Endometriosis is a common gynecological disease, and its ovarian-type lesion, i.e., endometriotic cyst (or so-called ovarian chocolate cyst), is the most common pathological type among its inpatients and one of the most common surgical indications in general gynecology. In recent years, especially since the introduction of the norms of endometriosis diagnosis and treatment in China in the last 10 years, its understanding has gradually deepened and its management is being gradually standardized. Due to the pathophysiological characteristics of endometriosis, as with the management of other types of lesions, the management of ovarian endometriosis cysts should be individualized, taking into account the patient’s condition, age, fertility status, and psychological status. The following factors should be considered: 1. Cyst size. Cyst diameter is closely related to the risk of malignancy of endometriosis, rupture, and intraoperative destruction of normal ovarian tissue. In addition, cyst size is the most important indicator of disease factors that affect the patient’s psychological status. Therefore, the diameter of the cyst remains by far the most important factor in deciding the management plan for both physicians and patients. For chocolate cysts larger than 5 cm in diameter, they should be treated surgically, and for those smaller than 3 cm, they can usually be followed and observed. For those in between, the patient’s age, fertility status and psychological status should be taken into account. 2. Age. The older the patient is, the greater the risk of malignant transformation of the coarctation. At the same time, most elderly patients have completed childbirth and tend to be less concerned about ovarian function. Therefore, surgical treatment should be considered for patients older than 45 years old. 3. Fertility status. Fertility status includes two aspects, one is the requirement to have another child, and the other is the history of infertility for many years. Large cochlea affects the function of the fallopian tubes and may also affect ovulation, and it is also prone to rupture during pregnancy, therefore, in large cochlea, it can be treated surgically before the planned pregnancy. In those who have been infertile for many years, the risk of malignant transformation of the coelomic bursa increases, and surgical treatment should also be chosen more often for those with a history of infertility. 4. Psychological condition of the patient. Different personality traits, different educational background, socio-economic status, etc. will affect the patient’s view of their disease and requirements for medical behavior, and the choice of medical treatment plan must be fully communicated with the patient and take into account the patient’s psychological condition. 5.Whether recurrence. For recurrence of coeliac disease, since there is already a clear diagnosis and the possibility of recurrence after reoperation is great, surgical treatment should be carefully chosen. 6.Whether there is a combination of other surgical indications. For those who have combined indications for other gynecological surgeries, the cochlea can be treated at the same time during surgery.