrioma surgical treatment before IVF, and current
recommendations for endometrioma removal were investigated.

Results: The total patient population from articles supporting removal of endometrioma before assisted
reproductive therapy and evidence against were 30,741 and 9983 respectively. However, the only study reporting
a statistically significant result found an 8.2% implantation rate for the surgical removal group vs . 12% in the
direct-to-IVF group, and 14.9% pregnancy rate in the surgical removal group vs . 24.9% in the direct-to-IVF
group. Damage to ovarian reserve and function due to surgery is exacerbated by large cyst size, stripping of the

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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