Journal of minimally invasive gynecology最新文献

{"title":"Functional and Surgical Outcomes of Nerve-Sparing Approaches in Deep Infiltrating Endometriosis: A Systematic Review and Meta-Analysis.","authors":"Jouri Aloslani, Juri Alnwman, Haifa Alsahli, Sama Alhejaili, Jana Alabdulwahhab, Jana Almutairi, Renad Alshaya, Sarah Alghabban, Dina Alrajhi, Fatimah Alnakhli, Ahmad Badeghies","doi":"10.1016/j.jmig.2026.10.006","DOIUrl":"https://doi.org/10.1016/j.jmig.2026.10.006","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the surgical safety and functional outcomes of nerve-sparing surgery in the management of deep infiltrating endometriosis (DIE).</p><p><strong>Data sources: </strong>PubMed, Embase, Scopus, and LILACS were searched from January 2000 to August 2025 for studies evaluating nerve-sparing surgery in women with surgically confirmed DIE.</p><p><strong>Methods of study selection: </strong>A systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 guidelines. Eligible studies included women with surgically confirmed DIE who underwent nerve-sparing procedures. Two reviewers independently screened studies and extracted data. Pooled estimates with 95% confidence intervals were calculated, and statistical heterogeneity was assessed using the I² statistic.</p><p><strong>Tabulation, integration and results: </strong>Sixteen studies involving 1,623 women were included. The pooled conversion rate to open surgery was 0.3%, while intraoperative and postoperative complication rates were 1.5% and 9.8%, respectively. Urinary voiding dysfunction occurred in 6.9% of patients, and Low Anterior Resection Syndrome occurred in 10.2%. The pooled postoperative Female Sexual Function Index score was 22.3. Substantial heterogeneity was observed across several functional outcomes.</p><p><strong>Conclusion: </strong>Nerve-sparing surgery for DIE appears feasible and is associated with acceptable surgical and functional outcomes. However, the current evidence is limited, and substantial heterogeneity precludes conclusions regarding equivalence or superiority compared with conventional surgery. Further well-designed prospective and comparative studies are needed.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter \"Author's Reply\".","authors":"Prathiba M De Silva, T Justin Clark","doi":"10.1016/j.jmig.2026.09.468","DOIUrl":"https://doi.org/10.1016/j.jmig.2026.09.468","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pelvic splenosis and endometriosis in adolescent with hereditary spherocytosis.","authors":"Sophie M Blackburn, Matthew B Dellinger, Tambu Kudze, Lissa X Yu","doi":"10.1016/j.jmig.2026.10.008","DOIUrl":"https://doi.org/10.1016/j.jmig.2026.10.008","url":null,"abstract":"<p><p>The patient is a 16-year-old with a history of hereditary spherocytosis. At age 12, she underwent a laparoscopic partial converted to total splenectomy for intraoperative bleeding. The spleen was placed in a retrieval bag and removed via morcellation. She first reported abdominal pain at age 8, with dysmenorrhea after menarche at age 13. Her dysmenorrhea was managed with a progesterone IUD. Due to worsening pain, she underwent MRI which showed multiple lobulated structures throughout the pelvis and ventral abdomen, suggestive of endometriomas versus splenules. Laparoscopy revealed dozens of black-blue nodules coating the anterior abdominal wall and multiple multi-centimeter nodules attached to the sigmoid colon, descending colon, jejunum, and ovarian fossae, with vesicular lesions deep in pelvis. Abdominal wall and pelvic lesions were excised; removal of the nodules adherent to the colon and small bowel was deferred given inadequate bowel preparation. Frozen section and final histopathology confirmed splenosis throughout the abdomen and pelvis, with presence of endometriosis in right uterosacral ligament and ovarian fossa. Future surgery is planned to excise remaining splenules. This patient's case demonstrates that splenosis and endometriosis can exist simultaneously and are difficult to differentiate from one another symptomatically, on imaging, and even under direct visualization. Gynecologic surgeons should include splenosis in the differential diagnosis of pelvic nodular masses, particularly in patients with a history of splenectomy.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous thromboembolism after laparotomic and laparoscopic myomectomy with large myoma burden.","authors":"Mateo G Leon, Jorge Cervantes, Aakriti R Carrubba, Melissa K Cantave, Anita H Chen, Randa J Jalloul","doi":"10.1016/j.jmig.2026.10.007","DOIUrl":"https://doi.org/10.1016/j.jmig.2026.10.007","url":null,"abstract":"<p><strong>Study objective: </strong>To investigate the incidence of venous thromboembolism (VTE) in patients undergoing myomectomy. To evaluate the impact of route of surgery, myoma burden, and operative time in the development of VTE in this population.</p><p><strong>Design: </strong>Retrospective cohort study (Canadian Task Force Classification II2) of targeted myomectomy data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) SETTING: NSQIP Database PATIENTS OR PARTICIPANTS: Women aged ≥18 years undergoing laparotomic and laparoscopic myomectomy between 2011 and 2022. Patients were classified by Current Procedural Terminology (CPT) codes as having low or high myoma burden (>250 g or >4 fibroids). Patients undergoing hysterectomy, vaginal or hysteroscopic myomectomy, with malignant pathology, or missing operative time were excluded.</p><p><strong>Interventions: </strong>Cases were identified by CPT codes. Variables including age, ethnicity, body mass index (BMI), smoking status, diabetes, hypertension, blood transfusion, inpatient status, and American Society of Anesthesiologists classification system scores were collected. Clinical predictors of VTE were evaluated by stratifying cases according to surgical route, operative time, year of procedure, and myoma burden.</p><p><strong>Measurements and main results: </strong>A total of 38,167 myomectomies occurring between 2011-2022 were included. Of these, 20,943 (54.9%) patients underwent laparotomy, and 17,224 (45.1%) patients underwent laparoscopy. The incidence of VTE after myomectomy was 0.28%. Patients undergoing laparotomy had twice the VTE rate (0.36%) compared with those undergoing laparoscopy (0.18%). Patients undergoing laparotomy were more likely to be younger, of non-Hispanic African American ethnicity, inpatient, with higher BMI, require blood transfusion, have higher myoma burden, and have shorter operative times. After multivariable adjustment, neither myoma burden nor surgical route was independently associated with VTE. However, longer operative time (>186 min, 75 percentile) was independently associated with increased odds of VTE (aOR 2.73; CI:1.52-4.90).</p><p><strong>Conclusion: </strong>The occurrence of VTE after laparoscopic and laparotomic myomectomy is uncommon. The rate of VTE is higher with longer operative times, but this outcome is not significantly associated with surgical route or myoma burden.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An update on miRNAs as non-invasive diagnostic markers for endometriosis: Why have we not reached consensus?","authors":"Warren B Nothnick, Emily Olig, Austin Findley","doi":"10.1016/j.jmig.2026.10.004","DOIUrl":"https://doi.org/10.1016/j.jmig.2026.10.004","url":null,"abstract":"<p><p>The objective of this narrative review is to provide an update on microRNAs (miRNAs) as non-invasive biomarkers for endometriosis diagnosis focusing on publications from 2016 to 2026. In addition to updating miRNAs reported during this time frame, we also discuss why consensus has not been reached on identification of miRNAs with suitable sensitivity and specificity as diagnostic markers. A literature search was performed on PubMed from January 1, 2016 to September 1, 2026 using the keywords endometriosis, miRNA, and biomarker. A total of 238 articles were retrieved of which 101 were reviews, meta-analysis, or database searches, 46 articles focused on tissue or cell assessment of miRNA expression limiting the non-invasive approach, 24 were not focused on endometriosis but diseases comorbid with endometriosis, 17 focused on exosomes, 15 focused on other body fluid assessment of miRNAs, 4 focused on AI/machine learning, and 2 focused on animal model assessment of miRNA expression leaving 29 publications for further evaluation. The search for non-invasive biomarkers for endometriosis remains ongoing. From the studies presented in this review, while several miRNAs have emerged as candidate biomarkers, there is still considerable variability with respect to differentially expressed miRNAs between women with and without endometriosis. Focused assessment on methodologies employed for isolating serum/plasma, extraction of RNA/miRNAs, amplification and data normalization from these samples and if and how sample hemolysis was assessed and revealed differences among the studies all which impact miRNA profiles. As such, it is imperative to develop a standardized protocol when assessing miRNAs from blood if we hope to identify miRNAs which may prove useful in non-invasive diagnosis of endometriosis.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Totally Enclosed Protective Device versus Conventional Retrieval Bag in Laparoscopic Ovarian Teratoma Cystectomy: A Multicenter Randomized Controlled Trial.","authors":"Chang Zhou, Shengdi Hou, Huan Yu, Qing Liu, Yuanguang Meng, Hua Duan, Haiyan Liang, Chunhong Rong, Fang Zhao, Yanjun Yang, Ying Liu, Guifang He, Qingyun Chen, Xiulan Li, Wen Yang, Yanan Chang, Wenhui Wang, Jing Liang, Dingqing Feng, Bin Ling","doi":"10.1016/j.jmig.2026.10.002","DOIUrl":"https://doi.org/10.1016/j.jmig.2026.10.002","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate a \"Totally Enclosed Protective Device\" in preventing macroscopic intraoperative leakage during laparoscopic ovarian cystectomy compared to conventional methods.</p><p><strong>Design: </strong>Prospective, multicenter, randomized controlled superiority trial (1:1).</p><p><strong>Setting: </strong>Four academic medical centers in Beijing, China.</p><p><strong>Participants: </strong>119 premenopausal women (18-45 years) scheduled for laparoscopic cystectomy for unilateral ovarian masses (3-10 cm) were randomized. After exclusions, 105 participants (intervention: 53; control: 52) were analyzed.</p><p><strong>Interventions: </strong>Laparoscopic cystectomy using the device for contained decortication/extraction, versus conventional decortication followed by standard retrieval bag extraction.</p><p><strong>Measurements and main results: </strong>Device deployment success was 100%. Macroscopic leakage (primary outcome) was significantly lower in the intervention group (0.0%, 0/53) than controls (25.0%, 13/52) (risk difference [RD], -25.0%; 95% CI, -36.8% to -13.2%; P<0.001). Intraoperative rupture rates were comparable (32.1% vs. 25.0%; RD, 7.1%; 95% CI, -10.3% to 24.5%; P=0.422). Operative times were similar. Over a 34.5-month median follow-up, 5 control patients (9.6%) developed new-onset chronic pelvic pain, versus 0 in the intervention group.</p><p><strong>Conclusion: </strong>Within this study cohort, the device provided an effective physical barrier, and no macroscopic intraoperative spillage was observed. Preliminary findings suggest that standardizing this contained extraction strategy is associated with the absence of long-term complications, specifically chronic pelvic pain, in this sample.</p><p><strong>Funding: </strong>This study was supported by Capital's Funds for Health Improvement and Research (No. 2022-2-406).</p><p><strong>Clinical trial registration: </strong>Registration Number: NCT04406597; Date of Registration: May 20, 2022.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to: Analgesia for Office Hysteroscopy: A Systematic Review and Meta-analysis.","authors":"Will Spratt, Dhruti Bhatta, Ruby Jabbour, Jan Bosteels, Ben Willem Mol","doi":"10.1016/j.jmig.2026.08.032","DOIUrl":"https://doi.org/10.1016/j.jmig.2026.08.032","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Recurrence and Safety Outcomes After Ethanol Sclerotherapy for Ovarian Endometriomas.","authors":"Batuhan Aslan, Necati Berk Kaplan, Cem Atabekoğlu, Murat Sönmezer, Yavuz Emre Şükür","doi":"10.1016/j.jmig.2026.09.471","DOIUrl":"https://doi.org/10.1016/j.jmig.2026.09.471","url":null,"abstract":"<p><strong>Study objective: </strong>To evaluate recurrence/persistence after the initial transvaginal ultrasound-guided ethanol sclerotherapy (EST) for ovarian endometriomas, identify recurrence-associated factors, and assess feasibility, safety, and ovarian reserve outcomes after the initial procedure.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary referral center, Ankara, Türkiye.</p><p><strong>Patients: </strong>Women aged 18-45 years undergoing transvaginal ultrasound-guided EST for ovarian endometriomas between January 2021 and January 2026. A total of 115 EST attempts were screened; 112 were technically successful. The primary study cohort included 91 patients; time-to-event analysis was available for 88 patients.</p><p><strong>Interventions: </strong>A standardized 10-step transvaginal EST technique was used: aspiration, saline irrigation, instillation of 96-96.5% ethanol at 60% of aspirated volume (maximum 100 mL), 10-minute retention, and complete aspiration.</p><p><strong>Measurements and main results: </strong>Recurrence/persistence was defined as ultrasonographic detection of an endometrioma-like cyst ≥20 mm after the initial EST; repeat intervention alone was not a recurrence criterion. Recurrence/persistence occurred in 22 of 88 evaluable patients (25.0%); Kaplan-Meier cumulative estimates were 22.3% at 12 months and 29.1% at 24 months. Higher BMI was associated with recurrence/persistence in univariable analysis (HR, 1.21 per 1 kg/m; 95% CI, 1.10-1.33; P<0.001) and in the primary multivariable model (HR, 1.20; 95% CI, 1.10-1.32; P<0.001). In an expanded sensitivity model, the adjusted HR for BMI was 1.22 (95% CI, 1.11-1.35; P<0.001). Technical success was 97.4% (112/115; 95% CI, 92.6%-99.5%). Periprocedural complications occurred in 8 of 91 patients (8.8%; 95% CI, 3.9%-16.6%); no Clavien-Dindo grade IIIb-V complications occurred (0/91; 95% CI, 0.0%-4.0%). Median AMH declined modestly at 1 month (-0.16 ng/mL; P<0.001) and 6 months (-0.12 ng/mL; P=0.019).</p><p><strong>Conclusion: </strong>EST achieved high technical success in this carefully selected cohort. Recurrence/persistence remained clinically relevant, and higher BMI was associated with recurrence/persistence across primary and sensitivity analyses. This observational association should not be interpreted as causal, and the absence of histological confirmation limits conclusions regarding oncologic safety.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Robotic Trade-Off in Endometriosis Surgery: Robot-Assisted Versus Conventional Laparoscopy - A Systematic Review and Meta-Analysis.","authors":"Ana Clara Pimenta Servidoni, Luca Schiliró Tristão, Maria Julia Lemos, Hanna Surmann, Berenice Curi-Pesantes, Pedro Mussi Perroni, Pedro Lucas Pinheiro Mello, Camila M Aihara Nakayama, Marcio Delascio Lopes, Paulo A Ribeiro, Hugh S Taylor, Mauricio S Abrao","doi":"10.1016/j.jmig.2026.09.469","DOIUrl":"https://doi.org/10.1016/j.jmig.2026.09.469","url":null,"abstract":"<p><strong>Objective: </strong>To compare intraoperative and postoperative outcomes between robotic-assisted and conventional laparoscopy for endometriosis and explore differences by disease phenotype.</p><p><strong>Data sources: </strong>Systematic search of PubMed and EMBASE (2000-2026).</p><p><strong>Methods of study selection: </strong>RCTs, prospective and retrospective cohort studies comparing robotic-assisted with conventional laparoscopy in adult women with confirmed endometriosis were included. Two reviewers screened 1,067 records; 16 studies met eligibility. Data were pooled using random-effects models.</p><p><strong>Tabulation, integration, and results: </strong>Laparoscopy was associated with significantly shorter operative time (MD -26.47 minutes; 95% CI -39.41 to -13.54; p<0.0001; I²=89%; 14 studies; 2,450 patients). No significant differences were found for intraoperative bleeding, hemoglobin loss, conversion to laparotomy, hospital stay, intraoperative complications, fistula formation, or overall postoperative complications. Postoperative pain, voiding dysfunction, and the requirement for surgical drainage could not be pooled in a meta-analysis because of the high proportion of studies reporting zero events and were therefore reported descriptively; in the single study reporting postoperative pain, the incidence was lower in the robotic arm than in the laparoscopic arm (40.5% versus 76.7%). Subgroup analysis demonstrated laparoscopy was faster across all subtypes: ovarian (MD -32.09 min; 4 studies; 533 patients), unspecified disease location (MD -24.70 min; 8 studies; 1,605 patients), and bowel endometriosis (MD -22.24 min; 2 studies; 312 patients). Sensitivity analyses confirmed stable estimates; no publication bias was found (Egger's test: bleeding p=0.103, operative time p=0.704).</p><p><strong>Conclusion: </strong>Conventional laparoscopy was significantly faster than robotic-assisted surgery across all endometriosis subtypes, while no significant differences were found for most other perioperative outcomes. Postoperative pain could not be pooled and was reported descriptively, with a lower incidence observed in the robotic arm in the single contributing study. The choice of surgical approach should be individualized based on disease location, surgical expertise, and disease complexity, rather than assuming superiority of one technique over the other.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative cyst rupture in early-stage ovarian cancer: an analysis of endometriosis-associated subtypes.","authors":"Giulia Mantovani, Francesco Mezzapesa, Elisa Scarpelli, Enrico Fiuzzi, Lucia Genovesi, Pietro Pasquini, Matteo Girlando, Jose Manuel Garcia Garcia, Antonio De Leo, Pierandrea De Iaco, Anna Myriam Perrone","doi":"10.1016/j.jmig.2026.09.470","DOIUrl":"https://doi.org/10.1016/j.jmig.2026.09.470","url":null,"abstract":"<p><strong>Study objective: </strong>To evaluate the incidence and oncologic impact of intraoperative cyst rupture in apparent early-stage epithelial ovarian cancer, with a focus on the role of endometriosis in modulating surgical risk and disease behaviour.</p><p><strong>Design: </strong>Retrospective single-center cohort study.</p><p><strong>Setting: </strong>Tertiary referral teaching hospital.</p><p><strong>Participants: </strong>A total of 239 patients with apparent FIGO stage I epithelial ovarian cancer who underwent primary surgical treatment. Patients were stratified into three groups according to histopathologic findings: endometriosis-correlated ovarian cancer (ECOC, n=75), endometriosis-incidental ovarian cancer (EIOC, n=46), and ovarian cancer without endometriosis (NEOC, n=118).</p><p><strong>Interventions: </strong>Occurrence of intraoperative cyst rupture was recorded for all patients.</p><p><strong>Measurements and main results: </strong>The primary outcomes were the incidence of intraoperative cyst rupture, progression-free survival, and peritoneal recurrence, evaluated using logistic and Cox regression models, whereas analyses of overall survival were conducted for exploratory purposes only. Intraoperative cyst rupture occurred significantly more often in ECOC (20%) than in EIOC (13%) and NEOC (5%) (p=0.006), with ECOC being the only factor independently associated with rupture risk. Despite this higher rupture rate, cyst rupture was not associated with worse progression-free survival or increased risk of peritoneal relapse. Conversely, ECOC was independently associated with improved progression-free survival and a lower risk of peritoneal recurrence. A minimally invasive surgical approach was associated with a higher risk of disease progression, although this finding should be interpreted with caution, as it may reflect residual confounding, selection bias, tumor biology, or other unmeasured factors.</p><p><strong>Conclusion: </strong>In apparent early-stage epithelial ovarian cancer, intraoperative cyst rupture occurs more frequently in ECOC but does not adversely affect oncologic outcomes. Tumor biology, rather than the surgical event of cyst rupture alone, appears to be the primary driver of disease behavior. These findings support a more biology-informed approach to surgical decision-making in early-stage epithelial ovarian cancer.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}