Surgeon Subspecialty and Ovarian Preservation in Endometrioma Surgery: A Retrospective Cohort Study

Megan Billow; Jensara Clay; Annemarie Newark; Meng Yao; Mariam AlHilli; Rosanne Kho

doi:10.1016/j.jmig.2026.01.036

Surgeon Subspecialty and Ovarian Preservation in Endometrioma Surgery: A Retrospective Cohort Study

J Minim Invasive Gynecol. 2026 Jan 20:S1553-4650(26)00061-0. doi: 10.1016/j.jmig.2026.01.036. Online ahead of print.

Authors

Megan Billow¹, Jensara Clay², Annemarie Newark³, Meng Yao⁴, Mariam AlHilli⁵, Rosanne Kho²

Affiliations

¹ Obstetrics and Gynecology Institute, Minimally Invasive Gynecologic Surgery Division, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: billowm3@ccf.org.
² Obstetrics and Gynecology Institute, Minimally Invasive Gynecologic Surgery Division, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
³ Obstetrics and Gynecology Institute, Obstetrics and Gynecology Department, Cleveland Clinic Akron General, 1 Akron General Avenue, Akron, OH 44307, USA.
⁴ Obstetrics and Gynecology Institute, Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
⁵ Obstetrics and Gynecology Institute, Gynecologic Oncology Division, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.

PMID: 41571147
DOI: 10.1016/j.jmig.2026.01.036

Abstract

Objective: To evaluate variation in ovarian preservation and excision of extra-ovarian endometriosis during endometrioma surgery across gynecologic subspecialties.

Design: Retrospective cohort study.

Setting: One tertiary academic medical center and four regional hospitals within a single health system.

Participants: Individuals aged 18-45 years who underwent surgery for pathology-confirmed ovarian endometrioma between 2012 and 2024. Exclusion criteria included hereditary cancer syndromes, prior malignancy, malignancy on final pathology, non-gynecologic surgeons, and incomplete documentation. The final cohort comprised 351 patients.

Interventions: Surgical management was assessed across four gynecologic subspecialties: general obstetrics and gynecology (OBGYN), minimally invasive gynecologic surgery (MIGS), reproductive endocrinology and infertility (REI), and gynecologic oncology (GYNONC). The primary outcome was ovarian-sparing surgery, defined as cystectomy without oophorectomy. The secondary outcome was excision of extra-ovarian endometriosis among patients with advanced-stage disease (rASRM stage III or IV). Multivariable logistic regression was used to adjust for clinical and surgical factors.

Results: Ovarian-sparing surgery was performed in 66% of cases and varied by surgeon subspecialty. Compared with OB/GYN surgeons, MIGS and REI surgeons had higher odds of ovarian-sparing surgery (adjusted odds ratio [aOR] 8.46, 95% confidence interval [CI] 3.07-23.29 and aOR 8.44, 95% CI 2.71-26.27, respectively; both p < 0.001). Among patients with advanced-stage disease, excision of extra-ovarian endometriosis also differed by subspecialty, with MIGS and REI surgeons demonstrating higher odds of extra-ovarian excision compared with OB/GYN surgeons (aOR 23.18, 95% CI 8.18-65.72 and aOR 13.09, 95% CI 4.44-38.63, respectively; both p < 0.001).

Conclusion: Surgical management of ovarian endometriomas varied across gynecologic subspecialties. Compared with OB/GYN and GYNONC surgeons, MIGS and REI surgeons were more likely to perform ovarian-sparing surgery and excise extra-ovarian endometriosis.

Keywords: Endometrioma; Endometriosis; Minimally Invasive Gynecologic Surgery; Ovarian Preservation; Surgeon Subspecialty.