Effect on ovarian reserve of hemostasis by
bipolar coagulation versus suture during laparoendoscopic single-site cystectomy for ovarian endometriomas.
J Minim Invasive Gynecol 2014;
22:415-20. [PMID:
25460517 DOI:
10.1016/j.jmig.2014.11.002]
[Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/05/2014] [Accepted: 11/06/2014] [Indexed: 01/19/2023]
Abstract
STUDY OBJECTIVE
To compare the postoperative decrease in ovarian reserve between hemostasis by bipolar coagulation and suture during laparoendoscopic single-site cystectomy (LESS-C) for ovarian endometriomas.
DESIGN
Prospective comparative study (Canadian Task Force Classification II-1).
SETTING
University hospital.
PATIENTS
One hundred twenty-five patients with ovarian endometriomas.
INTERVENTIONS
Patients with endometrioma were managed by hemostasis with either bipolar coagulation (n = 62) or suturing (n = 63) during LESS-C. We evaluated the impact of surgery on ovarian reserve using serum anti-Müllerian hormone (AMH) levels, which were measured before surgery and 3 months after surgery in all patients.
MEASUREMENT AND MAIN RESULTS
Baseline characteristics such as age, bilaterality of endometriomas, and preoperative AMH levels were similar between the 2 study groups. There were also no differences between the 2 groups in surgical outcomes, such as operative time, operative blood loss, or operative complications. In both study groups, postoperative AMH levels were lower than preoperative AMH levels (p < .001). The decline rate of AMH levels was significantly greater in the bipolar coagulation group than in the suture group (42.2% [interquartile range, 16.5%-53.0%] and 24.6% [interquartile range, 11.6%-37.0%], respectively, p = .001).
CONCLUSION
Hemostasis by bipolar coagulation after stripping of the endometrioma during LESS-C reduces ovarian reserve more than suturing does, as determined by serial AMH levels. Therefore, suturing may be a better hemostatic choice after stripping ovarian endometriomas.
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