Plasma energy ablation versus cystectomy in fertility-sparing surgery for endometriomas: impact on recurrence and ovarian reserve.

RESEARCH QUESTION: In women undergoing fertility-sparing surgery for unilateral ovarian endometriomas, how do recurrence rates and postoperative ovarian reserve compare between plasma energy ablation (PEA) and laparoscopic cystectomy?

DESIGN

Retrospective cohort study including 176 women aged 18-40 years with unilateral ovarian endometriomas treated at a single tertiary referral centre between 2011 and 2024. Patients underwent laparoscopic management with either PEA (n = 87) or cystectomy (n = 89). The primary outcome was the ipsilateral endometrioma recurrence rate over 48 months. Secondary outcomes were postoperative changes in serum anti-Müllerian hormone (AMH) and antral follicle count (AFC).

RESULTS

No significant differences were observed in ipsilateral recurrence-free survival between PEA and cystectomy (recurrence rate at 48 months: 23.7% versus 26.6%, respectively; log-rank P = 0.866). The recurrence rate in the contralateral ovary was also comparable between groups. Cox regression, adjusted for confounders, confirmed that surgical technique was not independently associated with risk of recurrence. Postoperative ovarian reserve was preserved more effectively in the PEA group. Mean reduction in serum AMH was -0.3 ± 0.5 ng/ml for the PEA group and -0.9 ± 0.7 ng/ml for the cystectomy group (P < 0.001). AFC in the operated ovary improved after PEA (2.0 ± 3.3), but declined after cystectomy (-1.0 ± 2.8) (P < 0.001). Complete absence of antral follicles (AFC = 0) in the operated ovary occurred in 1.1% of patients in the PEA group and 33.7% of patients in the cystectomy group (P < 0.001).

CONCLUSIONS

PEA and cystectomy demonstrated comparable recurrence rates for unilateral endometriomas over a 48-month follow-up period. However, PEA was associated with significantly better preservation of ovarian reserve.