{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T21:08:16Z","timestamp":1793740096729,"version":"4.6.1"},"reference-count":38,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Endometrioma recurrence after laparoscopic cystectomy remains a clinical challenge in the long-term management of endometriosis. The Empressin Injection Technique (EIT), which involves the use of a vasopressin analog during surgery, may reduce recurrence by improving the completeness of cyst removal. This study aimed to evaluate the impact of the EIT on recurrence rates compared to standard cystectomy without Empressin. Methods: We conducted a retrospective case\u2013control study of 263 patients who underwent laparoscopic cystectomy for unilateral or bilateral endometriomas between 2014 and 2024 at a tertiary endometriosis referral center. The patients were divided into two groups: EIT (n = 110) and control (n = 153). In the EIT group, 10 mL of diluted Empressin (1 mL in 100 mL NaCl 0.9%) was injected at the cyst capsule\u2013ovarian cortex interface prior to stripping. Demographic and clinical variables were analyzed using descriptive statistics (chi-square test and the Mann\u2013Whitney t-test) and logistic regression to identify factors associated with recurrence between the two groups. Results: No significant differences were found between the groups regarding age, BMI, #ENZIAN O score, or r-ASRM stage. No intraoperative or postoperative complications were reported. Recurrence was significantly lower in the EIT group (5.5%) compared to the control group (19.6%) (p = 0.001; OR 0.2, 95% CI: 0.08\u20130.55). Hormonal therapy was administered postoperatively in 69.1% of EIT patients and 62.5% of controls. Pregnancy rates were comparable between the groups. Repeat surgery for recurrence was required only in the control group (4.2%, p = 0.004). Conclusions: Use of Empressin during laparoscopic cystectomy significantly reduces endometrioma recurrence without adverse effects, particularly when combined with postoperative hormonal therapy.<\/jats:p>","DOI":"10.3390\/jcm14217716","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T05:28:43Z","timestamp":1761888523000},"page":"7716","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Is the EMpressin Injection in ENDOmetrioma eXcision Surgery Useful? The EMENDOX Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2835-9838","authenticated-orcid":false,"given":"Flavia","family":"Pagano","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, University Hospital of Berne, University of Bern, 3012 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Dedes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University Hospital of Berne, University of Bern, 3012 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clo\u00e9","family":"Vaineau","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University Hospital of Berne, University of Bern, 3012 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3415-9162","authenticated-orcid":false,"given":"Franziska","family":"Siegenthaler","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University Hospital of Berne, University of Bern, 3012 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Imboden","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University Hospital of Berne, University of Bern, 3012 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1947-1315","authenticated-orcid":false,"given":"Michael David","family":"Mueller","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University Hospital of Berne, University of Bern, 3012 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.ejogrb.2024.08.045","article-title":"Connecting the dots: Exploring appendiceal endometriosis in women with diaphragmatic endometriosis","volume":"302","author":"Pagano","year":"2024","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.jmig.2023.01.006","article-title":"True Prevalence of Diaphragmatic Endometriosis and Its Association with Severe Endometriosis: A Call for Awareness and Investigation","volume":"30","author":"Pagano","year":"2023","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.ajog.2015.08.074","article-title":"Continuous versus cyclic oral contraceptives after laparoscopic excision of ovarian endometriomas: A systematic review and metaanalysis","volume":"214","author":"Muzii","year":"2016","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1097\/AOG.0000000000005587","article-title":"Pathophysiology and Clinical Implications of Ovarian Endometriomas","volume":"143","author":"Nezhat","year":"2024","journal-title":"Obstet. Gynecol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1067\/mob.2003.7","article-title":"Coagulation or excision of ovarian endometriomas?","volume":"188","author":"Vercellini","year":"2003","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_6","first-page":"93","article-title":"Metastatic or Embolic Endometriosis, due to the Menstrual Dissemination of Endometrial Tissue into the Venous Circulation","volume":"3","author":"Sampson","year":"1927","journal-title":"Am. J. Pathol."},{"key":"ref_7","first-page":"318","article-title":"A histologic study of ovarian endometriosis with emphasis on hyperplastic and atypical changes","volume":"53","author":"Czernobilsky","year":"1979","journal-title":"Obstet. Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/S0015-0282(16)59766-0","article-title":"Histologic study of ovarian endometriosis after hormonal therapy","volume":"49","author":"Donnez","year":"1988","journal-title":"Fertil. Steril."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"hoac009","DOI":"10.1093\/hropen\/hoac009","article-title":"ESHRE guideline: Endometriosis","volume":"2022","author":"Becker","year":"2022","journal-title":"Hum. Reprod. Open"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.jmig.2024.01.002","article-title":"The Effect of Hormonal Treatment on Ovarian Endometriomas: A Systematic Review and Meta-Analysis","volume":"31","author":"Thiel","year":"2024","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.jmig.2022.12.014","article-title":"Combining Sclerotherapy with CO(2) Laser Ablation for the Laparoscopic Management of Large Endometrioma: Advantages and Pitfalls","volume":"30","author":"Alec","year":"2023","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3000","DOI":"10.1093\/humrep\/dei207","article-title":"Excisional surgery versus ablative surgery for ovarian endometriomata: A Cochrane Review","volume":"20","author":"Hart","year":"2005","journal-title":"Hum. Reprod."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1016\/S0015-0282(98)00385-9","article-title":"Randomized clinical trial of two laparoscopic treatments of endometriomas: Cystectomy versus drainage and coagulation","volume":"70","author":"Beretta","year":"1998","journal-title":"Fertil. Steril."},{"key":"ref_14","first-page":"2343","article-title":"The effects of vasopressin injection technique on ovarian reserve in laparoscopic cystectomy of bilateral ovarian endometrioma: A retrospective cohort study","volume":"14","author":"Xin","year":"2022","journal-title":"Am. J. Transl. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3146","DOI":"10.1210\/jc.2012-1558","article-title":"The impact of excision of ovarian endometrioma on ovarian reserve: A systematic review and meta-analysis","volume":"97","author":"Raffi","year":"2012","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Daniilidis, A., Grigoriadis, G., Kalaitzopoulos, D.R., Angioni, S., Kalkan, U., Crestani, A., Merlot, B., and Roman, H. (2023). Surgical Management of Ovarian Endometrioma: Impact on Ovarian Reserve Parameters and Reproductive Outcomes. J. Clin. Med., 12.","DOI":"10.20944\/preprints202307.1698.v1"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.jmig.2013.07.024","article-title":"Effect of vasopressin injection technique in laparoscopic excision of bilateral ovarian endometriomas on ovarian reserve: Prospective randomized study","volume":"21","author":"Ge","year":"2014","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1080\/01443615.2017.1355897","article-title":"Which factors are associated with the recurrence of endometrioma after cystectomy?","volume":"38","author":"Kucukbas","year":"2018","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.rbmo.2010.04.018","article-title":"Post-operative endometriosis recurrence: A plea for prevention based on pathogenetic, epidemiological and clinical evidence","volume":"21","author":"Vercellini","year":"2010","journal-title":"Reprod. Biomed. Online"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2171","DOI":"10.1093\/humrep\/del125","article-title":"Recurrence of ovarian endometrioma after laparoscopic excision","volume":"21","author":"Koga","year":"2006","journal-title":"Hum. Reprod."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1111\/1471-0528.16366","article-title":"Postoperative hormonal treatment for prevention of endometrioma recurrence after ovarian cystectomy: A systematic review and network meta-analysis","volume":"128","author":"Wattanayingcharoenchai","year":"2021","journal-title":"BJOG"},{"key":"ref_22","first-page":"CD004992","article-title":"Excisional surgery versus ablative surgery for ovarian endometrioma","volume":"11","author":"Kalra","year":"2024","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/S0002-9378(99)70247-4","article-title":"Recurrence of ovarian endometrioma after laparoscopic excision","volume":"180","author":"Busacca","year":"1999","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1080\/00016340600627154","article-title":"Recurrence rate of endometriomas following a laparoscopic cystectomy","volume":"85","author":"Kikuchi","year":"2006","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_25","first-page":"693","article-title":"Recurrence of endometriosis: Risk factors, mechanisms and biomarkers","volume":"11","author":"Bozdag","year":"2015","journal-title":"Womens Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s00404-016-4085-y","article-title":"Can postoperative GnRH agonist treatment prevent endometriosis recurrence? A meta-analysis","volume":"294","author":"Zheng","year":"2016","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1016\/j.jmig.2021.11.024","article-title":"Maintenance Therapy for Preventing Endometrioma Recurrence after Endometriosis Resection Surgery\u2014A Systematic Review and Network Meta-analysis","volume":"29","author":"Chiu","year":"2022","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_28","first-page":"199","article-title":"Vasopressin Effect on Operation Time and Frequency of Electrocauterization during Laparoscopic Stripping of Ovarian Endometriomas: A Randomized Controlled Clinical Trial","volume":"15","author":"Ghafarnejad","year":"2014","journal-title":"J. Reprod. Infertil."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.jmig.2009.11.004","article-title":"The vasopressin injection technique for laparoscopic excision of ovarian endometrioma: A technique to reduce the use of coagulation","volume":"17","author":"Saeki","year":"2010","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.jmig.2008.12.013","article-title":"Endometrioma excision and ovarian reserve: A dangerous relation","volume":"16","author":"Busacca","year":"2009","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1016\/j.fertnstert.2024.07.033","article-title":"Recurrence after surgery for endometrioma: A systematic review and meta-analyses","volume":"122","author":"Veth","year":"2024","journal-title":"Fertil. Steril."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2729","DOI":"10.1093\/humrep\/dep259","article-title":"Post-operative use of oral contraceptive pills for prevention of anatomical relapse or symptom-recurrence after conservative surgery for endometriosis","volume":"24","author":"Seracchioli","year":"2009","journal-title":"Hum. Reprod."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1093\/humrep\/deae257","article-title":"Endometrioma patients are under-treated with endocrine endometriosis therapy","volume":"40","author":"Cirkel","year":"2025","journal-title":"Hum. Reprod."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1016\/0029-7844(96)00071-3","article-title":"A randomized comparison of vasopressin and tourniquet as hemostatic agents during myomectomy","volume":"87","author":"Fletcher","year":"1996","journal-title":"Obstet. Gynecol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"431","DOI":"10.21873\/invivo.13456","article-title":"Effect and Safety of Diluted Vasopressin Injection for Bleeding Control During Robot-assisted Laparoscopic Myomectomy in Reproductive Women with Uterine Fibroids: A Randomized Controlled Pilot Trial (VALENTINE Trial)","volume":"38","author":"Park","year":"2024","journal-title":"In Vivo"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1097\/AOG.0b013e318187e795","article-title":"Bradycardia and cardiac arrest caused by intramyometrial injection of vasopressin during a laparoscopically assisted myomectomy","volume":"113","author":"Hobo","year":"2009","journal-title":"Obstet. Gynecol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.jmig.2006.01.015","article-title":"The effect of vasopressin on local and general circulation during laparoscopic surgery","volume":"13","author":"Shimanuki","year":"2006","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"386","DOI":"10.23736\/S2724-606X.23.05310-1","article-title":"Effect of vasopressin injection technique on ovarian reserve during laparoscopic cystectomy of ovarian endometriomas: A systematic review and meta-analysis of randomized controlled trials","volume":"76","author":"Baradwan","year":"2024","journal-title":"Minerva Obstet. Gynecol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7716\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T05:48:57Z","timestamp":1761889737000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7716"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,30]]},"references-count":38,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcm14217716"],"URL":"https:\/\/doi.org\/10.3390\/jcm14217716","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,30]]}}}