title: Postoperative recurrence and fertility after endometrioma ablation using plasma energy: retrospective assessment of a 3-year experience.
abstract: OBJECTIVE
  To assess recurrence and pregnancy rates in women with ovarian endometrioma treated via ablation using plasma energy.
  
  
  METHODS
  Retrospective non-comparative pilot study including 55 patients treated during 28 months, with prospective recording of data (Canadian Task Force classification II-2).
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Fifty-five consecutive women with pelvic endometriosis in whom ovarian endometriomas were managed solely via ablation using plasma energy. The minimum follow-up was 1 year.
  
  
  METHODS
  Endometrioma ablation using plasma energy.
  
  
  RESULTS
  Information was obtained from the database of the North-West Inter Regional Female Cohort for Patients with Endometriosis, based on self-questionnaires completed before surgery, surgical and histologic data, and systematic recording of recurrences, pregnancy, and symptoms. Recurrences were assessed using pelvic ultrasound examination. Mean (SD) follow-up was 20.6 (7.2) months (range, 12-39 months). In 75% of patients, deep infiltrating endometriosis was treated, and 40% had colorectal involvement. Preoperative infertility was recorded in 42% of patients. The rate of postoperative recurrence was 10.9% for the entire series. Of 33 women who wished to conceive, 67% became pregnant, spontaneously in 59%. Time from surgery to the first pregnancy was 7.6 (4.3) months. After discontinuation of postoperative hormone therapy, the probability of not conceiving at 12 months was 0.36 (95% confidence interval, 0.19-0.53), and at 24 months was 0.27 (95% confidence interval, 0.12-0.44).
  
  
  CONCLUSIONS
  Recurrence and pregnancy rates are encouraging in that they seem comparable to the best reported results after endometrioma cystectomy. Plasma energy may have an important role in the management of ovarian endometrioma in women seeking to conceive. Patients most in need of surgical procedures that can spare ovarian parenchyma, such as those with bilateral endometriomas or a history of ovarian surgery, may particularly benefit from ablation using plasma energy.
authors.affiliation: Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France; Research Group 4308, "Spermatogenesis and Gamete Quality," IHU Rouen Normandy, IFRMP23, Reproductive Biology Laboratory, Rouen University Hospital, Rouen, France. Electronic address: horace.roman@gmail.com.
authors.forename: Horace
authors.initials: H
authors.lastname: Roman
authors.forename: Mathieu
authors.initials: M
authors.lastname: Auber
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bourdel
authors.forename: Cécile
authors.initials: C
authors.lastname: Martin
authors.forename: Loïc
authors.initials: L
authors.lastname: Marpeau
authors.forename: Lucian
authors.initials: L
authors.lastname: Puscasiu
mesh_terms: D000328:Adult; D055356:Endometrial Ablation Techniques / Q000379:methods*; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D005298:Fertility / Q000502:physiology*; D006801:Humans; D010049:Ovarian Diseases / Q000601:surgery*; D010053:Ovary / Q000601:surgery*; D010865:Pilot Projects; D011184:Postoperative Period; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Ablation; Infertility; Ovarian endometrioma; Plasma energy; Pregnancy; Recurrence; Vaporization