Editor’s note: On May 16, 2015, the 23rd Beijing International Symposium on Hysterolaparoscopic and Minimally Invasive Surgery was held in Beijing, and Professor Xu Bing from the Eastern Hospital of Tongji University in Shanghai shared a report on “Ovarian Chocolate Cyst Surgery and Ovarian Reserve Function” for the participating experts. China Obstetrics and Gynecology Network had the honor to interview Prof. Xu about “Ovarian Chocolate Cyst Surgery and Ovarian Reserve Function”. China Obstetrics and Gynecology Network: Hello, Professor Xu! Thank you for the interview with China Obstetrics and Gynecology Network. In the 23rd Beijing International Symposium on Hysteroscopic and Minimally Invasive Surgery, you gave a presentation on “Ovarian Chocolate Cyst Surgery and Ovarian Reserve Function”, which was very good. Could you please explain to us why we should pay special attention to protect ovarian reserve function in clinical diagnosis and treatment? Prof. Bing Xu: Thank you for the invitation to interview me by China Obstetrics and Gynecology Network. I was honored to be invited by Ms. Xia to give a presentation on “Ovarian Chocolate Cyst Surgery and Ovarian Reserve Function” at this conference. Why do we need to emphasize the protection of ovarian reserve function in particular? First of all, ovarian chocolate cysts are more common in young women, and the main surgical procedure for patients in this age group is ovarian chocolate cyst debulking. During surgery, special attention needs to be paid to the protection of the patient’s reproductive and endocrine functions while striving for complete removal of the lesion. First of all, it is known that the formation of chocolate cysts is different from ordinary tumors and has its special aspects. In an ordinary tumor, there is a clear boundary between the cyst wall and the normal ovary, so it is relatively easy to peel off. In the case of chocolate cysts, the boundary between the cyst wall and the normal ovarian tissue is unclear due to recurrent cyclic bleeding, adhesive scarring, and inflammatory reaction, and as my report states, there is so-called “internal adhesion”. This is a special feature of ovarian chocolate cysts. Many studies suggest that the chocolate cyst itself has reduced ovarian reserve function. Secondly, surgery may further reduce ovarian reserve function. Due to the specificity of chocolate cyst formation, no matter how delicate the surgery is, it may result in misdissection of normal ovarian tissue, which may further lead to reduced ovarian reserve function. In addition, the use of thermal instruments during laparoscopic surgery exacerbates the adverse effects on ovarian tissues. Especially for recurrent cases and bilateral coarctation cases, the use of thermal instruments can further lead to the reduction of ovarian reserve function and even the occurrence of premature ovarian failure. Therefore, when performing laparoscopic chocolate cyst debridement, it is important to consider not only how to completely remove the lesion, but also to pay special attention to protect the ovarian reserve function, fertility function and endocrine function in young women. China Obstetrics and Gynecology: What are the issues that the operator needs to pay attention to during chocolate cyst surgery? What is the efficacy of this type of surgery? Prof. Bing Xu: First of all, it is important to emphasize the issue of surgical indications. According to the latest 2015 guidelines for endometriosis, the indications for this type of surgery are chocolate cysts larger than 4 centimeters. However, with the indication for surgery, is it necessary to do surgery? For this question, we have to do some specific and individualized treatment, and we have to make a treatment plan after careful consideration of the patient’s age, fertility status, life plan and the patient’s wishes. The first step is to assess whether the patient will really benefit from the procedure. The best time to perform the surgery must be taken into account. For example, if an 18 year old girl has a 4 cm chocolate cyst, does she have to undergo surgery? When operating, we particularly emphasize the thoroughness of the initial surgery. Although endometriosis is a benign disease, it has the characteristic of being prone to recurrence. In the case of malignant tumors, we cannot overemphasize the thoroughness of the initial treatment. Similarly, the thoroughness of the initial surgery for chocolate cyst is very important for the future of the patient, so an adequate preoperative evaluation, good surgical technique, and multidisciplinary cooperation when necessary are very important. And the search for a safe method of coeliac removal is what gynecologists are striving for. In this congress, we report a modified method of colectomy by aqueous separation of posterior pituitary hormone. We also confirmed that this procedure is safe and feasible, easy to learn, and easy to master by young surgeons by measuring AMH, FSH, and AFC to assess ovarian reserve function, as well as three-year clinical follow-up data. It is also important to emphasize that post-operative management is also very important, and long-term management has a positive effect on improving the quality of life of patients. China Obstetrics and Gynecology Network: Endometriosis belongs to the category of chronic diseases, which requires long-term management. What are your recommendations for postoperative management of this disease? Prof. Bing Xu: At the 12th Congress on Endometriosis (WCE) held in São Paulo, Brazil, there was a consensus that endometriosis has been considered a chronic disease and should be managed long-term and lifelong, just like hypertension and diabetes. Chocolate cysts are certainly no exception, and especially for patients who develop them at a young age, long-term management is emphasized. The surgeon has to choose the right time to do an effective surgery and to manage the patient for a long time after the surgery to prevent recurrence. We must inform patients that having surgery does not mean the end of treatment and that long-term management is important. We advocate a standardized long-term management model of surgery plus medication. What is the postoperative management to be done? It needs to be managed on a patient-by-patient basis. For patients with stage III-IV endometriosis who do not have fertility requirements, we advocate 4-6 postoperative injections of GnRH-a analogs followed by oral contraceptives. For patients with fertility requirements, preoperative and intraoperative fertility evaluation should be done, and postoperative guidance and management of fertility should be provided to patients as early as possible according to their condition. A good interface and cooperation between gynecologists and fertility doctors is of great importance here. China Obstetrics and Gynecology Network: It can be seen that the treatment of endometriosis is a long-term, comprehensive process, and the doctor’s consultation and treatment strategy is quite important in the treatment process. Thank you very much for giving us a detailed explanation about this disease. I wish you good luck in your future work and thank you for your continuous support to China Obstetrics and Gynecology Network, thank you! Prof. Xu Bing: You are welcome, and I wish the development of China Obstetrics and Gynecology Network is getting better and better!