Design: Retrospective chart review.

Setting: Urban academic health system.

Patients or Participants: All patients scheduled to undergo elective laparoscopic ovarian cystectomy for benign conditions.

Interventions: The Enterprise Data Warehouse was queried for all scheduled cases of laparoscopic ovarian cystectomy. Procedures initiated as ovarian cystectomy that subsequently underwent intraoperative oophorectomy were identified by postoperative CPT codes.

Measurements and Main Results: From January 2018 – December 2023, we identified a total of 3504 patients that were scheduled for laparoscopic ovarian cystectomy, of which 131 underwent intraoperative oophorectomy. Patients undergoing unscheduled oophorectomy had diverse final pathologic diagnoses including dermoid cyst (35.1%), serous/mucinous cystadenoma (22.1%), endometrioma (15.3%), and hemorrhagic cyst (12.2%). Minimally invasive gynecologic surgeons (MIGS) had a significantly lower rate of unplanned oophorectomy compared with non-MIGS surgeons (1.1% [7/638] vs. 4.3% [124/2866], OR: 4.08 [95%CI: 1.89 – 8.77]). All cases of unplanned oophorectomy by MIGS surgeons were related to endometriosis compared to varied diagnoses for oophorectomies performed by non-MIGS surgeons (dermoid [34.7%], endometrioma [13.7%], serous cystadenoma [12.9%], hemorrhagic cyst [12.9%]). All seven cases converted to laparotomy (5.7%) were performed by non-MIGS surgeons.

Conclusion: When compared to MIGS surgeons, non-MIGS surgeons had a 4-fold higher rate of intraoperative oophorectomy at the time of elective laparoscopic ovarian cystectomy. Endometriomas appeared to be a risk factor for unplanned oophorectomy for MIGS surgeons in contrast to a range of diagnoses for non-MIGS surgeons.