title: Histologic analysis of specimens from laparoscopic endometrioma excision performed by different surgeons: does the surgeon matter?
abstract: OBJECTIVE
  To evaluate whether the amount of ovarian tissue inadvertently removed along with the endometrioma cyst wall at laparoscopy differs in relation to the operating surgeon's level of expertise.
  
  
  METHODS
  Multicenter, prospective trial.
  
  
  METHODS
  Four tertiary care university hospitals.
  
  
  METHODS
  Fifty patients, aged 25 to 40 years, with monolateral ovarian endometriomas who underwent laparoscopic excision.
  
  
  METHODS
  Operation with the stripping technique by surgeons with specific expertise in endometriosis surgery in four centers (groups A, B, C, and D) and by residents with average training in laparoscopic surgery (group E).
  
  
  METHODS
  Histologic examination for the evaluation of the mean thickness of the cyst wall from each specimen, and the mean thickness and morphologic characteristics of any ovarian tissue removed.
  
  
  RESULTS
  No statistically significant differences were present in the rate of presence of ovarian tissue in the endometrioma wall specimens from the different groups (44%, 45%, 55%, 56%, and 60% in groups A, B, C, D, and E, respectively). For groups A+B+C+D versus group E, a statistically significant difference was found in the mean thickness of the tissue specimens (1.51 mm vs. 1.91 mm, respectively) and in the mean thickness of ovarian tissue inadvertently excised (0.49 mm vs. 0.97 mm, respectively).
  
  
  CONCLUSIONS
  Level of expertise in endometriosis surgery is inversely correlated with inadvertent removal of healthy ovarian tissue along with the endometrioma capsule.
authors.affiliation: Department of Obstetrics and Gynecology, Università Campus BioMedico, Rome, Italy. l.muzii@unicampus.it
authors.forename: Ludovico
authors.initials: L
authors.lastname: Muzii
authors.forename: Riccardo
authors.initials: R
authors.lastname: Marana
authors.forename: Roberto
authors.initials: R
authors.lastname: Angioli
authors.forename: Antonella
authors.initials: A
authors.lastname: Bianchi
authors.forename: Gaspare
authors.initials: G
authors.lastname: Cucinella
authors.forename: Michele
authors.initials: M
authors.lastname: Vignali
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Benedetti Panici
authors.forename: Mauro
authors.initials: M
authors.lastname: Busacca
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004715:Endometriosis / Q000473:pathology* / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D009929:Organ Size; D010049:Ovarian Diseases / Q000473:pathology* / Q000601:surgery*; D010053:Ovary / Q000473:pathology; D010820:Physicians / Q000706:statistics & numerical data; D016037:Single-Blind Method; D047368:Tumor Burden