Recurrent miscarriage investigation and treatment, structural causes (septum, adhesions, polyps, fibroids), progesterone and other medical treatment, ovarian cyst assessment and classification, ovary-sparing cystectomy and ovarian reserve, dermoid and endometrioma surgery.
This page is written for clinicians and referrers and is not advice for individual patients. If you are a patient, the plain-language pages are Fertility and miscarriage surgery and Ovarian cysts .
Each week the literature is searched for new papers on recurrent miscarriage and ovarian cysts, screened to the few that meet the evidence bar, and each one is verified on PubMed before it is summarised. I read every entry and give one verdict: whether the paper changes what I tell patients or do in theatre, supports current practice, or leaves it unchanged. Papers appear here newest first, grouped by the week they were found, with the study design, the main result and its effect size, and the reason for the verdict. Abstracts are not reproduced; the summaries are my own.
Catch-up digest, 22 September 2026 to 19 October 2026
Seeding run over a longer window, written 19 October 2026
With a standard retrieval bag, dermoid cyst contents spilled inside the abdomen in about one in four women; none spilled with a fully enclosed device: multicentre randomised trial
Multicentre randomised superiority trial (NCT04406597) in four academic hospitals in Beijing; 119 premenopausal women aged 18 to 45 with a unilateral ovarian mass of 3 to 10 cm were randomised to cystectomy carried out inside a totally enclosed protective device or to conventional cystectomy with extraction in a standard retrieval bag; 105 were analysed (53 against 52) after exclusions.
Finding
Macroscopic spillage inside the abdomen, the primary outcome, occurred in 0 of 53 women with the device against 13 of 52 (25.0%, about one in four) with a standard bag (risk difference -25.0%, 95% CI -36.8% to -13.2%, P<0.001); the cyst ruptured during surgery about as often in both groups (32.1% against 25.0%, risk difference 7.1%, 95% CI -10.3% to 24.5%); operating times were similar and the device deployed successfully every time; over a median 34.5 months, 5 of 52 control women (9.6%, about one in ten) developed new chronic pelvic pain and none of the device group did.
Supports current practicemoderate evidence
Avoiding spillage of dermoid contents is standard careful technique and the trial shows why: one in four spills with a conventional bag, and late pelvic pain only in that arm; it is a small trial of a device whose availability outside China is not described, so it supports strict spillage avoidance rather than a particular product.
What it means
For a woman having a dermoid cyst removed by keyhole surgery, the useful fact is in the control arm: with a standard retrieval bag the cyst contents spilled inside the abdomen in about one in four, and about one in ten of that group went on to develop long-term pelvic pain, against none when the whole cyst was handled inside a sealed device.
Conflicts of interest: Publicly funded (Capital's Funds for Health Improvement and Research, Beijing, No. 2022-2-406); the device's maker is not named in the record.
Reviewed by Mr Jan, .
Transvaginal (vNOTES) ovarian cystectomy gave less early pain and the same safety and sexual function as single-incision umbilical surgery: single-centre randomised trial
Single-centre randomised trial (ChiCTR2100053483) in a university-affiliated tertiary women's and children's hospital in China; 160 women with benign ovarian cysts, screened before and after anaesthesia as suitable for both approaches, randomised 1:1 to vNOTES or transumbilical single-site cystectomy; pain by visual analogue scale at 12, 24 and 48 hours, cosmetic satisfaction at one month, Female Sexual Function Index before surgery and at three to six months.
Finding
No conversions; intraoperative complications, operative time, blood loss, postoperative complications (5.0% against 3.8%), rescue analgesia, wound events, incisional hernia and postoperative sexual function scores were comparable, while vNOTES gave lower pain scores at 12, 24 and 48 hours, shorter total and postoperative stay and higher cosmetic satisfaction (all p<0.001); the abstract gives p values but no effect sizes.
No changemoderate evidence
A single-centre trial of an approach he does not use, against a single-port comparator rather than conventional laparoscopy; reassuring on sexual function after the vaginal route but not a reason to change technique.
What it means
For his patients nothing changes: he does not operate through the vagina for ovarian cysts, and the trial compares that route with a single umbilical incision rather than with the standard keyhole operation he performs.
Reviewed by Mr Jan, .
Every paper on this site's evidence pages is also available as open data at /evidence/papers.json. The search and screening rules are on the evidence index.
Last reviewed .Reviewed by Mr Haider Jan, Consultant Gynaecologist.
For patients: Fertility and miscarriage surgery and Ovarian cysts
The plain-language pages on what the condition is, how I assess it and the choices, written for the women I see.
