Feasibility study of a S-shaped incision technique in endometrioma surgery: Cold dissection with no thermal injury

Preserving ovarian reserve while minimising recurrence remains a major challenge in endometrioma surgery. Conventional bipolar excision may cause thermal injury to the ovarian cortex and impair fertility potential. We conducted a pilot feasibility study of a technical modification of laparoscopic cystectomy using an S-shaped incision at the ovarian hilum with cold dissection to reduce thermal exposure and cortical damage. Twelve patients underwent cystectomy with this approach, and all procedures were completed without intraoperative complications. Postoperative evaluation included serum anti-Müllerian hormone (AMH), antral follicle count (AFC), pain score, CA-125, and sonographic assessment. Early postoperative findings were compatible with short-term technical feasibility and safety in this small initial series. The observed postoperative changes in ovarian reserve markers and symptoms provide preliminary data to inform future comparative studies with longer follow-up.