Postoperative Recurrence and Fertility after Endometrioma Ablation Using Plasma Energy: Retrospective Assessment of a 3-Year Experience

Horace Roman, Mathieu Auber, Nicolas Bourdel, Cèecile Martin, Loıc Marpeau, Lucian Puscasiu

Journal of Minimally Invasive Gynecology, 2013

Study Objective: To assess recurrence and pregnancy rates in women with ovarian endometrioma treated via ablation using plasma energy.
Design: Retrospective non-comparative pilot study including 55 patients treated during 28 months, with prospective record-ing of data (Canadian Task Force classification II-2).
Setting: Tertiary referral center.
Patients: Fifty-five consecutive women with pelvic endometriosis in whom ovarian endometriomas were managed solely via ablation using plasma energy. The minimum follow-up was 1 year.
Intervention: Endometrioma ablation using plasma energy.
Measurements and Main Results: Information was obtained from the database of the North-West Inter Regional Fe-male Cohort for Patients with Endometriosis, based on self-questionnaires completed before surgery, surgical and histologic data, and systematic recording of recurrences, pregnancy, and symptoms. Recurrences were assessed using pelvic ultrasound examination. Mean (SD) follow-up was 20.6 (7.2) months (range, 12–39 months). In 75% of pa-tients, deep infiltrating endometriosis was treated, and 40% had colorectal involvement. Preoperative infertility was recorded in 42% of patients. The rate of postoperative recurrence was 10.9% for the entire series. Of 33 women who wished to conceive, 67% became pregnant, spontaneously in 59%. Time from surgery to the first pregnancy was 7.6 (4.3) months. After discontinuation of postoperative hormone therapy, the probability of not conceiving at 12 months was 0.36 (95% confidence interval, 0.19–0.53), and at 24 months was 0.27 (95% confidence interval, 0.12–0.44).
Conclusions: Recurrence and pregnancy rates are encouraging in that they seem comparable to the best reported re-sults after endometrioma cystectomy. Plasma energy may have an important role in the management of ovarian en-dometrioma in women seeking to conceive. Patients most in need of surgical procedures that can spare ovarian parenchyma, such as those with bilateral endometriomas or a history of ovarian surgery, may particularly benefit from ablation using plasma energy. Journal of Minimally Invasive Gynecology (2013) -, -–- 􀀁 2013 AAGL. All rights reserved.

Keywords: Ablation; Infertility; Ovarian endometrioma; Plasma energy; Pregnancy; Recurrence; Vaporization

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