A Cross-Sectional Study of Endometriosis Surgeries Across Obstetrics and Gynecology Subspecialties: Does Minimally...

Objective The objective of this study was to compare the surgical approaches and postoperative outcomes of endometriosis surgeries performed by different obstetrics and gynecology (OBGYN) subspecialties: minimally invasive gynecologic surgery (MIGS), gynecologic oncology (GONC), and other OBGYN subspecialties (OBGYNS).  Methods This was a retrospective cross-sectional study on patients who presented to a tertiary healthcare center between 2018 and 2019 and had undergone their first endometriosis surgery at the same center in 2000 or later (n = 258). Variables were compared across subspecialties using Chi-squared and Fisher's exact tests. A multinomial multivariable logistic model (MMLM) was applied to assess adjusted associations between subspecialty, presence of deep endometriosis (DE), and surgical techniques used. Results Univariate analysis revealed significant differences among subspecialties in several areas (p < .001). First, laparoscopy was predominantly used by MIGS (99.3%) and OGYNS (87.9%), while laparotomy was common in GONC cases (66.7%). Pain was the primary indication for MIGS (92.9%), whereas 45% of GONC cases had other indications, like large endometriomas or postmenopausal cysts. OGYNS favored ablation (77.6%), including 85.7% of DE cases. MIGS employed excision in 30.7% of patients and a combination of excision and ablation in 33.6% of cases, with excision not necessarily complete. GONC primarily used ablation (48.3%) and performed isolated endometrioma removal (38.3%). DE was excised in 34.4% (MIGS), 18.8% (GONC), and 0% (OGYNS) of DE cases. Postoperative pain outcomes did not differ significantly (p = .735); persistent pain was reported in MIGS (76.9%), GONC (78.1%), and OGYNS (84.4%). MMLM indicated GONC (p = .011and p = .006) and OGYNS (p = .001 and p = .017) were significantly more likely than MIGS to perform ablation or remove endometriomas alone when adjusting for DE presence. Conclusion Despite variations in surgical techniques among subspecialties, persistent postoperative pain and low DE excision rates underscore the need for standardized endometriosis training and specialized referrals.