{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T23:05:54Z","timestamp":1787785554199,"version":"build-2784847793"},"reference-count":44,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,5,28]],"date-time":"2023-05-28T00:00:00Z","timestamp":1685232000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Objective: The surgical management of polycystic ovary syndrome (PCOS) represents an unclear option compared to medical therapy, and it is necessary to deepen the role of minimally invasive surgery, represented by laparoscopic ovarian drilling (LOD) and transvaginal hydrolaparoscopy (THL), for the treatment of PCOS in infertile women resistant to drug therapy and to establish its success in terms of ovulation and pregnancy rates. Methods: A search was performed in the main electronic databases (MEDLINE, EMBASE, Web of Science, PubMed, and the Cochrane Library) from 1994 to October 2022 in order to evaluate the role of surgery in patients with PCOS resistant to pharmacological treatment. Only original scientific articles in English were included. Results: Seventeen studies were analyzed in this review. In all analyzed studies, more than 50% of the population underwent spontaneous ovulation after surgical treatment without great differences between the two surgical techniques (LOD and THL). More than 40% of patients delivered, with a higher rate after LOD, although eight ectopic pregnancies and sixty-three miscarriages were reported. A lower risk of adhesion formation after THL has been reported. No clear data regarding the effect of surgery on the regularization of the menstrual cycle has been described. A reduction in LH and AMH serum levels as well as the LH\/FSH ratio compared to preoperative levels for both surgical techniques has been described. Conclusions: Despite the scarcity and heterogeneity of data, surgical therapy could be considered an effective and safe approach in the management of PCOS patients with resistance to pharmacological treatment who desire to become pregnant.<\/jats:p>","DOI":"10.3390\/life13061270","type":"journal-article","created":{"date-parts":[[2023,5,28]],"date-time":"2023-05-28T15:29:52Z","timestamp":1685287792000},"page":"1270","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Is There Still a Place for Surgery in Patients with PCOS? A Review"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0584-2181","authenticated-orcid":false,"given":"Luigi","family":"Della Corte","sequence":"first","affiliation":[{"name":"Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominga","family":"Boccia","sequence":"additional","affiliation":[{"name":"Department of Public Health, School of Medicine, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Palumbo","sequence":"additional","affiliation":[{"name":"Department of Public Health, School of Medicine, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2113-7706","authenticated-orcid":false,"given":"Antonio","family":"Mercorio","sequence":"additional","affiliation":[{"name":"Department of Public Health, School of Medicine, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9023-282X","authenticated-orcid":false,"given":"Carlo","family":"Ronsini","sequence":"additional","affiliation":[{"name":"Department of Woman, Child and General and Specialized Surgery, School of Medicine, University of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Bifulco","sequence":"additional","affiliation":[{"name":"Department of Public Health, School of Medicine, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierluigi","family":"Giampaolino","sequence":"additional","affiliation":[{"name":"Department of Public Health, School of Medicine, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,28]]},"reference":[{"key":"ref_1","unstructured":"Wo\u0142czy\u0144ski, S., and Zgliczy\u0144ski, W. (2012). Large Interna\u2014Endocrinology, Medical Tribune. [2nd ed.]."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"The Rotterdam ESHRE\/ASRM-Sponsored PCOS Consensus Workshop Group (2004). Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum. Reprod., 19, 41\u201347.","DOI":"10.1093\/humrep\/deh098"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1080\/09513590.2017.1391205","article-title":"Ovarian volume and PCOS: A controversial issue","volume":"34","author":"Giampaolino","year":"2017","journal-title":"Gynecol. Endocrinol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"409","DOI":"10.5603\/EP.2013.0025","article-title":"Reimbursement of metformin for polycystic ovary syndrome","volume":"64","author":"Milewicz","year":"2013","journal-title":"Endokrynol. Pol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"33","DOI":"10.4239\/wjd.v2.i3.33","article-title":"Assessing and treating insulin resistance in women with polycystic ovarian syndrome","volume":"2","author":"Traub","year":"2011","journal-title":"World J. Diabetes"},{"key":"ref_6","first-page":"415","article-title":"Insulin resistance and fertility in polycystic ovary syndrome","volume":"1","author":"Fica","year":"2008","journal-title":"J. Med. Life"},{"key":"ref_7","first-page":"488","article-title":"Psychiatric disorders related to polycystic ovary syndrome","volume":"63","author":"Lenarcik","year":"2012","journal-title":"Endokrynol. Pol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1055\/s-0029-1237705","article-title":"The Effect of metformin treatment for 2 years without caloric restriction on endocrine and metabolic parameters in women with polycystic ovary syndrome","volume":"118","author":"Oppelt","year":"2009","journal-title":"Exp. Clin. Endocrinol. Diabetes"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1093\/humupd\/dmw025","article-title":"The management of anovulatory infertility in women with polycystic ovary syndrome: An analysis of the evidence to support the development of global WHO guidance","volume":"22","author":"Balen","year":"2016","journal-title":"Hum. Reprod. Update"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Mercorio, A., Della Corte, L., De Angelis, M.C., Buonfantino, C., Ronsini, C., Bifulco, G., and Giampaolino, P. (2022). Ovarian Drilling: Back to the Future. Medicina, 58.","DOI":"10.3390\/medicina58081002"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Seow, K.-M., Chang, Y.-W., Chen, K.-H., Juan, C.-C., Huang, C.-Y., Lin, L.-T., Tsui, K.-H., Chen, Y.-J., Lee, W.-L., and Wang, P.-H. (2020). Molecular Mechanisms of Laparoscopic Ovarian Drilling and Its Therapeutic Effects in Polycystic Ovary Syndrome. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21218147"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"30","DOI":"10.3389\/fsurg.2015.00030","article-title":"Ovarian Drilling in PCOS: Is it Really Useful?","volume":"2","author":"Lebbi","year":"2015","journal-title":"Front. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1080\/09513590.2016.1188280","article-title":"Serum anti-Mullerian hormone levels after ovarian drilling for the second-line treatment of polycystic ovary syndrome: A pilot-randomized study comparing lapa-roscopy and transvaginal hydrolaparoscopy","volume":"33","author":"Giampaolino","year":"2017","journal-title":"Gynecol. Endocrinol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s41073-019-0064-8","article-title":"SANRA\u2014A scale for the quality assessment of narrative review articles","volume":"4","author":"Baethge","year":"2019","journal-title":"Res. Integr. Peer Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"407","DOI":"10.3109\/00016349409006253","article-title":"Ovarian electrocautery in the treatment of women with polycystii ovary syndrome (PCOS): Factors affecting the results","volume":"73","year":"1994","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1111\/j.1471-0528.1998.tb10097.x","article-title":"Factors affecting the outcome of laparoscopic ovarian drilling for polycystic ovarian syndrome in women with anovulatory infertility","volume":"105","author":"Li","year":"1998","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/S1074-3804(05)60613-5","article-title":"Laparoscopic ovarian drilling in clomiphene citrate-resistant women with polycystic ovary syndrome","volume":"8","author":"Kriplani","year":"2001","journal-title":"J. Am. Assoc. Gynecol. Laparosc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/S0015-0282(00)01746-5","article-title":"Operative transvaginal hydrolaparoscopy for treatment of polycystic ovary syndrome: A new minimally invasive surgery","volume":"75","author":"Fernandez","year":"2001","journal-title":"Fertil. Steril."},{"key":"ref_19","first-page":"1","article-title":"Laparoscopic Ovarian Drilling for Polycystic Ovarian Syndrome in Clomiphene Citrate-Resistant Women with Anovulatory Infertility","volume":"2","year":"2003","journal-title":"Bahrain Med. Bull."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1016\/S0015-0282(02)04848-3","article-title":"Success of laparoscopic ovarian wedge resection is related to obesity, lipid profile, and insulin levels","volume":"79","author":"Duleba","year":"2003","journal-title":"Fertil. Steril."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1067\/mob.2003.289","article-title":"Characteristics predictive of response to ovarian diathermy in women with polycystic ovarian syndrome","volume":"188","author":"Stegmann","year":"2003","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1719","DOI":"10.1093\/humrep\/deh343","article-title":"Ovulation induction using laparoscopic ovarian drilling in women with polycystic ovarian syndrome: Predictors of success","volume":"19","author":"Amer","year":"2004","journal-title":"Hum. Reprod."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1093\/humrep\/deh712","article-title":"Predictors for treatment failure after laparoscopic electrocautery of the ovaries in women with clomiphene citrate resistant polycystic ovary syndrome","volume":"20","author":"Bayram","year":"2005","journal-title":"Hum. Reprod."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1080\/09513590600645700","article-title":"Efficacy of laparoscopic ovarian diathermy in clomiphene citrate-resistant women with polycystic ovary syndrome: Relationships with chronological and ovarian age","volume":"22","author":"Palomba","year":"2006","journal-title":"Gynecol. Endocrinol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2760","DOI":"10.1093\/humrep\/dep271","article-title":"The value of measuring anti-Mullerian hormone in women with anovulatory polycystic ovary syndrome undergoing laparoscopic ovarian diathermy","volume":"24","author":"Amer","year":"2009","journal-title":"Hum. Reprod."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2520","DOI":"10.1016\/j.fertnstert.2008.04.020","article-title":"Transvaginal hydrolaparoscopy in the treatment of polycystic ovary syndrome","volume":"91","author":"Gordts","year":"2009","journal-title":"Fertil. Steril."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1186\/1477-7827-7-153","article-title":"Luteinizing hormone and androstendione are independent predictors of ovulation after laparoscopic ovarian drilling: A retrospective cohort study","volume":"7","author":"Ott","year":"2009","journal-title":"Reprod. Biol. Endocrinol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"39","DOI":"10.5005\/jp-journals-10016-1059","article-title":"Outcome of Laparoscopic Ovarian Drilling in Patients of Clomiphene Resistant Polycystic Ovarian Syndrome in a Tertiary Care Center","volume":"4","author":"Kaur","year":"2013","journal-title":"Int. J. Infertil. Fetal Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1080\/09513590.2017.1323204","article-title":"Operative transvaginal hydrolaparoscopy improve ovulation rate after clomiphene failure in polycystic ovary syndrome","volume":"34","author":"Giampaolino","year":"2017","journal-title":"Gynecol. Endocrinol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"131","DOI":"10.52054\/FVVO.13.2.014","article-title":"Systematic use of transvaginal hydrolaparoscopy as a minimally invasive procedure in the exploration of the infertile patient: Results and reflections","volume":"13","author":"Gordts","year":"2021","journal-title":"Facts Views Vis. Obgyn"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1007\/s00404-016-4146-2","article-title":"Post-operative ovarian adhesion formation after ovarian drilling: A randomized study comparing conventional laparoscopy and transvaginal hydrolaparoscopy","volume":"294","author":"Giampaolino","year":"2016","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1080\/09513590.2021.1958310","article-title":"Polycystic ovarian syndrome and infertility: Overview and insights of the putative treatments","volume":"37","author":"Mawet","year":"2021","journal-title":"Gynecol. Endocrinol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.clinbiochem.2018.03.012","article-title":"Fertility and infertility: Definition and epidemiology","volume":"62","author":"Wyns","year":"2018","journal-title":"Clin. Biochem."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"117","DOI":"10.3389\/fendo.2017.00117","article-title":"The Distribution of Stroma and Antral Follicles Differs between Insulin-Resistance and Hyperandrogenism-Related Polycystic Ovarian Syndrome","volume":"8","author":"Alviggi","year":"2017","journal-title":"Front. Endocrinol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1210\/er.2015-1018","article-title":"Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome","volume":"36","author":"Dumesic","year":"2015","journal-title":"Endocr. Rev."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.bpobgyn.2014.11.001","article-title":"Polycystic ovaries and obesity","volume":"29","author":"Messinis","year":"2015","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Costello, M.F., Garad, R.M., Hart, R., Homer, H., Johnson, L., Jordan, C., Mocanu, E., Qiao, J., Rombauts, L., and Teede, H.J. (2019). A Review of Second- and Third-line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome. Med. Sci., 7.","DOI":"10.3390\/medsci7070075"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1111\/aogs.13395","article-title":"Ovulation induction in polycystic ovary syndrome","volume":"97","author":"Tanbo","year":"2018","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1080\/09513590.2017.1370644","article-title":"Therapeutic approach for metabolic disorders and infertility in women with PCOS","volume":"34","author":"Morgante","year":"2017","journal-title":"Gynecol. Endocrinol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/S0015-0282(16)48129-X","article-title":"Monitoring techniques for improved pregnancy rates during clomiphene ovulation induction","volume":"42","author":"Wallach","year":"1984","journal-title":"Fertil. Steril."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e3","DOI":"10.1017\/S1462399408000598","article-title":"Polycystic ovarian syndrome: Pathophysiology, molecular aspects and clinical implications","volume":"10","year":"2008","journal-title":"Expert Rev. Mol. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"23","DOI":"10.3389\/fendo.2019.00023","article-title":"Follicle Stimulating Hormone Receptor (FSHR) Polymorphisms and Polycystic Ovary Syndrome (PCOS)","volume":"10","author":"Laven","year":"2019","journal-title":"Front. Endocrinol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1080\/13543784.2020.1781815","article-title":"Current and experimental drug therapy for the treatment of polycystic ovarian syndrome","volume":"29","author":"Foreste","year":"2020","journal-title":"Expert Opin. Investig. Drugs"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Giampaolino, P., Foreste, V., Di Filippo, C., Gallo, A., Mercorio, A., Serafino, P., Improda, F.P., Verrazzo, P., Zara, G., and Buonfantino, C. (2021). Microbiome and PCOS: State-of-Art and Future Aspects. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22042048"}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/6\/1270\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:43:41Z","timestamp":1760125421000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/6\/1270"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,28]]},"references-count":44,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["life13061270"],"URL":"https:\/\/doi.org\/10.3390\/life13061270","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,28]]}}}