Plasma Energy for Ovarian Endometriomas

Plasma energy may be a feasible technique in the management of ovarian endometriomas.

Key Points

Highlights:

• When the recurrence rate, pregnancy rate, postoperative pain score, and the duration of return to work following surgery were taken into consideration, patients with ovarian endometriomas may benefit from the use of plasma energy devices for endometrioma ablation surgery.

What's done here:

• The efficacy of this new technique in terms of recurrence, pregnancy rate, postoperative pain and return to work following surgery were analyzed.
• A total of 21 women who underwent unilateral or bilateral ovarian endometrioma ablation using plasma energy were included in this retrospective cohort study.
• All the women had at least one ovarian endometrioma measuring 25 mm in diameter or more, associated with pain and/or subfertility.

Key Results:

• A significant decrease in postoperative pain scores, the proportion of symptoms of dysmenorrhoea, dyspareunia, and chronic pelvic pain; and quick postoperative recovery were observed.
• The median duration of return to work was shorter (9 days) when compared to patients undergoing similar laparoscopic gynecological operations (14 days).
• The rate of pregnancy achieved by medically assisted reproduction postoperatively (%46.2) is comparable to pregnancy rates reported following stripping cystectomy in the literature.
• The authors found that the recurrence rate following the use of a plasma energy device was 9.5%, which is comparable to those following stripping cystectomy in the literature.
• The authors also observed that a larger cyst diameter is a risk factor for the recurrence of endometrioma, consistent with the literature.

Limitations:

• This is a retrospective pilot study lacking a control group.
• The variable follow-up time, owing to varying clinical factors causes differences in necessary management. Therefore whether the use of plasma energy alone may account for the results presented in the current study or the results were the consequence of, or influenced by, the operative workup cannot be certainly said.
• Ablation, hence the absence of histopathological evaluation is a question in terms of both diagnosis and possibility of malignancy.
• The effect of this type of energy on egg quality is not clear.

Lay Summary

There are many different approaches used in the management of ovarian endometriomas such as stripping cystectomy, ablation, including electrical/thermal and CO2 laser ablation, fenestration/aspiration, and combined techniques.

Plasma energy is a new promising treatment option for ovarian endometrioma and may be an alternative to stripping cystectomy. This is according to a study conducted by researchers from the Netherlands and published in the Facts, Views and Vision in Obstetrics and Gynaecology.

In this retrospective cohort study, researchers evaluated the efficacy of this new technique in terms of recurrence, pregnancy rate, postoperative pain, and return to work following surgery. A total of 21 women who underwent unilateral or bilateral ovarian endometrioma ablation using plasma energy was analyzed. All the women had at least one ovarian endometrioma measuring 25 mm in diameter or more associated with pain and/or subfertility.

A significant decrease in postoperative pain scores and a quick postoperative recovery was observed. Also, a statistically significant decrease in the proportion of patients with dysmenorrhoea, dyspareunia, and chronic pelvic pain postoperatively was seen.

The median duration of return to work was found to be shorter (9 days) when compared to patients undergoing similar laparoscopic gynecological operations (14 days).

The rate of pregnancy achieved by medically assisted reproduction postoperatively was detected to be 46.2% which is comparable to pregnancy rates reported following stripping cystectomy ranging from 30 to 67% in the literature. Also, the recurrence rate of 9.5% following the use of a plasma energy device was comparable to those following stripping cystectomy ranging from 6.2 to 29% in the literature. A larger cyst diameter to be a risk factor for recurrence was also consistent with the literature.

When the recurrence rate, pregnancy rate, postoperative pain score, and duration of return to work following surgery were taken into account, plasma energy may be a feasible technique in the management of ovarian endometriomas. However, larger randomized trials comparing plasma energy ablation to other management approaches in the treatment of endometriomas, including stripping cystectomy are needed, the authors concluded.

Research Source: https://pubmed.ncbi.nlm.nih.gov/31695857/?from_term=endometriosis&from_filter=ds1.y_5&from_sort=date&from_size=50&from_page=14&from_pos=9