RESUMO
OBJECTIVE: To use postoperative examination by three-dimensional (3D) ultrasound to compare loss of ovarian parenchyma after ovarian endometrioma ablation with the use of plasma energy versus cystectomy. DESIGN: Retrospective "before and after" comparative study. SETTING: University tertiary referral center. PATIENT(S): Thirty women with no previous history of ovarian surgery managed for unilateral ovarian endometrioma >30 mm in diameter. INTERVENTION(S): Endometrioma ablation using plasma energy and ovarian tissue-sparing cystectomy. MAIN OUTCOME MEASURE(S): 3D ultrasound assessment of postoperative reduction in ovarian volume and antral follicle count (AFC). RESULT(S): Fifteen women with comparable baseline characteristics were managed by each technique. Those who underwent cystectomy showed a statistically significant reduction in ovarian volume and AFC when compared with women who underwent ablation using plasma energy. Multivariate analysis showed that the relationship between the decrease in ovarian volume and AFC and the use of cystectomy remained statistically significant after adjustment for age, previous pregnancy, and cyst diameter. CONCLUSION(S): When compared with plasma energy ablation, cystectomy is responsible for a statistically significant decrease in ovarian volume and a statistically significant reduction in AFC. This data should be taken into account in therapeutic decision-making concerning women attempting pregnancy, especially where there are other risk factors for postoperative ovarian failure.
Assuntos
Endometriose/cirurgia , Preservação da Fertilidade/métodos , Procedimentos Cirúrgicos em Ginecologia/métodos , Terapia a Laser/métodos , Tratamentos com Preservação do Órgão/métodos , Doenças Ovarianas/cirurgia , Adulto , Endometriose/complicações , Feminino , Fertilização/fisiologia , Humanos , Cistos Ovarianos/complicações , Cistos Ovarianos/cirurgia , Doenças Ovarianas/complicações , Ovariectomia/métodos , Ovário/patologia , Ovário/cirurgia , Ovário/ultraestrutura , Gases em Plasma/uso terapêutico , Gravidez , Estudos RetrospectivosRESUMO
We performed a retrospective three-dimensional ultrasound evaluation of the ovarian features in ten women with no previous ovarian surgery who benefited from ablation by plasma energy for unilateral endometriomas greater than to 30 mm in diameter. Values of ovarian volume and antral follicle count in operated ovaries were decreased by an average 12% and 18%, respectively, suggesting that endometrioma ablation using plasma energy spares the underlying ovarian parenchyma.
Assuntos
Técnicas de Ablação , Endometriose/cirurgia , Imageamento Tridimensional , Doenças Ovarianas/cirurgia , Folículo Ovariano/diagnóstico por imagem , Ovário/cirurgia , Técnicas de Ablação/efeitos adversos , Adulto , Endometriose/diagnóstico por imagem , Endometriose/patologia , Feminino , França , Humanos , Doenças Ovarianas/diagnóstico por imagem , Doenças Ovarianas/patologia , Folículo Ovariano/lesões , Ovário/diagnóstico por imagem , Ovário/lesões , Ovário/patologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia , Adulto JovemRESUMO
In ten ovarian endometriomas of diameter exceeding 30 mm, managed by complete vaporization of the inner surface using plasma energy followed by cystectomy, we performed histologic evaluation of the depth of necrosis and the effectiveness of endometrial tissue ablation. We observed that plasma energy allows the ablation of endometrial tissue with minimal damage to the ovarian parenchyma, which suggests that this technique might be of particular interest for women with risk factors of postoperative ovarian reserve impairment, such as recurrent and bilateral endometriomas.
