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Ovarian endometriomas are a common manifestation of endometriosis (EM) in reproductive-aged women and frequently require surgical management.
Surgeon subspecialty strongly influences surgical outcomes in ovarian endometrioma management, with MIGS and REI specialists more consistently preserving ovaries and excising extra-ovarian endometriosis compared with OB/GYN and GYNONC surgeons.
Ovarian endometriomas are a common manifestation of endometriosis (EM) in reproductive-aged women and frequently require surgical management. Surgical treatment must balance disease clearance with preservation of ovarian tissue to maintain fertility and long-term hormonal health. Ovarian endometriomas are associated with reduced ovarian reserve, commonly evaluated using anti-Müllerian hormone (AMH) levels, and surgical excision may further compromise ovarian function.
Professional societies such as the American Society for Reproductive Medicine (ASRM) recommend ovarian conservation whenever feasible; however, operative approaches vary widely, particularly in advanced disease involving extra-ovarian EM. Differences in gynecologic training and subspecialty expertise may contribute to this variability in surgical decision-making.
This study aimed to evaluate whether gynecologic surgeon's subspecialty was associated with differences in ovarian preservation and excision of extra-ovarian EM among patients undergoing surgery for ovarian endometriomas, including those with advanced disease classified using the revised ASRM (rASRM) staging system.
This retrospective cohort study included patients (aged 18 to 45 years) who underwent operative care for pathology-confirmed ovarian endometriomas across five hospitals within a single academic health system. Patients were excluded if they had malignancy, hereditary cancer syndromes, surgery performed by non-gynecologic surgeons, or incomplete operative documentation. Surgeries were performed by the following gynecologic subspecialties:
The key endpoint was ovarian-sparing surgery, marked as cyst removal with preservation of the ovary. The secondary endpoint was excision of extra-ovarian EM among those with advanced-stage disease based on rASRM staging. Multivariable logistic regression analysis was conducted, and results were reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs).
A total of 351 patients were included.
(a) Primary Outcome: Ovarian-Sparing Surgery
Overall, ovarian-sparing surgery was performed in 66% (232) of patients. Ovarian preservation rates varied significantly by surgeon subspecialty. Patients treated by MIGS and REI surgeons demonstrated higher ovarian preservation rates compared with those treated by OB/GYN and GYNONC surgeons. After adjustment, MIGS surgeons showed an aOR of 8.46 (95% CI: 3.07–23.29), and REI surgeons showed an aOR of 8.44 (95% CI: 2.71–26.27), compared with OB/GYN surgeons (Table 1).
(b) Secondary Outcome: Excision of Extra-Ovarian EM
Among patients with advanced disease classified by rASRM stage III or IV, excision of extra-ovarian EM differed significantly by surgeon subspecialty. After adjustment, MIGS surgeons demonstrated an aOR of 23.18 (95% CI: 8.18–65.72), while REI surgeons demonstrated an aOR of 13.09 (95% CI: 4.44–38.63), compared with OB/GYN surgeons (Table 2).
Gynecologic surgeon subspecialty was strongly associated with the surgical management of ovarian endometriomas. MIGS and REI specialists achieved higher ovarian preservation and more comprehensive excision of extra-ovarian EM than OB/GYN and GYNONC surgeons. These findings underscore the role of specialized training in optimizing fertility-preserving outcomes for reproductive-aged patients.
Journal of Minimally Invasive Gynecology
Surgeon Subspecialty and Ovarian Preservation in Endometrioma Surgery: A Retrospective Cohort Study
Megan Billow DO et al.
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