Ovarian Endometrioma Research Articles

SR-16234, a Unique Selective Estrogen Receptor Modulator, Suppressed Proliferation and Pain-Related Factor Expression by Inhibition of the Nuclear Factor-kappa B Pathway in Endometriotic Stromal Cells.

What is the effect of SR-16234 (SR), a selective estrogen receptor (ER) modulator, on human endometriotic stromal cells (ESCs)? Endometriotic tissues were obtained from 21 patients undergoing laparoscopic surgery for ovarian endometriomas (OEs). Normal eutopic endometrium during the luteal phase was obtained from 18 patients without endometriosis. ESCs isolated from OEs and normal eutopic endometrial stromal cells (NESCs) were cultured with SR and subsequently exposed to tumor necrosis factor (TNF)-α. After 48 h of incubation, the effect of SR on cell proliferation was evaluated by the WST-8 assay. The gene expressions of inflammatory and pain-related factors, including interleukin (IL)-6, IL-8, cyclooxygenase (COX)-2, transient receptor potential vanilloid (TRPV)1, ESR1, and ESR2, were evaluated by real-time RT-PCR. The phosphorylation of Inhibitor κBα (IκBα), extracellular signal-regulated kinase (ERK)1/2, and Protein Kinase B (AKT) were evaluated by western blot analysis. ILs, prostaglandin (PG) E2, and intranuclear p65 syntheses were assessed by ELISA. SR treatment repressed TNF-α-induced proliferation by 20% in ESCs but not NESCs. SR also reduced IL-6, IL-8, COX-2, TRPV1, ESR1, and ESR2 mRNA expressions and ILs protein, and PGE2 synthesis in ESCs, whereas in NESCs, only TRPV1 mRNA expression was decreased. SR suppressed TNF-α-induced phosphorylated IκBα levels by approximately 50%, and intranuclear p65 protein was reduced by 30% compared to addition of only TNF-α in ESCs. However, SR did not affect the phosphorylation of AKT and ERK1/2. SR appears to be a potential therapeutic agent for endometriosis by suppressing inflammatory and pain-related factor expressions by inhibiting the nuclear factor-kappa B pathway.

Dissecting the cell microenvironment of ovarian endometrioma through single-cell RNA sequencing.

Ovarian endometrioma (OE), also known as "chocolate cysts," is a cystic mass that develops in the ovaries due to endometriosis and is a common gynecological condition characterized by the growth of endometrial tissue outside the uterus, leading to symptoms such as dysmenorrhea, pelvic pain, and infertility. However, the precise molecular and cellular mechanisms driving this pathophysiology remain largely unknown, posing challenges for diagnosis and treatment. Here, we employed integrated single-cell transcriptomic profiling of over 52,000 individual cells from endometrial tissues of OE patients and healthy donors and identified twelve major cell populations. We identified notable alterations in cell type-specific proportions and molecular signatures associated with OE. Notably, the activation of IGFBP5+ macrophages with pro-inflammatory properties, NK cell exhaustion, and aberrant proliferation of IQCG+ and KLF2+ epithelium are key features and may be the potential mechanisms underlying the pathogenesis of OE. Collectively, our data contribute to a better understanding of OE at the single cell level and may pave the way for the development of novel therapeutic strategies.

Outcome of Endometriosis Treatment In Infertile Patients In A Tertiary Level Hospital

Introduction: Prevalence of endometriosis is 6-10% in reproductive-age females. Around 25-35% of infertile women may be affected by endometriosis. Modalities of treatment for infertile patients depends on the stage of the disease. It starts from ovulation inducing drug to advanced ART. The objective of this study was to assess the outcome of surgical treatment in infertile, endometriosis patients. Materials and Methods: It was an observational study, which was conducted at Reproductive Endocrinology and infertility Unit, Dhaka Medical College. Total 144 patients were included during July 2018 to July 2021, aged 20-40 yrs. All the demographic variables, clinical and sonographic findings, and hormonal assessment were done. Then, staging was done by clinical pelvic assessment, and ultrasonographic findings. Patients who had ovarian endometrioma, more than 4 cm, were selected for laparoscopic surgery. In patients whose endometrioma was less than 4 cm, or had no ovarian endometrioma, were selected for ovulation induction with or without prior GnRH agonist therapy. Further infertility management were planned according to ovarian reserve, tubal patency, and male factor. Result: Mean age of the patients were 28.30±4.95 yrs. 75.0% patients had primary infertility. Dysmenorrhea was the most common symptom (86.96%), followed by chronic pelvic pain (81.16%). Bilaterality of endometrioma was associated with decreased serum AMH. Laparoscopic surgery was the mainstay of treatment, Cystectomy was done in 58% patients. Conservative treatment was done in remaining patients. Fertility enhancing treatment was done by ovulation inducing drug -letrozole, GnRH agonist, followed by controlled ovarian stimulation and followed by IUI. IVF was advised for fertility management in 26patients (18.06%). Conclusion: Endometriosis is not only associated with decreased ovarian reserve but also responsible for diminished response to ovarian stimulation. So, it is a great challenge to obtain successful fertility treatment for this group of patients. J Dhaka Med Coll. 2023; 32(1) : 9-15

Revolutionizing endometriosis treatment: automated surgical operation through artificial intelligence and robotic vision.

Clinical limitations due to poverty significantly impact the lives and health of many individuals globally. Nevertheless, this challenge can be addressed with modern technologies, particularly through robotics and artificial intelligence. This study aims to address these challenges using advanced technologies in robotic surgery and artificial intelligence, proposing a method to fully automate endometriosis robotic surgery with a focus on interpretability, accuracy, and reliability. A methodology for fully automatic endometriosis surgery is introduced. Given the complexity of endometriosis lesions detection, they are categorized by their anatomical location to improve system interpretability. Then, three ensemble U-Net frameworks are designed to detect and localize common types of endometriosis lesions intraoperatively. A cross-training approach is employed, exploring U-Net models with diverse neural architectures-such as ResNet50, ResNet101, VGG19, InceptionV3, MobileNet, and EfficientNetB7-to develop U-Net ensemble models for precise endometriosis lesions segmentation. A novel image augmentation technique is also introduced, enhancing the segmentation models' accuracy and reliability. Furthermore, two U-Net models are developed to localize the ovaries and uterus, mitigating unexpected noise and bolstering the method's accuracy and reliability. The image segmentation models, assessed using the Intersection over Union (IoU) metric, achieved outstanding results: 97.57% for ovarian, 96.35% for uterine, and 92.58% for peritoneal endometriosis. This study proposes a fully automatic method for some common types of endometriosis surgery, including ovarian endometriomas and superficial endometriosis. This method is centered around three ensemble U-Net frameworks and a noise reduction technique using two additional U-Nets for localizing the ovaries and uterus. This approach has the potential to significantly improve the accuracy and reliability of robotic surgeries, potentially reducing healthcare costs and improving outcomes for patients worldwide.

Factors Influencing Postoperative Recurrence and Live Birth Achievement after Laparoscopic Surgery for Ovarian Endometrioma: A Retrospective Study in a Regional Core Hospital

Background: Ovarian endometrioma (OMA) is a common gynecological condition affecting women of reproductive age, often requiring laparoscopic surgery for removal. However, the management of OMA, including postoperative hormone therapy, is complex and must be tailored to the individual's conditions. Therefore, to provide meaningful insights, we aimed to analyze 10 years of accumulated data from patients who underwent laparoscopic surgery for OMA, with a primary focus mainly on postoperative OMA recurrence and live birth outcomes. Methods: We reviewed the medical records of 158 patients who underwent laparoscopic surgery for OMA, including total laparoscopic cystectomy (TLC) (79 patients), total laparoscopic adnexectomy (TLA) (62 patients), or both unilateral TLA and contralateral TLC (17 patients), between January 2014 and December 2023. Among the OMA patients, we identified 7 cases of postoperative OMA recurrence out of 158 patients, and 23 live births among 79 TLC patients. We performed a multivariate logistic regression analysis to assess the impact of each representative factor on postoperative OMA recurrence and live birth achievement. Results: The multivariate analyses of the 158 patients revealed that advance age and massive blood loss were significantly associated with an increased risk of postoperative OMA recurrence, while postoperative hormone treatment was associated with a decreased risk of recurrence. In the analysis of live birth achievement among the 79 TLC patients, advanced age, postoperative hormone treatment and cancer antigen 125 (CA125) positivity were significantly associated with a reduced likelihood of achieving live birth. Conclusions: Our data highlight the unfavorable effects of advanced age, massive blood loss and CA125 positivity on the outcomes of laparoscopic surgery for OMA. Additionally, postoperative hormone treatment was found to decrease postoperative OMA recurrence. These findings may offer more accurate information to guidance in selecting treatment options for patients with OMA.

Experience of using transvaginal sclerotherapy in the treatment of ovarian endometriomas

BACKGROUND: Ethanol sclerotherapy is an effective and a safe surgical treatment method for ovarian endometrioma (OMA). Destruction with 95% ethanol solution of the capsule allows minimal impact on the ovarian reserve. However, this method should be thoroughly evaluated for the possibility to be used more frequently in practice. AIM: To determine the indications for the use of transvaginal sclerotherapy in surgical treatment of OMA. MATERIAL AND METHODS: Between October 2021 and October 2023, 17 patients with OMA were operated at the Moscow Regional Research Institute of Obstetrics and Gynecology, with sclerotherapy performed by transvaginal access. Clinical manifestations included pelvic pain (76.4%), dysmenorrhea (82.3%), dyspareunia (47.0%), bowel symptoms (35.3%), polymenorrhea (47.0%), and infertility (64.7%). Eleven (64.7%) of the patients had been previously operated because of ОМА. RESULTS: Postoperative anti-Mullerian hormone (AMH) levels were slightly reduced (mean difference before and after the surgery was 0.47 ng/ml). The mean antral follicle count in the both ovaries were 10.8 before surgery and 8.6 after surgery. The volume of the ovary decreased from 2 to 6 times after sclerotherapy of the endometrioma. Symptoms recurred in four women. Six (35.2%) recurrences of endometrioma were noted with ultrasound control after 3, 6, and 12 months postoperatively. Endometrioid detritus in the cyst capsule was not detected in 64.8% of cases. CONCLUSION: Preliminary results indicates the use of sclerotherapy by transvaginal access with ultrasound control for the treatment of endometriomas in women of reproductive age and patients planning pregnancy by ART with any level of ovarian reserve and recurrent, previously histologically confirmed, symptomatic endometriomas in women of reproductive age with no plans for pregnancy presently with a reduced ovarian reserve (AMH 1.2 ng/ml) and with any level of ovarian reserve but with symptomatic endometrioma in the preserved ovary. Transvaginal access is applicable for symptomatic endometriomas in women who had undergone several operations in the past.

Factors affecting the technical outcome of catheter-directed sclerotherapy for ovarian endometriomas

PurposeTo identify factors related to technical outcomes of catheter-directed sclerotherapy (CDS) and suggest selection criteria for CDS in patients with ovarian endometrioma. MethodThis retrospective study included patients with endometriomas treated with CDS between November 2015 and June 2023. The characteristics of the endometriomas, including diameter, morphology (unilocular or multilocular), and T2 signal intensity were evaluated using pre-procedure magnetic resonance imaging. Moreover, the size of the catheter (7- or 8.5-French) and route of access (transabdominal vs. transvaginal) was also analyzed. Multivariate logistic regression analyses were used to identify factors associated with the technical outcomes of CDS. ResultsTechnical success was defined as successful completion of the following: 1) insertion of a 7- or 8.5-French catheter into the endometrioma, 2) full aspiration of the internal content, and 3) completion of sclerotherapy without ethanol leakage. Of the 323 women (mean age = 32.2 ± 6.0 years) with 401 endometriomas included in our study, technical success was achieved in 377 endometriomas (94.0 %). No major complications were observed. In the multivariate analysis, a diameter < 3 cm (odds ratio, 25.641; p < 0.001), T2 dark signal intensity (odds ratio, 7.462; p = 0.001), and transvaginal access (odds ratio, 4.016; p = 0.004) were associated with technical failure. ConclusionsSmall endometrioma size (<3cm), T2 dark signal intensity, and transvaginal access were identified as significant risk factors for technical failure during catheter-directed sclerotherapy.

Long-term outcomes of catheter-directed sclerotherapy for ovarian endometrioma.

Although favorable results have been reported on catheter-directed sclerotherapy (CDS) for ovarian endometrioma, a thorough evaluation of its long-term efficacy is lacking. This study evaluates the long-term efficacy and safety of CDS with 99% ethanol for treatment of ovarian endometrioma. Between January 2020 and February 2022, data from 33 consecutive patients with symptomatic ovarian endometriomas who underwent CDS were retrospectively evaluated. All patients underwent pre-procedural and 6- and 12-month post-procedural ultrasonography. To assess the effect on ovarian reserve, serum anti-Müllerian hormone (AMH) levels were measured before and after the procedure. Procedure-related complications were also assessed. The mean volume of endometriomas decreased from 80.22 ± 66.43 to 0.73 ± 1.10 mL (P < 0.001), and the mean percentage of volume reduction was 98.99% ± 1.53%. No recurrences were observed during the follow-up period. In patients whose serum AMH levels were monitored for 1 year, no significant change in AMH level before and after CDS was observed (3.07 ± 1.81 vs. 2.72 ± 2.02 ng/mL, P = 0.190). One patient complained of moderate abdominal pain after CDS, which was conservatively managed. CDS remained safe and effective in treating ovarian endometrioma at the 1-year follow-up. Ovarian function after CDS was well preserved. CDS is a safe and effective treatment option for patients with ovarian endometrioma without compromising ovarian function.

Long Term Postoperative Recurrence Rates and Fertility Outcomes after Endometrioma CO2-Laser Vaporization: A 5 years Follow-up Experience

Although cystectomy remains the gold standard for the surgical treatments of endometriomas, concerns about the negative effect on ovarian reserve are rising. Laser-CO2 vaporization of endometriomas has showed encouraging data on ovarian reserve preservation, postoperative pregnancy rates and recurrency. The aim of this study was to assess postoperative recurrence rate and pregnancy rate in patients with endometriomas managed by CO2 fiber laser vaporization after at least 5 years following surgery. Retrospective study. Italian tertiary center from October 2023 to February 2024. We included women aged >18 years who underwent laparoscopic CO2 fiber laser vaporization for endometriomas. Age ≥ 40 years, previous ovarian surgery, previous salpingectomy or hysterectomy, negative histologic finding for endometriosis or any findings of malignancy at histology were exclusion criteria. Ovarian endometriomas were vaporized through laparoscopic CO2 fiber laser. After surgery, patients were included in a surveillance program with periodic clinical follow-up. Seventy-eight patients were included. The mean age was 33.2±4.6 years, the basal AMH was 2.7 ± 1.9 ng/mL and the median diameter of the endometriomas was 4(3-5)cm. The median duration of follow-up was 72.5 months(67-84.5). After surgery, 65.5%(n=36) of women with reproductive desire achieved a pregnancy, 55.6% spontaneously and 44.4% through Assisted Reproduction Techniques, with a mean time to pregnancy of 17.7±18.1 months. A Kaplan-Meier curve for the 7 patients who experienced an ipsilateral recurrence showed that the median time to recurrence was 26 months and the estimated rate of disease-free patients was 91.03% at 100 months (95% CI 82.10%-95.62%). CO2 fiber laser vaporization is an effective and safe surgical treatment of ovarian endometriomas, combining the advantage of being an ovarian tissue-sparing technique with long-term post-operative recurrence rate comparable with that described in literature for the cystectomy.

Recurrent pain after laparoscopic surgery for ovarian endometrioma: Clinical features and long-term follow up

PurposeWe aimed to examine the clinical characteristics of patients with ovarian endometriosis (OMA) who were diagnosed with recurrent pain after laparoscopic surgery in an 8- to 12- year postoperative follow-up. MethodsWe retrospectively analyzed data of 45 OMA patients with recurrent pain, including a minimum 8 years of post-laparoscopic follow-up reports. All laparoscopic cystectomy procedures were performed by the same surgeon at Peking Union Medical College Hospital between January 2009 and April 2013. Clinical data were retrieved to analyze patients' preoperative characteristics, relevant surgical findings, and postoperative outcomes at follow-up. ResultsA total of 45 patients with OMA were included, with a mean age of 31.8±4.92 years. The mean recurrence period was 45.78±24.89 months. Before surgery, 60% (27/45) of patients had severe dysmenorrhea. During surgery, 93.3% (42/45) of patients were in stage III/IV, 51.1% (23/45) had coexisting adenomyosis, and 66.7% (30/45) had deep infiltrating endometriosis (DIE). For the whole study group, mean follow-up time was 121.96±15.55 months. All patients underwent postoperative medical treatment. The mean recurrence period was 45.78±24.89 months. Cyst recurrence was presented in 24.4% (11/45) of patients, while 75.6% (34/45) only complained of pain recurrence. At the end of follow-up, spontaneous pregnancy was seen in 24.4% (11/45) of patients and 6.7% (3/45) received in vitro fertilization and embryo transfer (IVF-ET). ConclusionsPatients with symptomatic recurrence after surgery had more severe dysmenorrhea, larger proportion of coexisting adenomyosis and DIE, and a higher revised American Fertility Society (rAFS) stage. Recurrence of endometrial cysts was not related to pain recurrence. Long-term postoperative pharmacological therapy is recommended to reduce recurrence.

Robot-assisted nerve-sparing eradication of deep endometriosis using the da Vinci SP

ObjectiveThe evolution of nerve-sparing surgery has been supported by a growing body of literature on anatomic details, dissection techniques, and functional outcomes, suggesting that nerve-sparing surgery for deep endometriosis (DE) reduces postoperative pelvic organ dysfunction, including voiding and rectal dysfunction [1]. Recently, newer single-port robotic systems (da Vinci SP) have become available with articulating instruments and cameras that allow for intracorporeal triangulation, which may overcome some of the weaknesses of conventional single-port laparoscopic surgery [2]. Although such systems are believed to allow more complex surgeries than conventional single-port laparoscopic surgery, the scope of application remains unexplored. The objective of this video is therefore to demonstrate the anatomical and technical highlights of a complex intrapelvic procedure, nerve-sparing modified radical hysterectomy and complete removal of DE using the da Vinci SP (SP). SettingAn urban general hospital. Stepwise demonstration of the technique with narrated video footage. ParticipantsThe patient was a 47-year-old woman who presented with chronic pelvic pain resistant to pharmacotherapy. Magnetic resonance imaging showed uterine adenomyosis and bilateral ovarian endometrioma with DE, involving the uterosacral ligament and surface of the rectum, with complete cul-de-sac obliteration. InterventionsThe surgical steps were completely identical to conventional multiport laparoscopic robotic surgery [3,4]. This suggests that conventional laparoscopic or robotic skills are highly transferrable to SP. SP offer several advantages, including high-resolution three-dimensional visualization, articulating instruments, and improved dexterity and range of motion. These advantages allow us to comfortably perform meticulous dissection and suturing even in difficult situations such as DE. The postoperative course was uneventful, with no perioperative complications, including no postoperative bladder or rectal dysfunction [5]. She was very satisfied with the invisible operative scar and low degree of postoperative pain. ConclusionNerve-sparing eradication of DE using SP is technically safe and feasible, with cosmetic advantages and less pain.

Efficacy and safety of dienogest on ovarian endometrioma

Objective: To observe the effects and safety of dienogest on the volume and symptoms of ovarian endometrioma (OMA). Methods: The clinical data of 75 patients with OMA who underwent treatment with dienogest (2 mg/day) at the First Affiliated Hospital of Nanjing Medical University from July 1st 2020 to March 31st 2024 were retrospectively analysed, mainly comparing the changes in the volume of OMA and the visual analogue scale (VAS) scores of endometriosis-related pain before and after the treatment, as well as observing the changes in the blood biological indicators, liver and kidney function, coagulation function and changes in breast. Results: The median cyst volumes of the OMA patients at 3, 6 and 12 months of dienogest treatment were 13.21 cm3 (volume reduction rate: 36.00%), 8.33 cm3 (volume reduction rate: 56.00%) and 4.10 cm3 (volume reduction rate: 77.62%), respectively, which were all significantly decreased from the pre-treatment period (all P<0.05). The VAS scores of pain of the OMA patients at 3, 6 and 12 months of dienogest treatment all were 0 mm. Blood cancer antigen 125 (CA125) and cancer antigen 19-9 (CA19-9) levels decreased progressively during treatment (all P<0.05). There were no statistical differences in the coagulation indexes, liver and kidney function indexes of the patients during dienogest treatment compared with those before treatment (all P>0.05). During the follow-up period, there were a few patients with changes in the growth sites or lesion category of the breast nodules, but there were no occurrence of breast cancer or precancerous lesions. Conclusion: Dienogest is effective in reducing OMA volume and alleviating endometriosis-related pain with few adverse effects.

Current evidence on CA-125 levels in differentiation between endometriomas and endometriosis-associated ovarian cancer – A systematic review and meta-analysis

Background: Although significant advancements have been made in the diagnostic and therapeutic methods of gynecological oncology, ovarian cancer continues to pose a significant challenge. The measurement of CA-125 levels is commonly considered the preferred approach for assessing the necessity of surgical intervention, hence guaranteeing a conclusive diagnosis. The objective of this study is to conduct a comparative analysis of existing literature about the effectiveness of serum CA-125 levels in distinguishing between endometriosis-associated ovarian cancer (EAOC) from ovarian endometrioma. Material and methods: The researchers conducted separate searches in the PubMed and Web of Science databases to identify peer-reviewed papers that examined the serum or plasma CA-125 marker. The search was conducted from the start of both databases until April 4th, 2024. Results: After conducting a literature search, a total of 114 studies were identified for review. Out of these, three studies satisfied the inclusion criteria and were consequently included. The results of the pooled analysis indicate that there is no statistically significant difference between the groups (336.3 ± 667.6 vs 530.6 ± 548.9, respectively; standard deviation = 0.51; 95% confidence interval: −0.63 to 1.64; p = 0.39). Conclusion: Unfortunately, the biomarker CA-125, which is commonly selected, has exhibited restricted effectiveness in distinguishing between EAOC and endometriomas. The existing body of literature on this topic indicates a significant dearth of research regarding the use of CA-125 as a means of differentiating between EAOC and endometriomas. Enhanced diagnostic techniques are necessary for the detection and characterization of ovarian tumors, encompassing those originating from endometriosis.

Association between anti Mullerian hormone levels with size and bilaterality of ovarian endometrioma : a cross-sectional study

Association between anti Mullerian hormone levels with size and bilaterality of ovarian endometrioma : a cross-sectional study

Endometrial E-cadherin and N-cadherin Expression during the Mid-Secretory Phase of Women with Ovarian Endometrioma or Uterine Fibroids.

Endometriosis and uterine fibroids are benign conditions frequently linked to subfertility/infertility. Recent research has highlighted the importance of epithelial-mesenchymal transition between embryonic and endometrial cells in the context of embryo implantation. Additionally, the adverse endometrial environment during implantation has been proposed as a mechanism contributing to infertility in endometriosis. Nevertheless, the role of cadherin molecule alterations in relation to endometrial receptivity and embryo invasion remains a subject of controversy. We investigated the expression patterns of E-cadherin and N-cadherin in the endometria of women with ovarian endometrioma or uterine fibroids and assessed whether they differed from those of healthy women. We enrolled 17 women with ovarian endometrioma, 16 with uterine fibroids, and 6 healthy women. Endometrial tissues were obtained at the mid-secretory phase on days 19-24 of the menstrual cycle. The E-cadherin and N-cadherin mRNA and protein expression levels were measured using quantitative reverse transcriptase polymerase chain reaction and Western blot analysis, respectively. The E-cadherin and N-cadherin mRNA expression levels were higher and lower, respectively, in the endometrium of women with ovarian endometrioma than in those of the controls. In the endometrium of women with uterine fibroids, similar patterns with higher E-cadherin and lower N-cadherin levels were observed compared with that of the controls. Protein expression showed similar patterns. Our findings revealed higher E-cadherin expression and lower N-cadherin expression in the endometria of women with infertility-related diseases than in those of healthy women in the mid-secretory phase. This suggests a resistance to endometrial receptivity, potentially reflecting mesenchymal-epithelial transition properties.

Progressively Diminished Prostaglandin E2 Signaling in Concordance with Increasing Fibrosis in Ectopic Endometrium.

The prostaglandin E2 (PGE2) signaling has traditionally been viewed to play a pivotal role in endometriosis, linking inflammation and hyperestrogenism. We have previously reported that asectopic endometrium becomes more fibrotic, the expression of both COX-2 and PGE2 receptors (EP2 and EP4) are reduced. This study further investigatedwhether the expression levels of genes involved in the biosynthesis and metabolism of PGE2in ectopic endometrium diminish in concordance with increasing lesional fibrosis. We performed immunohistochemistry analyses of COX-2, mPGES-1, mPGES-2, cPGES, 15-PGDH, EP2 and EP4 and Masson trichrome staining for ovarian endometrioma (OE), adenomyosis (AD), and deep endometriosis (DE) tissue samples and control endometrial tissue samples (CT). Gene and protein expression analyses were performed by real-time RT-PCR and Western blotting, respectively. We found that as the extent of lesional fibrosis increased, immunoexpression of COX-2, mPGES-1/2, cPGES, EP2 and EP4 in OE lesions was increased but no change in these genes/proteins in DE lesions as compared with CT. Immunoexpression of COX-2 was found to be reduced while that of 15-PGDH was found to be elevated in DE lesions. In AD lesions, only EP2 and COX-2 were overexpressed. Thus, our data indicate that when the extent of lesional fibrosis is high, the PGE2 signaling pathway is depressed, manifesting as reduced COX-2 expression and elevated expression of 15-PGDH. They underscore the fact that not all ectopic endometria are the same and equal, and highlight the importance of the extracellular matrix in shaping the lesional behavior and response to drug treatment.

Potential damage to ovarian reserve from laparoscopic electrocoagulation in endometriomas and benign ovarian cysts: a systematic review and meta-analysis.

Laparoscopic cystectomy for ovarian endometriomas and benign ovarian cysts is often conducted through hemostatic methods, with bipolar electrocoagulation as a common approach. This study evaluated the impact of electrocoagulation, primarily through bipolar energy, versus nonthermal hemostatic methods on ovarian reserve in patients undergoing laparoscopic cystectomy for ovarian endometriomas and benign ovarian cysts. A systematic review with meta-analysis was conducted by searching the Cochrane Library, PubMed, EMBASE, and Web of Science databases. Randomized controlled trials (RCTs) comparing the impact of nonthermal hemostatic methods and electrocoagulation on the ovarian reserve during laparoscopic cystectomy were included. The Cochrane Risk of Bias Tool for Randomized Controlled Trials (ROB 2.0) was utilized to assess the quality of the included studies. The meta-analysis included 13 RCTs involving 1043 patients. Postoperative serum anti-Müllerian hormone (AMH) levels and antral follicle counts (AFCs) were analyzed using Review Manager ver. 5.4. Compared with the bipolar group, patients with endometriomas in the nonthermal hemostatic group exhibited significantly higher postoperative AMH levels at 1, 3, 6, and 12months. Conversely, no significant differences in AMH levels were observed in patients with benign ovarian cysts. Similarly, AFCs showed no significant differences, except for lower postoperative AFCs in patients with endometrioma in the electrocoagulation group. Nonthermal hemostatic methods are associated with more effective preservation of the ovarian reserve compared with bipolar electrocoagulation in laparoscopic cystectomy for ovarian endometriomas. However, no significant impact of bipolar electrocoagulation on the ovarian reserve was observed in patients with benign ovarian cysts. Registered in PROSPERO on April 10, 2023; ID # CRD42023413158.

Segmental Bowel Resection for Rectal Endometriosis Using the da Vinci SP

ObjectiveThe da Vinci SP Surgical System (SP) received regulatory approval for use in gynecological surgeries in Japan in 2023. Given the advantages of the precision of a robot, less pain, and the cosmesis of single-port surgery, the da Vinci SP is expected to be further used for minimally invasive surgeries. To the best of our knowledge, this is the first report of the use of SP for the treatment of rectal endometriosis with segmental bowel resection. SettingAn urban general hospital. Stepwise demonstration of the technique with narrated video footage. ParticipantsThe patient was a 46-year-old woman presented with chronic pelvic pain, pain on defecation, and constipation. Magnetic resonance imaging showed uterine large fibroid, left ovarian endometrioma, and 38 mm of rectal endometriosis, with complete cul-de-sac obliteration. InterventionsWe made a 30-mm vertical incision at the umbilicus, then placed the access port, and inserted three articulating instruments and a camera. An assistant port was placed in the right lower quadrant for using the linear stapler. The surgical steps were completely identical to conventional multiport laparoscopic robotic surgery. This suggests that conventional laparoscopic or robotic skills are highly transferrable to SP. SP offer several advantages, including high-resolution three-dimensional visualization, articulating instruments, and improved dexterity and range of motion. In addition, the umbilical access port was particularly useful for proximal bowel resection, specimen retrieval, and anvil positioning during bowel resection. The total operative time was 216 minutes. The estimated blood loss was 100 ml without any complications. The uterine weight was 800 g. The postoperative course was uneventful, with no perioperative complications, including no postoperative bladder dysfunction or low anterior resection syndrome [1,2]. ConclusionThe use of SP with the access port for segmental bowel resection for rectal endometriosis is technically safe and feasible, with good cosmesis and less pain.

Management of Ovarian Endometrioma: A Detailed Case Analysis

Women play an integral role in the society, there health and well-being are vital in such journey, certain health conditions like endometriomas often affect the quality of life of many women. These endometriomas are cystic lesions that stem from endometriosis. And are most commonly found in the ovaries. Ovarian endometrioma is the most common form of endometriosis, with its prevalence ranging between 17% and 44%. The clinical challenges include persistent pain, dysmenorrhea, and infertility, all of which adversely affect women's quality of life and their ability to reproduce. In Ayurveda, this condition is comparable to Udavartini Yonivyapad, a known gynecological disorder. It has a significant prevalence among women, reflecting its widespread impact on female reproductive health. Methods: Case study of a 30-year-old married woman came with severe pain during menstruation along with prolonged bleeding during cycles in the last 4 years and the patient was initially diagnosed with an ovarian endometrioma through sonography before she approached us. Based on the Lakshanas and Nidana Panchaka it was diagnosed as Udavartini Yonivyapad. This case was effectively managed using Shodhana therapy combined with internal medications. Results: Following Shodhana her condition exhibited signs of improvement, and there was noticeable reduction in the size of endometrioma. Conclusion: This case is an example to explain the Ayurveda’s role in managing such disease conditions by demonstrating the improvement in the pain and size of the endometrioma which was confirmed by a sonography before and after the treatment

CLINICAL FEATURES AND LABORATORY CHARACTERISTICS OF PATIENTS WITH OVARIAN ENDOMETRIOMA AND INFERTILITY DEPENDING ON THE TYPE OF PRECONCEPTION PREPARATION

Approximately 30-40% of all forms of endometriosis consist of endometriotic ovarian cysts, which directly affect the ovarian reserve of women by mechanical impact on healthy tissues and foci of local inflammatory processes and oxidative stress.The aim of the study was to evaluate the impact of preconception antioxidant and vitamin therapy in combination with sclerotherapy of ovarian endometrioma on hormonal profile indicators and serum tumor markers in women with endometriosis-associated infertility.Materials and Methods. In a prospective clinical study, changes in hormonal profile indicators and serum tumor markers depending on the type of preconception preparation of women with endometriosis-associated infertility before IVF cycle were evaluated. 110 women were divided into 3 clinical groups.Results and Discussion. Significant differences between groups were found depending on the preparation for the IVF cycle. In both the first clinical group, where only sclerotherapy was performed, and the second group, where women received preconception preparation in combination with sclerotherapy, a decrease in basal FSH levels by 1.2 and 1.5 times, respectively, was established. This decrease in FSH levels contributed to the normalization of the LH to FSH ratio, whereas in the comparison group, the FSH level remained almost unchanged and the LH/FSH ratio remained low. There was a tendency towards relatively stable levels of anti-Müllerian hormone in serum, indicating the safety of the sclerotherapy method and its gentle impact on ovarian reserve. A more pronounced decrease in serum CA 125 tumor rmarker levels was observed in the second clinical group (by 1.95 times), somewhat less in the first group (by 1.6 times), while in the comparison group, the indicator remained relatively stable.Conclusions. The use of sclerotherapy of ovarian endometrioma in combination with preconception antioxidant and vitamin therapy before the IVF cycle positively affects the main parameters of hormonal profile and serum tumor markers in patients with endometriosis-associated infertility.