Minimizing Repeat Surgeries for Endometriomas: The Impact of Surgical Intervention by Minimally Invasive Gynecologic Surgeons

Objective: The objective of this study is to determine whether patients who are diagnosed with ovarian endometrioma(s) on imaging undergo fewer total surgeries for treatment of their endometrioma and endometriosis if the initial surgery is performed by a fellowship-trained minimally invasive gynecologic surgeon (MIGS) compared to an obstetrician/gynecologist (Ob/Gyn). Design: Single-center, retrospective cohort study. Setting: Academic, urban, tertiary care institution in the United States. Participants: In total, 383 female patients ages 18 and older with endometrioma(s) diagnosed on pelvic ultrasound between January 1, 2010, and December 31, 2015, who underwent surgical treatment. Results: Patients who underwent primary surgery by MIGS were significantly less likely to undergo a second and third surgery than if the procedure was initially performed by an Ob/Gyn (second surgery n = 19, 10.4% vs. n = 24, 18.2%; third surgery n = 2, 1.1% vs. n = 9, 6.8%; p < 0.01). A higher proportion of patients whose first surgery was performed by MIGS had only one surgery than patients whose first surgery was performed by an Ob/Gyn ( n = 162, 88.5% vs. n = 99, 75.0%). MIGS were more likely to use a laparoscopic approach compared to Ob/Gyns for all cases (first surgery n = 183, 54.8% vs. n = 106, 31.7%, second surgery n = 41, 73.2% vs. n = 9, 16.1%, third surgery n = 11, 84.6% vs. n = 1, 7.7%; p < 0.01). Conclusion: Patients diagnosed with endometriomas on imaging undergo fewer surgeries for treatment if their initial surgery was performed by MIGS as compared to Ob/Gyn. These findings have important implications for the surgical referral patterns of patients diagnosed with endometriomas on preoperative imaging.