Laparoscopic Treatment Of Endometriosis Research Articles

Emergency department attendances for persistent pelvic pain are not reduced following laparoscopic surgery for women with or without endometriosis.

To explore the change in emergency department (ED) attendances for persistent pelvic pain (PPP) following laparoscopic treatment of endometriosis. A retrospective service evaluation was conducted on a convenience sample of 1 calendar year of elective gynaecological laparoscopies for PPP. Data were collected on ED visits for surgical complications, and for PPP in the 12 months prior to and following surgery. Of the 195 women undergoing laparoscopy, 30 had attended the ED owing to their PPP in the preceding year. Endometriosis was found and treated in 51% of the cohort and no cause for pain was found in the other 96 women. Eighteen women suffered postoperative complications. In the subsequent 12 months, 31 of the cohort attended the ED for PPP. Likelihood of unscheduled hospital visits for post-operative complications and for exacerbations of pain in the year prior to and following surgery was independent of the presence of endometriosis lesions. In a cohort of women living with PPP, laparoscopic surgery failed to reduce the need to attend the ED owing to their pain. Further investigation into interventions that can reduce the burden of pain on these women and the healthcare system is required.

Hyaluronic acid gel application versus ovarian suspension for prevention of ovarian adhesions during laparoscopic surgery on endometrioma: a double-blind randomized clinical trial

BackgroundThis study aimed to compare the effect of ovarian suspension and hyaluronic acid gel to prevent re-adhesions after laparoscopic endometrioma surgery.MethodsThis randomized clinical trial was conducted at Rasoul-e-Akram and Pars Hospitals, Tehran, Iran, 2016-18. Fifty patients with bilateral endometrioma and pelvic adhesions, the candidates of laparoscopic surgery, were included. In each patient, at the end of ovarian cystectomy and adhesiolysis, one of the ovaries was randomly sutured to the abdominal wall, and the HYAcorp Endogel covered the other; the adhesion rate was compared between the groups by ultrasonography, three-month after surgery.ResultsMean age of patients was 32.6 years. Presurgical variables were similar between right and left ovaries and the study groups (P > 0.05). Postsurgical ultrasonography showed that ovarian soft markers, including < 1/3 ovarian adhesions (minimal adhesions) in 80.5% of ovaries of the Endogel group and 35.5% of the ovarian suspension group (P < 0.001) with higher ovarian mobility in the Endogel group (65% vs. 22%) (P = 0.001). In addition, site-specific tenderness and ovarian fading margin were lower in the Endogel group (P < 0.001).Trial registration Clinical trial registry number: IRCT2015081723666N1, 12.19.2015, Date of registration: 01/02/2016; https://en.irct.ir/trial/20174?revision=20174. Date and number of IRB: 2015, I.R.IUMS.REC.1394.24703.ConclusionHyaluronic acid gel can be more effective than ovarian suspension in preventing ovarian adhesions after laparoscopic treatment of endometriosis.

Endometriosis fertility index predicts pregnancy in women operated on for moderate and severe symptomatic endometriosis

ABSTRACT Endometriosis Fertility Index (EFI) is a clinical staging system created to predict spontaneous pregnancy outcomes in patients with endometriosis. The present study aimed at evaluating the performance of EFI in symptomatic patients, submitted to laparoscopy for moderate and severe endometriosis associated to infertility in a Brazilian population. Seventy-seven women with endometriosis and pelvic pain, who desired to become pregnant, were selected from a tertiary care unit between those operated on between May 2007 and March 2017. All of them were submitted to laparoscopy for the surgical treatment of endometriosis and allowed to attempt natural conception for 36 months or immediately referred to in vitro fertilization (IVF). EFI was calculated according to surgical description and clinical information in medical records. Pregnancy rates and live birth rates after natural conception or IVF are reported and correlated to EFI. Fifty-three women tried natural conception and 24 were referred to IVF. Of the 53 who tried natural conception, 29 achieved pregnancy (54.7%) and 28 had live birth (52.8%). The majority of pregnancies (82.7%) occurred in the first 12 months after surgery and 75% of the patients who became spontaneously pregnant had EFI ≥ 7. Of the 24 patients referred to IVF, 13 became pregnant (54.1%) and 10 had live birth (41.7%). Infertility duration of 36 months or more and the presence of endometrioma increased the probability of having EFI ≤ 5. The overall live birth rate (LBR) for patients with low EFI scores (2–4) was 17% compared with 83.8% for those with higher EFI scores (6–9). EFI predicts pregnancy rates in patients operated on for moderate and severe endometriosis. Scores seem also to predict pregnancy rates after IVF.

Suburethral Endometriosis as a Clinical Finding of Extensive Disease - a Case Report and Review of Literature

Study Objective Endometriosis spreading to the vagina is rare, present in only 0.02% of women with symptomatic endometriosis. Suburethral lesion site is exceptional. Our objective is to present a case of primary vaginal suburethral endometriosis and a literature review of the only 4 previously published suburethral endometriosis cases. Design Case report and literature review using key words: urethral endometriosis, suburethral endometriosis and urethral diverticulum. Setting Video laparoscopy, hysteroscopy and cystourethroscopy were performed. Patients or Participants A 31-year-old patient who presented with chronic pelvic pain that worsened with menstruation, dyspareunia and dysuria. Physical exam revealed a 2 cm suburethral bluish cystic-appearing lesion. Her exam was also significant for enlarged, tender uterus and adnexa. Based on examination and imaging, adenomyosis and endometriosis were suspected. Interventions Surgical excision of a 2 cm suburethral lesion revealing a chocolate like material with a fibrocystic wall adherent to the paraurethral tissue with no urethral muscularis invasion. Cystourethroscopy examination revealed no evidence of mucosal involvement of the urethra and no evidence of bladder endometriosis. Laparoscopic treatment of endometriosis was performed with pelvic sidewall and rectovaginal dissection with vaporization, excision of endometriotic lesions and restoration of the anatomy. There was one enlarged presacral lymph node that was excised and was positive for endometriosis on frozen section. A wedge cytoreductive resection of fundal adenomyotic lesion was performed without cavity penetration. The uterus was reconstructed in multiple layers with absorbable polyglactin 910 sutures. Measurements and Main Results Surgical evaluation revealed extensive endometriosis with lymph node involvement at laparoscopic exploration. Suburethral endometriotic lesion was excised confirmed to be endometriosis by histopathology. Dysuria and dyspareunia symptoms completely resolved, and her pelvic pain markedly improved after the surgery. Conclusion Primary vaginal suburethral endometriosis, although rare, could be an indication of extensive endometriosis. This case highlights the importance of careful clinical examination, surgical excision and laparoscopic evaluation when identifying suburethral vaginal endometriotic lesions. Endometriosis spreading to the vagina is rare, present in only 0.02% of women with symptomatic endometriosis. Suburethral lesion site is exceptional. Our objective is to present a case of primary vaginal suburethral endometriosis and a literature review of the only 4 previously published suburethral endometriosis cases. Case report and literature review using key words: urethral endometriosis, suburethral endometriosis and urethral diverticulum. Video laparoscopy, hysteroscopy and cystourethroscopy were performed. A 31-year-old patient who presented with chronic pelvic pain that worsened with menstruation, dyspareunia and dysuria. Physical exam revealed a 2 cm suburethral bluish cystic-appearing lesion. Her exam was also significant for enlarged, tender uterus and adnexa. Based on examination and imaging, adenomyosis and endometriosis were suspected. Surgical excision of a 2 cm suburethral lesion revealing a chocolate like material with a fibrocystic wall adherent to the paraurethral tissue with no urethral muscularis invasion. Cystourethroscopy examination revealed no evidence of mucosal involvement of the urethra and no evidence of bladder endometriosis. Laparoscopic treatment of endometriosis was performed with pelvic sidewall and rectovaginal dissection with vaporization, excision of endometriotic lesions and restoration of the anatomy. There was one enlarged presacral lymph node that was excised and was positive for endometriosis on frozen section. A wedge cytoreductive resection of fundal adenomyotic lesion was performed without cavity penetration. The uterus was reconstructed in multiple layers with absorbable polyglactin 910 sutures. Surgical evaluation revealed extensive endometriosis with lymph node involvement at laparoscopic exploration. Suburethral endometriotic lesion was excised confirmed to be endometriosis by histopathology. Dysuria and dyspareunia symptoms completely resolved, and her pelvic pain markedly improved after the surgery. Primary vaginal suburethral endometriosis, although rare, could be an indication of extensive endometriosis. This case highlights the importance of careful clinical examination, surgical excision and laparoscopic evaluation when identifying suburethral vaginal endometriotic lesions.

Laparoscopic treatment of endometriosis and predictors of major complications: A retrospective cohort study.

Patients with advanced endometriosis may be at an increased risk of surgical complications following laparoscopic treatment of endometriosis; however, this relationship has not been examined. We sought to identify predictors of major complications following laparoscopic treatment of endometriosis. A retrospective cohort study of women who underwent laparoscopic treatment of suspected endometriosis between 2009 and 2016 within the Division of Minimally Invasive Gynecologic Surgery at Brigham and Women's Hospital, Boston, MA, USA. Predictors of major perioperative complications were assessed by comparing the characteristics of women who had any major intraoperative or postoperative complication with those of women who had no complication. A total of 397 women underwent laparoscopic treatment of suspected endometriosis including excision of superficial endometriosis (55.4%), excision of deep-infiltrating endometriosis (24.9%), fulguration of endometriosis (38.3%), hysterectomy (23.2%), ovarian cystectomy (35.5%), salpingectomy (18.6%), oophorectomy (15.1%), and bowel resection (1.0%). Women were followed for 60days following surgery, over which time 18 women (4.5%) had a major perioperative complication. Patient characteristics and preoperative imaging were similar between women with and without complications. Women with advanced endometriosis, including stage III or IV endometriosis, deep-infiltrating endometriosis, or rectovaginal disease, were more likely to have a complication, though this did not reach statistical significance (77.8% of women with a complication versus 56.7% of women without a complication had advanced endometriosis, P=0.077). Women who had a complication were more likely to have undergone adhesiolysis or ureterolysis (88.9% of women with a complication versus 52.5% without a complication underwent adhesiolysis, P=0.002; and 61.1% of women with a complication versus 28.8% without a complication underwent ureterolysis, P=0.003). The total number of procedures was greater for women who had a complication (4.3±1.2 vs 3.2±1.5, P=0.003). All other procedure characteristics were similar between women with and without complications. Complications following laparoscopic treatment of suspected endometriosis could not be predicted by preoperative patient characteristics or surgical findings of advanced endometriosis. Adhesiolysis, ureterolysis, and an increased number of total procedures may be predictive of perioperative complications, suggesting that surgical complexity as measured by the procedures performed, rather than the disease severity, may increase the risk of a complication compared with women who do not undergo these procedures.

Identification of Predictive Factors in Endometriosis for Improvement in Patient Quality of Life

To investigate predictive factors for change in quality of life (QOL) between pre- and postoperative periods in patients with endometriosis. A prospective and multicenter cohort study. Five districts including a tertiary referral center and private and general public hospitals. Nine hundred eighty-one patients aged 15 to 50 years underwent laparoscopic treatment (preferred approach) for endometriosis between January 2004 and December 2012. Laparoscopic treatment for endometriosis. All revised American Fertility Society stages were included. QOL was evaluated using the 36-Item Short Form Survey questionnaire. Factors influencing changes for each 36-Item Shorty Form Survey domain score between t0 (before surgery) and 1 year after surgery were predicted on the basis of univariate and multivariable analyses. The effect size (ES) method was used to measure changes in QOL. Univariate analysis revealed that 47% of stage IV endometriosis patients presented an improvement in the postoperative Physical Component Summary (PCS) score (ES ≥ 0.8) versus 26%, 31.3%, and 27.5% of patients with stage I, II, and III, respectively (p <.001). Forty-four percent and 38% of patients with chronic pelvic pain (CPP) presented an improvement in postoperative PCS and Mental Component Summary scores (ES>0.8) versus 23% and 24% of patients without CPP, respectively (p <.001). Multivariable analysis (ES > 0.8 vs ES < 0) revealed that women with CPP were more likely to experience greater improvement in postoperative PCS and Mental Component Summary scores than women without CPP (relative risk [RR] = 2.7; 95% confidence interval [CI], 1.7-4.4; p <.001 and RR = 1.8; 95% CI, 1.2-2.8; p <.01, respectively). Accordingly, fertile patients were more likely to show higher rates of improvement in the postoperative PCS score than infertile patients (RR = 1.8; 95% CI, 1.1-3.1; p <.05). Patients presenting with severe endometriosis and who experience higher levels of pain are more likely to show improvement in QOL after surgery. CPP is the most significant independent predictive factor for changes in QOL scores.

The Role of Magnetic Resonance Imaging–Diffusion Tensor Imaging in Predicting Pain Related to Endometriosis: A Preliminary Study

ObjectivesTo evaluate the sacral nerve root features by the means of magnetic resonance imaging–diffusion tensor imaging (MRI-DTI) tractography in women with endometriosis and/or adenomyosis, and to analyze the correlations among DTI abnormalities, pain symptoms, and endometriotic lesions found at surgery. DesignA cross-sectional, observational study (Canadian Task Force classification II-2). SettingUniversity hospital. PatientsWomen (n = 76) with clinical suspicion of endometriosis. InterventionsBefore surgery, dysmenorrhea, deep dyspareunia, and noncyclic pelvic pain (NCPP) were assessed using a 10-point visual analog scale. MRI enabled a 3-dimensional reconstruction of S1, S2, and S3. Fractional anisotropy was calculated for each root. Laparoscopic treatment of endometriosis was performed in 56 patients. Measurements and Main ResultsOur findings revealed correlations among sacral root reconstruction by MRI-DTI, pain symptoms, and laparoscopic findings. DTI of sacral roots revealed a regular and homogeneous appearance in 17 patients (25.8%) and abnormalities in microstructure reconstruction, with fiber irregularities and disorganization and loss of the simple unidirectional course, in 44 patients (66.7%). At laparoscopy, ovarian endometriomas were found in 82.1% of the patients, and deeply infiltrating endometriosis (DIE) were found in 57.1%. Endometriosis was staged according to the revised American Society for Reproductive Medicine classification. Pathological DTI findings were significantly associated with the severity of dysmenorrhea and NCPP, pain duration, presence of tubo-ovarian and cul-de-sac adhesions, and DIE. ConclusionThe presence of pathological DTI findings of the sacral nerve roots correlates with the type of pain, adhesions, and DIE. At present, DTI can be useful for providing a better understanding of pain; however, DTI could become a useful tool in therapeutic planning for patients with endometriosis.

Laparoscopia en endometriosis

El tratamiento quirúrgico de la endometriosis debe encaminarse al tratamiento del dolor y la recuperación de la función reproductiva, mediante la eliminación de los implantes y la reconstitución de la anatomía pélvica alterada. El manejo quirúrgico laparoscópico de la endometriosis, en comparación con el abordaje a cielo abierto, permite una estancia hospitalaria corta, recuperación rápida, incisiones más pequeñas, entre otros. Asimismo, posibilita una mayor accesibilidad y magnificación de los nódulos profundos recto-vaginales. La ablación de lesiones endometriósicas y la ablación laparoscópica de nervios uterosacros (LUNA) en la enfermedad mínima a moderada reduce el dolor asociado a endometriosis, comparado con la laparoscopia diagnóstica. En el tratamiento quirúrgico de la infertilidad asociada a endometriosis la ablación de lesiones endometriósicas y la liberación de adherencias mejoran la fertilidad en la endometriosis mínima y leve, comparada con la laparoscopìa diagnóstica sola. En casos de endometriomas mayores de 4 cm, la quistectomía laparoscópica mejora la fertilidad, comparada con el drenaje y cauterización. La técnica quirúrgica de la quistectomía debe ser lo más cuidadosa posible, para evitar dañar tejido ovárico sano, evitando así reducir la reserva ovárica. Es muy importante referir a la paciente con endometriosis severa, con compromiso de intestino o uréter, o con implantes profundos en el tabique rectovaginal, a centros de mayor complejidad, que dispongan de la experiencia y el equipamiento necesario para realizar cirugía laparoscópica avanzada.

Fertility Outcome after Laparoscopic Treatment of Endometriosis in Infertile Women

Fertility Outcome after Laparoscopic Treatment of Endometriosis in Infertile Women

In vitro fertilization (IVF) success rates in patients with surgically diagnosed endometriosis and effect of time interval from surgery to IVF cycle

Endometriosis is a condition that affects a significant proportion of the infertile population. Natural fecundity as well as IVF success decreases with increasing severity of disease. Our objective was to determine whether IVF outcomes after laparoscopic treatment of endometriosis are affected by surgical stage at diagnosis and to determine whether there is a relationship between time interval to start of first IVF cycle and pregnancy rate.

Endometriosis: an overview of Cochrane Reviews.

Endometriosis: an overview of Cochrane Reviews.

Manejo de la endometriosis e Infertilidad

Las decisiones clínicas en el manejo de la infertilidad asociada a endometriosis son difíciles y muchos aspectos no han sido evaluados en ensayos clínicos aleatorizados. La laparoscopia es el estándar de oro para el diagnóstico de endometriosis, y la decisión de hacerla dependerá de la edad de la paciente, duración de la infertilidad, historia familiar, dolor pélvico, presencia de tumoraciones pélvicas en la ecografía, entre otros. El tratamiento quirúrgico conservador de la endometriosis debe encaminarse a la recuperación de la función reproductiva mediante la eliminación de los implantes y la reconstitución de la anatomía pélvica alterada. El manejo quirúrgico laparoscópico de la endometriosis, en comparación con el abordaje a cielo abierto, permite una estancia hospitalaria corta, recuperación rápida, incisiones más pequeñas. En el tratamiento quirúrgico de la infertilidad asociada a endometriosis, la ablación de lesiones endometriósicas y la liberación de adherencias mejoran la fertilidad en endometriosis mínima y leve, comparada con la laparoscopia diagnóstica sola. En casos de endometriomas mayores de 4 cm, la quistectomía laparoscópica mejora la fertilidad, comparada con el drenaje y cauterización. La técnica quirúrgica de la quistectomía debe ser lo más cuidadosa posible, para evitar dañar tejido ovárico sano, evitando así reducir la reserva ovárica. Luego de la laparoscopia se puede proceder a superovulación con inseminación intrauterina, aunque el manejo expectante es una opción para mujeres jóvenes. La fertilización asistida de alta complejidad es el tratamiento aconsejado en casos de factor tubo-peritoneal severo, factor masculino severo o cuando otros tratamientos de menor complejidad han fallado. El tratamiento con agonistas de GnRH durante 3 a 6 meses antes de la fertilización in vitro (FIV) debe ser considerado en casos de endometriosis severa.

Laparoscopic treatment of endometriosis and effects on quality of life: A retrospective study using the short form EHP-5 endometriosis specific questionnaire

Complete surgical eradication is considered the mainstay of treatment for endometriosis. The aim of the present study was to investigate patients’ own assessment of whether their laparoscopic treatment made a difference to their quality of life, as well as to assess local recurrence rates. We performed a retrospective analysis of 49 women who had laparoscopic treatment for endometriosis at our unit between 1 January 2008 and 1 January 2010. Patients were sent the Short Form EHP-5 questionnaire and asked to score their quality of life in relation to endometriosis symptoms, prior to the surgery and up to 48 months afterwards. Subgroup analysis of stage I/II and stage III/IV disease was performed as well as stratification of the period post-operation into 12–24, 25–36 and 37–48 months for follow-up analysis. Overall, the patients reported improvement in quality of life scores with a significant drop in mean scores from 46.9 pre- to 27.5 post-surgery, signifying benefits from the surgical intervention. All subgroups reported improvement in quality of life scores. The overall symptom recurrence rate was 18.3%. We conclude that patients, post-laparoscopic treatment of endometriosis, experience significant improvement in their quality of life, regardless of stage and this can be quantified and qualified.

A Comparative Study of the use of Different Energy Sources in Laparoscopic Management of Endometriosis-Associated Infertility

Background: Although there is controversy about the mechanism by which endometriosis causes infertility, laparoscopic treatment for endometriosis-associated infertility is becoming popular. However, the optimal modality of energy sources used for dissection and ablation in infertile women remains unexplored. Objective: To study the best available evidence exploring the use of laparoscopic surgery in infertile women with endometriosis, compare various available energy sources, and their effect on surgical outcome and probability of pregnancy. Methods: A retrospective review of literature was done to explore the role of laparoscopic surgery and various energy sources in managing endometriosis-associated infertility, using keywords—endometriosis, laparoscopy, infertility, electrosurgery and ultrasonic energy. Results: Laparoscopic treatment of endometriosis using mechanical or electrical technologies was proposed in the 1980s. Later, use of lasers to vaporize endometriosis and to excise adhesions became popular. The invention of ultrasonic generator and tissue response electrosurgical generator has revolutionized laparoscopic surgery for endometriosis. Conclusion: No prospective randomized double-blind controlled trial has been conducted to date in this area. Current evidence suggests that laparoscopic excision or ablation, either by electrocautery or laser, improves pregnancy rates. However, the impact of newer energy sources and tissue dissection techniques in this field is yet to be explored.

Long-term follow-up after laparoscopic treatment for endometriosis: multivariate analysis of predictive factors for recurrence of endometriotic lesions and pain

Objective To investigate factors that might influence the recurrence of both painful symptoms and endometriotic lesions following laparoscopic treatment of endometriosis. Study design Retrospective cohort study in a University teaching hospital. We reviewed data from patients referred for laparoscopy between March 1993 and November 2007. We selected women who were followed up throughout Transvaginal-ultrasound (TV-US) after a first conservative laparoscopy for endometriosis. After laparoscopy, all patients were followed up according to an internal protocol: a standard gynaecologic examination, the assessment of painful symptoms and a TV-US scan that were repeated at 3, 6, and 12 months, and subsequently on a yearly basis. Sixteen factors were assessed by univariable and multivariable Cox proportional hazards models to evaluate their associations with recurrence of endometriotic lesions and pain related-endometriosis. Results 401 women were enrolled. A total of 154 (38.4%) experienced moderate or severe pain after laparoscopy; endometriotic lesions were observed by TV-US in 74 (18.4%) patients. In the multivariable model, age at menarche, severity of chronic pelvic pain (CPP) and dysmenorrhoea prior to surgery were significant risk factors for recurrence/occurrence of pain. Age at the first laparoscopy, stage of disease, pre-operative severity of CPP, and pregnancy were predictive factors of the recurrence for such lesions. Conclusion The severity of CPP prior to the first laparoscopy showed the only significant factor in the overall prediction of recurrence of pain and endometriotic lesions. Patients with severe CPP at the time of their first surgery might represent a sub-group of women with a more aggressive form of endometriosis.

Laparoscopic Management of Peritoneal Mesothelioma Associated with Pelvic Endometriosis

Objective To describe 3 cases of peritoneal mesothelioma associated with endometriosis that were managed laparoscopically. Design Case series. Setting University and community hospitals. Patients Three women with well-differentiated papillary mesothelioma of the peritoneum associated with endometriosis. Interventions Laparoscopic excision and treatment of mesothelioma and endometriosis. Results Three patients underwent laparoscopy for treatment of endometriosis and were found to have peritoneal mesothelioma. All 3 patients underwent total laparoscopic excision of the lesions and were followed up regularly for surveillance of possible recurrence. Conclusions In selected cases of well-differentiated papillary mesothelioma associated with pelvic endometriosis, operative laparoscopy can be used effectively to diagnose and treat this condition.

A comparison of the effect of short-term aromatase inhibitor (letrozole) and GnRH agonist (triptorelin) versus case control on pregnancy rate and symptom and sign recurrence after laparoscopic treatment of endometriosis

To compare the role of an aromatase inhibitor (letrozole) with a GnRH agonist (triptorelin) versus case control on the pregnancy rate and recurrence of symptoms and signs in patients with endometriosis. In a prospective randomized clinical trial, after treatment of 144 infertile women in their reproductive age by laparoscopy (whose endometriosis was confirmed by prior laparoscopy), they were divided into 3 groups: group 1 (47 cases) who received letrozole for 2 months, group 2 (40 patients) who were prescribed triptorelin for 2 months and group 3 who were 57 patients in the control group and did not receive any medication. We followed up each group at least for 12 months after their restoration of regular cycle. Pregnancy rate was 23.4% in group 1, 27.5% in group 2, and 28.1% in group 3. The results did not show significant differences among the 3 groups. Recurrence rate of endometriosis was 6.4% in group 1, 5% group 2 and 5.3% in group 3, which was not statistically significantly different as well. Pregnancy rate and endometriosis recurrence rate are comparable among the 3 groups.

Patients' report on how endometriosis affects health, work, and daily life

The objective of this study was to assess the burden of endometriosis by obtaining patient-reported outcome data describing the experience of living with this disease. Survey data from 107 women with self-reported, surgically diagnosed endometriosis showed that living with this disease may be characterized by physical limitations that disrupt health, work, and daily life.

O428 The significance of laparoscopic treatment of endometriosis in infertile patients

O428 The significance of laparoscopic treatment of endometriosis in infertile patients

The experience of the surgeons affects ovarian reserve and pregnancy outcome after laparoscopic treatment of endometriosis in infertile patients with IVF/ICSI

OBJECTIVE: To assess whether the surgeon's experience can significantly affect ovarian reserve and pregnancy outcome in IVF/ICI patients who previously underwent laparoscopic treatment for endometriosis DESIGN: Retrospective study MATERIALS AND METHODS: We retrospectively reviewed all IVF/ICSI cycles with patients who previously underwent laparoscopic surgery for endometriosis from January 2005 through December 2008 in Chang Gung Memorial Hospital Linkou Medical Center. To clarify the impact of experience of the operators on the outcome of IVF/ICSI, we divided the surgeons into experienced and inexperienced surgeons. The main inexperienced surgeons were local clinical physicians, chief residents and fellow physicians. Antral follicle count, number of oocytes, good-quality embryos for transfer, clinical pregnancy rate, implantation rate and “take home” baby were analyzed. RESULTS: The number of antral follicle count, clinical pregnancy, and “take home” baby rate per cycle were significantly lower in the inexperienced group compared to the experienced group.Table 1Comparison of the Treatment Outcome Between the Two GroupsvariableInexperienced surgeonExperienced surgeonP valueCycles7673No. of oocytes retrieved10.1+6.49.2+6.9NSMature (MII) oocytes7.6+4.76.9+5.2NSNormal fertilization rate (%)64.4+21.763.5+22.5NSNo. of embryos transferred3.2+1.32.9+1.0NSGood-quality embryos for transfer (%)57.865.8NSImplantation rate (%)30/21938/205NSClinical pregnancy rate per cycle (%)26.341.1<0.001“take-home” baby rate per cycle (%)9.332.9<0.001 Open table in a new tab However, all other parameters, including mean number of oocytes, metaphase II oocytes, fertilization rate, the mean number of embryos transferred, implantation rate, and the rate of good quality embryos transferred were comparable among the two groups. CONCLUSIONS: The experience of the surgeons on laparoscopic surgery for endometriosis plays a detrimental effect on ovarian reserve and pregnancy outcome.