ASRM2012: Surgery for endometriosis and endometrioma
San Diego, 21 and 24 October 2012
The 68th Annual Meeting of the ASRM had plenty of coverage on endometriosis; not least two serious sessions on how to manage endometriosis surgically — and whether endometrioma can also be managed medically.
Surgical management of endometriosis
ASRM EndoSIG Chair, Dr Tommaso Falcone, presented an excellent overview of the surgical management of endometriosis in the second key note lecture of the meeting. His main messages included:
ASRM EndoSIG Chair, Professor Tommaso Falcone
- Experience does count in surgery in order to reduce recurrence of disease (ie. the more experienced the surgeon, the more likely s/he is to recognise and skilfully remove all disease, reducing the risk of recurrence);
- We still have no definitive answer about whether to remove endometrioma (endometriotic cysts) prior to IVF and to what extent such removal may damage ovarian tissue and thus further compromise fertility;
- We don’t know whether ablation surgery is better than excision surgery, and conducting a trial to determine this would be futile. Dr Falcone stressed that even randomising women, with different physical manifestations of the disease, to either treatment would be very difficult. As an example he used endometriosis above the ureter: if this is ablated (burnt) you risk serious damage (burning) to the ureter, so how could one ethically randomise a woman to such a treatment?
- Whereas there is no consensus on how to deal with bowel endometriosis (shaving vs. discoid resection vs. bowel resection) Dr Falcone stressed that as a surgeon it is important to recognise the risks and consequences associated with all of these procedures, and to discuss these with patients before embarking on this kind of surgery.
The value of removing endometrioma
The ASRM EndoSIG’s “interactive session” on Wednesday afternoon included presentations from Drs David Adamson and Paolo Vercellini “debating” the value of removing endometrioma (also known as “chocolate cysts”).
Drs Paolo Vercellini and David Adamson, with session chair Dr Pamela Stratton
The overall “take-home message” was that of INDIVIDUALISATION.
In terms of fertility outcome, today there is no proven treatment pathway for women with endometrioma. There is no known evidence of whether surgical removal, medical suppression, or immediate IVF treatment will improve pregnancy rates in women with endometriosis.
Furthermore one of the concerns raised during this session was whether surgical removal of ovarian cysts may compromise ovarian reserve.
Moving forward
How to handle endometrioma (chocolate cysts) is one of the (many) unanswered questions in endometriosis, and one of which the World Endometriosis Research Foundation (WERF) will attempt to address through one of its new studies (EndoART).
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