Oct 16, 2024
Endometrioma
- Alexandra Ioannidou1,
- Nikolaos Machairiotis1,
- Sofoklis Stavros1,
- Anastasios Potiris1,
- Theodoros Karampitsakos1,
- Athanasios Pantelis1,
- Petros Drakakis1
- 1Third Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens Medical School, Attikon Hospital,1 Rimini, 124 62 Athens, Greece
Protocol Citation: Alexandra Ioannidou, Nikolaos Machairiotis, Sofoklis Stavros, Anastasios Potiris, Theodoros Karampitsakos, Athanasios Pantelis, Petros Drakakis 2024. Endometrioma. protocols.io https://dx.doi.org/10.17504/protocols.io.kqdg3227pv25/v1
Manuscript citation:
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License: This is an open access protocol distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Protocol status: Working
We use this protocol and it's working
Created: June 02, 2024
Last Modified: October 16, 2024
Protocol Integer ID: 101092
Keywords: endometriosis, endometrioma, anti-mullerian hormone, laparoscopic cystectomy, CO2 laser vaporization, plasma energy ablation, sclerotherapy, GnRH agonist treatment, assisted reproduction treatment
Abstract
Background:
Endometriosis is characterized by the presence of endometrial tissue outside
the uterus. Beyond medical treatment, surgical intervention is also a viable
consideration. However, current guidelines do not clearly indicate whether
laparoscopic cystectomy, ablative methods (CO2 laser vaporization, plasma
energy), or sclerotherapy is the preferred option. Methods: We conducted
searches in two databases (PubMed, Europe PMC) to retrieve articles containing
the keywords ‘surgical intervention for Endometrioma, ovarian reserve,
pregnancy rates, fertility’, published between January 1, 2000, and December
31, 2023. We will include articles presenting information on surgical intervention
for endometrioma and its correlation with infertility parameters. Articles
describing conservative treatment will be excluded. Data will be extracted by two
authors using predefined criteria.
Image Attribution
One figure with flow diagram including studies' selection.
Guidelines
According to PRISMA 2020 checklist.
TITLE
The report is identified as a systematic review.
ABSTRACT
This research is written according to PRISMA 2020 checklist for Abstracts.
Title: The report is identified as a systematic review.
Background: An explicit statement of the main objective the review addresses is provided.
Methods: The inclusion and exclusion criteria for the review are specified. The information sources (e.g. databases, registers) used to identify studies and the date when each was last searched are specified. The methods used to assess risk of bias in the included studies are specified.
INTRODUCTION
The rationale for the review is described in the context of existing knowledge. An explicit statement of the objective the review addresses is provided.
Materials
The conduct of this systematic review will adhere to the guidelines set by the Preferred Reporting Items for Reviews and Meta-Analyses (PRISMA) Statement.
Data sources and Search Strategy
Search will be conducted across two databases—PubMed and Europe PMC—to collect articles
containing the keywords ‘surgical intervention for endometrioma, ovarian reserve, pregnancy rates, fertility’ published between January 1, 2000, and October 30, 2023.
Eligibility Criteria for Articles of Inclusion
The articles will be limited to those written in English and only full research articles will be included. Abstracts presented in scientific meetings will be excluded as well as review articles. Only articles presenting information about surgical intervention for endometrioma and their correlation with infertility parameters will be included. Any articles describing conservative treatment for endometrioma will be also excluded. To avoid bias, articles that refer to the combined treatment of endometrioma will be also considered.
Data Extraction
Specific data will be extracted from each publication in duplicate, including publication date, authorship, studied population, methodologies employed, criteria for inclusion or exclusion (I/E), sample type, and primary outcome measures.
Safety warnings
None to declare.
Ethics statement
Not applicable.
Introduction
Introduction
Introduction
Endometriosis, growing outside the uterus, takes various forms, including peritoneal lesions,
ovarian cysts (endometrioma), deep-seated variants, and extrapelvic involvement. The retrograde
menstruation hypothesis suggested backward movement of endometrial tissue through fallopian
tubes, settling in the pelvis, causing inflammation and adhesions. Current research explores
genetic and epigenetic origins, focusing on intracellular aromatase activity. This updated
perspective investigates genetics, gene expression, and cellular activity, particularly aromatase.
Its manifestation includes not only pain, but disrupts also everyday life, having negative impact to
infertility. Despite affecting 6-10% of women in their reproductive years, 50% of those seeking
fertility treatment hide endometriosis lesions.
Statistics suggest that approximately 17-44% of women diagnosed with endometriosis will
experience an endometrioma, the most prevalent form of endometriosis manifestation.
These lesions, colloquially known as "chocolate cysts," owe their name to the dark brown fluid they
contain. Beyond their appearance, endometriomas signal a more severe state of the disease in
individuals with endometriosis. Research on endometrioma's effect on ovarian reserve,
specifically concerning serum anti-Müllerian hormone (AMH) levels, has conflicting findings. Some
studies indicate a decrease in AMH levels among women with endometriomas, while others find no
significant differences compared to control groups. To reach a conclusive understanding, more
extensive and prolonged investigations are essential.
Surgical interventions, notably excision of the cyst's capsule (cystectomy), show a potential to
improve post-operative pregnancy rates compared to drainage and ablative methods. Yet, the
delicate ovarian tissue and follicles face possible harm from surgical excision. Fears of ovarian
failure after cystectomy have led healthcare providers to embrace ablative approaches. In this
approach, rather than entirely removing it, the "pseudo-capsule" undergoes ablation using energy
sources with limited thermal dispersion. A new approach, the 'one step' or 'three step' laser
vaporization, employing CO2 laser technology, Looks as a promising option by minimizing energy
usage and consequently decreasing potential damage. It offers hope in preserving fertility while
effectively managing endometrioma. Another alternative is sclerotherapy, aiming to
eliminate the pseudocapsule of an endometrioma by introducing alcoholic substances into it. This
method is regarded as a cost-effective and safe way to protect healthy ovarian tissue. The
procedure involves injecting a sclerosing substance directly into the cyst, followed by rinsing or
retaining it. Hydrosoluble dehydrating antiseptic fluids can alter the proteins in microorganism
envelopes and dissolve the lipids of their capsules. Ethanol is often chosen for its superior track
record in managing renal and hepatic cysts.
Material and methods
Material and methods
The conduct of this systematic review will adhere to the guidelines set by the Preferred Reporting Items for Reviews and Meta-Analyses (PRISMA) Statement.
Data sources and Search Strategy
Search will be conducted across two databases—PubMed and Europe PMC—to collect articles
containing the keywords ‘surgical intervention for endometrioma, ovarian reserve, pregnancy rates, fertility’ published between January 1, 2000, and October 30, 2023.
Eligibility Criteria for Articles of Inclusion
The articles will be limited to those written in English and only full research articles will be included. Abstracts presented in scientific meetings will be excluded as well as review articles. Only articles presenting information about surgical intervention for endometrioma and their correlation with infertility parameters will be included. Any articles describing conservative treatment for endometrioma will be also excluded. To avoid bias, articles that refer to the combined treatment of endometrioma will be also considered.
Data Extraction
Specific data will be extracted from each publication in duplicate, including publication date, authorship, studied population, methodologies employed, criteria for inclusion or exclusion (I/E), sample type, and primary outcome measures.
Results
Results
Results will be presented in a standardized fashion and the publication and author data, demographics, metrics, and key findings of the included studies will be tabulated to optimize readability.
Discussion
Discussion
A critical appraisal of the included studies will be undertaken.
Conclusion
Conclusion
In this section, we will recapitulate the key findings of our research.
Protocol references
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