Histologic findings from ablation of ovarian endometriomas using argon plasma coagulation (APC-ENDO): a pilot study

Although cystectomy remains the gold standard for ovarian endometrioma surgery, its potential harm to ovarian reserve due to inadvertent removal of ovarian parenchyma has raised concerns. Ablative techniques, like Argon Plasma Coagulation (APC), ensure precision with minimal thermal spread, preserving ovarian reserve. This pilot study aimed to evaluate the thermal damage induced by APC on the endometrioma pseudocapsule in women undergoing surgery for ovarian endometriomas.

From February 2023 to February 2024, symptomatic women aged >18 years undergoing laparoscopic surgery for ovarian endometriomas were included. APC ablation of a 2 × 2 cm area on the cyst's inner surface was performed ex vivo. The primary endpoint was histological evaluation of coagulation depth on the pseudocapsule. Secondary endpoints included the extent of damage to adjacent ovarian parenchyma (in adnexectomy cases) and confirmation of complete ablation of endometriotic tissue.

Eleven women were included. Two underwent cystectomy, and nine underwent adnexectomy, both followed by ex vivo APC ablation of the endometriomas. The mean coagulation depth was 0.8 mm (95 % CI: 0.42-1.17), with no residual endometrial epithelium in coagulated areas and no evidence of ovarian parenchyma damage.

Our pilot study shows promising results for this new surgical strategy to manage ovarian endometriomas while preserving ovarian reserve. However, due to the limited sample size, further large-scale prospective studies are needed to confirm these findings and assess their long-term efficacy and safety.