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Follow-Up of Recurrent Pattern of Endometrioma for 10 Years
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Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S91–S135
429 Rehabilitation of Patients with Endometriosis: Opportunities and Realities of Life Malanova TB, Ipatova MV. Gynecological Department of Rehabilitation Treatment, Federal State Institution ‘‘Research Center for Obstetrics, Gynecology and Perinatology’’ Ministry of Healthcare and Social Development of the Russian Federation, Moscow, Russian Federation Study Objective: The concept of treating patients with endometriosis, as the first part of medical rehabilitation, includes surgery of different volume and pathogenetic hormone. At the same time, according to the recommendations of the SOGC for the treatment can be used any effective and safe treatment to relieve pain, to achieve pregnancy or menopause, improve the quality of life of the patient. Physiotherapy is not independent treatment options for endometriosis , but many years of experience of our Center showed that the most appropriate and clinically effective is their inclusion in the medical complex . It must be emphasized that each treatment has its place and time. Use of physiotherapy in the postoperative period reduces the incidence of complications , improve the overall condition and restore the ability to work at an earlier date . Application of physical factors in combination with hormonal therapy enables us to strengthen and cumulate the effect of the latter, and increase the interval between repeated courses and reduce the side effects of hormones. The concept of rehabilitation is implemented parallel to the main treatment strategy , whose ultimate goal is the preservation of women as persons , restoration of its reproductive function and disability. Effectiveness of rehabilitation as a whole depends on the psychological characteristics of a particular individual , making reasonable and necessary to conduct a focused and differentiated psychotherapy. Fizioreabilitatsiya endometriosis is advisable to start early as possible : during hospital stay , post-hospital outpatient continue to multiply and to sustain in the sanatorium. Only such gradualness and continuity in physiotherapy and fizioreabilitatsiya provides a stable and long-term clinically beneficial effect . 430 Endometrioma Excision: Outcomes Using Consistent Technique Mathews S, Orbuch I, Orbuch L. Gynecology, Lenox Hill Hospital, New York, New York Study Objective: In this study, we propose careful removal of the endometrioma cyst while intact, instead of intentional initial rupture, leads to decreased recurrence of endometriomas by better allowing complete excision of the cyst wall. We suspect the actual rupture of the cyst inhibits complete removal of the cyst wall and this, combined with spread of endometrioma contents, likely contributes to higher recurrence rates. We believe that these procedures are best performed by highly skilled minimally invasive surgeons to improve patient outcomes and satisfaction. Design: We will conduct a chart review of the patients treated by the principal investigator and identify those patients that have had a laparoscopic cystectomy for endometrioma. These charts will be thoroughly reviewed for preoperative diagnosis, operative technique, status of cyst upon excision (ruptured vs. intact), postoperative follow up (imaging, complications, pregnancy, recurrence). Subjects will be contacted via phone to obtain information regarding postoperative followup- postoperative course, current status, symptom recurrence, pain scale, etc. We will obtain any follow up imaging done, or perform imaging at office of principle investigator. Setting: Patients have been treated at two institutions by the principle investigator. Charts are kept in the office and will be reviewed for relevant data. Patients will be contacted via phone for interview, follow up questions, identify those that require follow up ultrasound. Patients will be called into the office for follow up ultrasound. Patients: We hope to enroll between 50 to 100 patients in this study.
Intervention: The data we will examine includes the technique of surgery, the ability to excise an endometrioma, the number of cysts ruptured vs. unruptured, and the recurrence rate post procedure. Post procedure fertility rates will also be a secondary outcome of interest. Measurements and Main Results: Study is currently ongoing- will be complete by July 2014. Conclusion: Study is currently ongoing- will be complete by July 2014. 431 Pathogenesis of Endometriosis Mohyeldin YA. Obstetrics and Gynecology, Alexandria Faculty of Medicine, Alexandria, Egypt Study Objective: Endometriosis implants are commonly implanted on the peritonium and in the utero sacral cardinal ligament complex.Healing by fibrosis causing retraction and morphological changes affecting the ovarian bed and Douglas pouch.Increase concavity of ovarian bed leading at the end to formation of ‘‘Ovarian Cup’’ in which the ovary is embeded.The ureter may be pushed medially or laterally.Changes in DP starts by fibrosis of pararectal areas and approximation of the rectum to back of cervix and vagina untill complete fusion and obliteration of DP occur.This process will be depicted by many short clips taken for more than 10 years. 432 Laparoscopic Management in Patients with Ovarian Endometriosis: Clinical and Operative Characteristics Morgan-Ortiz F,1 Baez-Barraza J,2 Soto-Pineda JM,1 Cervin-Baez C,1 Lopez-De la Torre MA.1 1Obstetrics and Gynecology, Autonomous University of Sinaloa, Culiacan, Sinaloa, Mexico; 2Obstetrics and Gynecology, Hospital Angeles of Culiacan, Culiacan, Sinaloa, Mexico Study Objective: To describe the clinical and operative characteristics of patients undergoing operative laparoscopy by ovarian endometriosis. Design: Retrospective case series (Canadian Task Force classification II-3). Setting: A teaching hospital in Culiacan, Sinaloa, Mexico. Patients: Women undergoing laparoscopic management for a diagnosis of ovarian endometriosis. Intervention: From August 2009 and August 2012 we carried out sixty laparoscopic procedures in patients with ovarian endometriosis diagnosed by ultrasound. Retrospective review of medical records was performed. Measurements and Main Results: Mean age was 29.5 years (SD 5.9) with a BMI of 25.1 kg/m2 (SD: 7.2); 60% had at least one previous surgery, 33.3% had one or more pregnancies. Ten percent had been treated with GnRH analogues and 23.3% with combined oral contraceptives. The most common indication for surgery was infertility (46.7%). The right ovary was the most affected (53.3%). The endometrioma size was 7.8 cm (SD: 2.1) and 30% were found attached to the ovarian fossa and posterior wall of the uterus. Ninety percent of patients were managed by cystectomy, with a operative time of 97.1 minutes (SD 28.0) and operative bleeding of 125 ml (SD 93.8). The recurrence rate was 6.6 %. Conclusion: Ovarian endometriosis (endometriomas) is a common cause of infertility and pelvic pain that affects women of reproductive age, feasible to be managed by laparoscopy, with minimal bleeding, surgical time and complications which are related to the case complexity and the surgeon expertise. 433 Follow-Up of Recurrent Pattern of Endometrioma for 10 Years Oh S-T. Obstetrics & Gynecology, Chonnam University Medical School, Gwangju, GJ, Korea Study Objective: The endometriosis is highly recurrent disease. this study is to evaluate the recurrent pattern of endometrioma for 10 years.
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S91–S135 Design: This study was the comparison of the difference between recurrent group and non-recurrent group. Setting: University hospital. Patients: The 226 patients who received the laparoscopic operation for endometrima at 1997-2001 (5 years), and followed-up for 10 years. Intervention: In the 188 patients, endometriomas were not recurred for 10 years (Group A). Endometriomas were recurred twice in 28 patients Group B), and 3 times in 10 patients (Group C). The comparisons among Group A,B and C were done by the levels of tumor markers, age, the degree of adhesion (grade 0-3 by none, mild, moderate and severe) and the duration of recurrence by SPSS 13.0. Measurements and Main Results: The age-distributions among Group A (34.0 +/- 7.6) and B (34.9 +/- 6.8) and C (34.8 +/- 7.2) were not significantly different. The levels of tumor markers among Group A and B and C were not significantly different. The degrees of adhesions among Group A and B and C were not significantly different. However, the durations of first recurrences of endometriomas were 4.2 +/- 2.1 years in Group B and 2.6 +/- 2.3 years in Group C. The duration of Group B was shorter than the duration of Group C (P\0.05). The duration to second recurrence of endometrioma was 3.6 +/- 0.9 years in Group C, and it was not significantly different than the duration of first recurrence of Group B. Conclusion: Therefore, endometrioma may be recurred in special persons. The more than one recurrence may be also in the other special persons. If recurrence is not occurred within 6-7 years, further recurrence of endometrioma may not be occurred. The genetic comparison between recurrent person and non-recurrent person may be needed by further study.
434 Ovarian Pregnancy on an Endometriosis Area Olaru F,1 Narad V,2 Olaru C,1 Erdelean D,1 Corpade A.1 1Obstetrics and Gynecology, Emergency Hospital Timisoara, Timisoara, Timis, Romania; 2 Plastic Surgery, District Emergency Hospital Timisoara, Timisoara, Timis, Romania Study Objective: Diagnosis of a rare case of ectopic ovarian pregnancy on an area of endometriosis. Design: Clinical case. Setting: Tertiary care unit. Patients: We present the case of an 28 year old woman, with no history of gynecological disorders. She presented for amenorrhea and pain in the right iliac fossa. On palpation, the right anexa was distended. Transvaginal ultrasound revealed a real uterine cavity, with a gestational pseudosac, without a hyperechoic ring and with an anechoic area. The right anexa had an apparently normal ovary, with a juxtaposited mass, more echogenic than the ovary, with an hypoechoic ring, which we interpreted as the corpus luteum for an ectopic pregnancy. Beta hCG was 1000 mUI/ml. Our first diagnosis was right ectopic tubular pregnancy and we chose the laparoscopic approach for resolving the case. Intervention: On laparoscopic approach, we found a right ectopic ovarian pregnancy, who met all three of Spiegelberg’s criteria from 1882 : the gestational sac is located in the region of the ovary, the ectopic pregnancy is attached to the uterus by the ovarian ligament and the tube on the involved side is intact. The fouth criteria, histological confirmation, described our finding as a right ectopic ovarian pregnancy on an area of endometriosis. Measurements and Main Results: The ectopic gestational sac was removed with the preservation of the healthy ovary. The postoperative recovery was excellent and one year later the patient became pregnant and had a succesfull term birh. Conclusion: The presence of trophoblastic activity in the ovarian tissue confirmed an ovarian pregnancy in accordance to the four Spiegelberg criteria. The diagnosis is now easier because of the improved diagnostic modalities. Ultrasonographic appearance of an ovarian cyst in a patient with suspected ectopic pregnancy should imply us an ovarian pregnancy.
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435 Evaluation of Factors Influencing Serial Changes in Serum Anti-Mullerian Hormone Levels after Laparoscopic Cystectomy for Endometrioma Ozaki R, Kumakiri J. Obstetrics and Gynecology, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan Study Objective: To evaluate factors influencing serial changes in serum anti-Mullerian hormone (AMH) levels after laparoscopic cystectomy for endometriomas. Design: Prospective study. Setting: University hospital. Patients: Eighty-seven women who underwent laparoscopic cystectomy for endometriomas. Intervention: Laparoscopic cystectomy. Measurements and Main Results: Serum AMH levels were measured before and at 3 and 6 months after laparoscopic surgery, and the mean levels at these three time points were 3.2 2.8, 1.8 1.8, and 2.0 2.2 ng/mL, respectively. Compared with AMH levels at 3 months after surgery, those at 6 months after surgery were increased in 45 patients and decreased in 42. There was a significant difference in the rate of change in AMH levels at 6 months after surgery between the two groups (17% vs. 52%, p \ 0.01). In the 42 patients with decreased levels, the rate of change was significantly correlated with the excision of bilateral endometriomas (R = 0.37, p = 0.016) and adhesiolysis of cul-de sac obliterations (R = 0.41, p = 0.007). Conclusion: Our data suggest that not only cystectomy for bilateral endometriomas but also adhesiolysis of cul-de sac obliterations is a positive factor influencing postoperative ovarian reserve after laparoscopic cystectomy for endometriomas.
436 Should We Access the Ovarian Reserve in Young Women with Endometrioma before Laparoscopic Surgery? Park SY, Jeong K, Chung H. Department of Obstetrics and Gynecology, School of Medicine, Ewha Womans University, Seoul, Korea Study Objective: To evaluate whether serum anti-m€ullerian hormone (AMH) levels are lower in young women with ovarian endometrioma compared to other benign cyst before laparoscopic surgery. Design: Retrospective case-control study. Setting: Ewha Womans University Mokdong Hospital, Seoul, Korea. Patients: After excluding polycystic ovary syndrome or previous ovarian surgery, seventy women who underwent laparoscopic surgery for treatment of ovarian cysts were included. Forty one patients with advanced (stage III and IV) endometriomas were compared to twenty nine patients with other benign cysts. Measurements and Main Results: Histopathologic confirmation after laparoscopic ovarian cystectomy, fourty-one were endometriomas and twenty-nine were other benign cyst (teratoma, Serous cystadenoma, mucinous cystadenoma, hemorrhagic corpus luteal cyst, adenofibroma). The mean age was almost identical in both groups (endometrioma 29.6 3.7 years vs. other benign cyst 27.9 4.1 years, p=NS). Although mean diameter and maximum diameter measured by transvaginal sonography, were smaller in endometrioma group (45.7 16.9 mm, 52.0 19.8 mm) than other benign cyst group ( 58.7 24.0 mm, 66.1 24.9 mm) (p=0.014), preoperative AMH levels were significantly lower in endometrioma group than other benign cyst group (3.73 1.91 ng/mL vs. 5.02 2.69 ng/mL, p=0.031). Baseline characteristics and serum AMH between patients with endometrioma and other ovarian cyst
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S91–S135
429 Rehabilitation of Patients with Endometriosis: Opportunities and Realities of Life Malanova TB, Ipatova MV. Gynecological Department of Rehabilitation Treatment, Federal State Institution ‘‘Research Center for Obstetrics, Gynecology and Perinatology’’ Ministry of Healthcare and Social Development of the Russian Federation, Moscow, Russian Federation Study Objective: The concept of treating patients with endometriosis, as the first part of medical rehabilitation, includes surgery of different volume and pathogenetic hormone. At the same time, according to the recommendations of the SOGC for the treatment can be used any effective and safe treatment to relieve pain, to achieve pregnancy or menopause, improve the quality of life of the patient. Physiotherapy is not independent treatment options for endometriosis , but many years of experience of our Center showed that the most appropriate and clinically effective is their inclusion in the medical complex . It must be emphasized that each treatment has its place and time. Use of physiotherapy in the postoperative period reduces the incidence of complications , improve the overall condition and restore the ability to work at an earlier date . Application of physical factors in combination with hormonal therapy enables us to strengthen and cumulate the effect of the latter, and increase the interval between repeated courses and reduce the side effects of hormones. The concept of rehabilitation is implemented parallel to the main treatment strategy , whose ultimate goal is the preservation of women as persons , restoration of its reproductive function and disability. Effectiveness of rehabilitation as a whole depends on the psychological characteristics of a particular individual , making reasonable and necessary to conduct a focused and differentiated psychotherapy. Fizioreabilitatsiya endometriosis is advisable to start early as possible : during hospital stay , post-hospital outpatient continue to multiply and to sustain in the sanatorium. Only such gradualness and continuity in physiotherapy and fizioreabilitatsiya provides a stable and long-term clinically beneficial effect . 430 Endometrioma Excision: Outcomes Using Consistent Technique Mathews S, Orbuch I, Orbuch L. Gynecology, Lenox Hill Hospital, New York, New York Study Objective: In this study, we propose careful removal of the endometrioma cyst while intact, instead of intentional initial rupture, leads to decreased recurrence of endometriomas by better allowing complete excision of the cyst wall. We suspect the actual rupture of the cyst inhibits complete removal of the cyst wall and this, combined with spread of endometrioma contents, likely contributes to higher recurrence rates. We believe that these procedures are best performed by highly skilled minimally invasive surgeons to improve patient outcomes and satisfaction. Design: We will conduct a chart review of the patients treated by the principal investigator and identify those patients that have had a laparoscopic cystectomy for endometrioma. These charts will be thoroughly reviewed for preoperative diagnosis, operative technique, status of cyst upon excision (ruptured vs. intact), postoperative follow up (imaging, complications, pregnancy, recurrence). Subjects will be contacted via phone to obtain information regarding postoperative followup- postoperative course, current status, symptom recurrence, pain scale, etc. We will obtain any follow up imaging done, or perform imaging at office of principle investigator. Setting: Patients have been treated at two institutions by the principle investigator. Charts are kept in the office and will be reviewed for relevant data. Patients will be contacted via phone for interview, follow up questions, identify those that require follow up ultrasound. Patients will be called into the office for follow up ultrasound. Patients: We hope to enroll between 50 to 100 patients in this study.
Intervention: The data we will examine includes the technique of surgery, the ability to excise an endometrioma, the number of cysts ruptured vs. unruptured, and the recurrence rate post procedure. Post procedure fertility rates will also be a secondary outcome of interest. Measurements and Main Results: Study is currently ongoing- will be complete by July 2014. Conclusion: Study is currently ongoing- will be complete by July 2014. 431 Pathogenesis of Endometriosis Mohyeldin YA. Obstetrics and Gynecology, Alexandria Faculty of Medicine, Alexandria, Egypt Study Objective: Endometriosis implants are commonly implanted on the peritonium and in the utero sacral cardinal ligament complex.Healing by fibrosis causing retraction and morphological changes affecting the ovarian bed and Douglas pouch.Increase concavity of ovarian bed leading at the end to formation of ‘‘Ovarian Cup’’ in which the ovary is embeded.The ureter may be pushed medially or laterally.Changes in DP starts by fibrosis of pararectal areas and approximation of the rectum to back of cervix and vagina untill complete fusion and obliteration of DP occur.This process will be depicted by many short clips taken for more than 10 years. 432 Laparoscopic Management in Patients with Ovarian Endometriosis: Clinical and Operative Characteristics Morgan-Ortiz F,1 Baez-Barraza J,2 Soto-Pineda JM,1 Cervin-Baez C,1 Lopez-De la Torre MA.1 1Obstetrics and Gynecology, Autonomous University of Sinaloa, Culiacan, Sinaloa, Mexico; 2Obstetrics and Gynecology, Hospital Angeles of Culiacan, Culiacan, Sinaloa, Mexico Study Objective: To describe the clinical and operative characteristics of patients undergoing operative laparoscopy by ovarian endometriosis. Design: Retrospective case series (Canadian Task Force classification II-3). Setting: A teaching hospital in Culiacan, Sinaloa, Mexico. Patients: Women undergoing laparoscopic management for a diagnosis of ovarian endometriosis. Intervention: From August 2009 and August 2012 we carried out sixty laparoscopic procedures in patients with ovarian endometriosis diagnosed by ultrasound. Retrospective review of medical records was performed. Measurements and Main Results: Mean age was 29.5 years (SD 5.9) with a BMI of 25.1 kg/m2 (SD: 7.2); 60% had at least one previous surgery, 33.3% had one or more pregnancies. Ten percent had been treated with GnRH analogues and 23.3% with combined oral contraceptives. The most common indication for surgery was infertility (46.7%). The right ovary was the most affected (53.3%). The endometrioma size was 7.8 cm (SD: 2.1) and 30% were found attached to the ovarian fossa and posterior wall of the uterus. Ninety percent of patients were managed by cystectomy, with a operative time of 97.1 minutes (SD 28.0) and operative bleeding of 125 ml (SD 93.8). The recurrence rate was 6.6 %. Conclusion: Ovarian endometriosis (endometriomas) is a common cause of infertility and pelvic pain that affects women of reproductive age, feasible to be managed by laparoscopy, with minimal bleeding, surgical time and complications which are related to the case complexity and the surgeon expertise. 433 Follow-Up of Recurrent Pattern of Endometrioma for 10 Years Oh S-T. Obstetrics & Gynecology, Chonnam University Medical School, Gwangju, GJ, Korea Study Objective: The endometriosis is highly recurrent disease. this study is to evaluate the recurrent pattern of endometrioma for 10 years.
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S91–S135 Design: This study was the comparison of the difference between recurrent group and non-recurrent group. Setting: University hospital. Patients: The 226 patients who received the laparoscopic operation for endometrima at 1997-2001 (5 years), and followed-up for 10 years. Intervention: In the 188 patients, endometriomas were not recurred for 10 years (Group A). Endometriomas were recurred twice in 28 patients Group B), and 3 times in 10 patients (Group C). The comparisons among Group A,B and C were done by the levels of tumor markers, age, the degree of adhesion (grade 0-3 by none, mild, moderate and severe) and the duration of recurrence by SPSS 13.0. Measurements and Main Results: The age-distributions among Group A (34.0 +/- 7.6) and B (34.9 +/- 6.8) and C (34.8 +/- 7.2) were not significantly different. The levels of tumor markers among Group A and B and C were not significantly different. The degrees of adhesions among Group A and B and C were not significantly different. However, the durations of first recurrences of endometriomas were 4.2 +/- 2.1 years in Group B and 2.6 +/- 2.3 years in Group C. The duration of Group B was shorter than the duration of Group C (P\0.05). The duration to second recurrence of endometrioma was 3.6 +/- 0.9 years in Group C, and it was not significantly different than the duration of first recurrence of Group B. Conclusion: Therefore, endometrioma may be recurred in special persons. The more than one recurrence may be also in the other special persons. If recurrence is not occurred within 6-7 years, further recurrence of endometrioma may not be occurred. The genetic comparison between recurrent person and non-recurrent person may be needed by further study.
434 Ovarian Pregnancy on an Endometriosis Area Olaru F,1 Narad V,2 Olaru C,1 Erdelean D,1 Corpade A.1 1Obstetrics and Gynecology, Emergency Hospital Timisoara, Timisoara, Timis, Romania; 2 Plastic Surgery, District Emergency Hospital Timisoara, Timisoara, Timis, Romania Study Objective: Diagnosis of a rare case of ectopic ovarian pregnancy on an area of endometriosis. Design: Clinical case. Setting: Tertiary care unit. Patients: We present the case of an 28 year old woman, with no history of gynecological disorders. She presented for amenorrhea and pain in the right iliac fossa. On palpation, the right anexa was distended. Transvaginal ultrasound revealed a real uterine cavity, with a gestational pseudosac, without a hyperechoic ring and with an anechoic area. The right anexa had an apparently normal ovary, with a juxtaposited mass, more echogenic than the ovary, with an hypoechoic ring, which we interpreted as the corpus luteum for an ectopic pregnancy. Beta hCG was 1000 mUI/ml. Our first diagnosis was right ectopic tubular pregnancy and we chose the laparoscopic approach for resolving the case. Intervention: On laparoscopic approach, we found a right ectopic ovarian pregnancy, who met all three of Spiegelberg’s criteria from 1882 : the gestational sac is located in the region of the ovary, the ectopic pregnancy is attached to the uterus by the ovarian ligament and the tube on the involved side is intact. The fouth criteria, histological confirmation, described our finding as a right ectopic ovarian pregnancy on an area of endometriosis. Measurements and Main Results: The ectopic gestational sac was removed with the preservation of the healthy ovary. The postoperative recovery was excellent and one year later the patient became pregnant and had a succesfull term birh. Conclusion: The presence of trophoblastic activity in the ovarian tissue confirmed an ovarian pregnancy in accordance to the four Spiegelberg criteria. The diagnosis is now easier because of the improved diagnostic modalities. Ultrasonographic appearance of an ovarian cyst in a patient with suspected ectopic pregnancy should imply us an ovarian pregnancy.
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435 Evaluation of Factors Influencing Serial Changes in Serum Anti-Mullerian Hormone Levels after Laparoscopic Cystectomy for Endometrioma Ozaki R, Kumakiri J. Obstetrics and Gynecology, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan Study Objective: To evaluate factors influencing serial changes in serum anti-Mullerian hormone (AMH) levels after laparoscopic cystectomy for endometriomas. Design: Prospective study. Setting: University hospital. Patients: Eighty-seven women who underwent laparoscopic cystectomy for endometriomas. Intervention: Laparoscopic cystectomy. Measurements and Main Results: Serum AMH levels were measured before and at 3 and 6 months after laparoscopic surgery, and the mean levels at these three time points were 3.2 2.8, 1.8 1.8, and 2.0 2.2 ng/mL, respectively. Compared with AMH levels at 3 months after surgery, those at 6 months after surgery were increased in 45 patients and decreased in 42. There was a significant difference in the rate of change in AMH levels at 6 months after surgery between the two groups (17% vs. 52%, p \ 0.01). In the 42 patients with decreased levels, the rate of change was significantly correlated with the excision of bilateral endometriomas (R = 0.37, p = 0.016) and adhesiolysis of cul-de sac obliterations (R = 0.41, p = 0.007). Conclusion: Our data suggest that not only cystectomy for bilateral endometriomas but also adhesiolysis of cul-de sac obliterations is a positive factor influencing postoperative ovarian reserve after laparoscopic cystectomy for endometriomas.
436 Should We Access the Ovarian Reserve in Young Women with Endometrioma before Laparoscopic Surgery? Park SY, Jeong K, Chung H. Department of Obstetrics and Gynecology, School of Medicine, Ewha Womans University, Seoul, Korea Study Objective: To evaluate whether serum anti-m€ullerian hormone (AMH) levels are lower in young women with ovarian endometrioma compared to other benign cyst before laparoscopic surgery. Design: Retrospective case-control study. Setting: Ewha Womans University Mokdong Hospital, Seoul, Korea. Patients: After excluding polycystic ovary syndrome or previous ovarian surgery, seventy women who underwent laparoscopic surgery for treatment of ovarian cysts were included. Forty one patients with advanced (stage III and IV) endometriomas were compared to twenty nine patients with other benign cysts. Measurements and Main Results: Histopathologic confirmation after laparoscopic ovarian cystectomy, fourty-one were endometriomas and twenty-nine were other benign cyst (teratoma, Serous cystadenoma, mucinous cystadenoma, hemorrhagic corpus luteal cyst, adenofibroma). The mean age was almost identical in both groups (endometrioma 29.6 3.7 years vs. other benign cyst 27.9 4.1 years, p=NS). Although mean diameter and maximum diameter measured by transvaginal sonography, were smaller in endometrioma group (45.7 16.9 mm, 52.0 19.8 mm) than other benign cyst group ( 58.7 24.0 mm, 66.1 24.9 mm) (p=0.014), preoperative AMH levels were significantly lower in endometrioma group than other benign cyst group (3.73 1.91 ng/mL vs. 5.02 2.69 ng/mL, p=0.031). Baseline characteristics and serum AMH between patients with endometrioma and other ovarian cyst