Clinical study of the impact on ovarian reserve by different hemostasis methods in laparoscopic cystectomy for ovarian endometrioma

Abstract

ObjectiveTo evaluate the impact of different hemostasis methods on ovarian reserve in laparoscopic cystectomy in treatment of ovarian endometrioma for the long-term. Materials and MethodsA total of 207 patients with ovarian endometrioma, aged from 18 years to 45 years, were randomized into three groups: Group A (69 patients) treated by bipolar electrocoagulation hemostasis in laparoscopic cystectomy for ovarian endometrioma; Group B (69 patients) with ultrasound scalpel hemostasis; and Group C (69 patients) with suture technique hemostasis. The follicle-stimulating hormone (FSH), anti-Mullerian hormone (AMH), antral follicle count (AFC), and peak systolic velocity (PSV) were observed and compared at the 3rd day of the 1st, 3rd, 6th, and 12th menstrual cycle after surgery. Results(1) A total of 13 out of 207 patients failed; four in Group A, five in Group B, and four in Group C. There was no statistically significant difference between groups (p > 0.05). The failure rate was the highest during the 3rd month in the follow up (10 cases). (2) FSH: at the 1st month, 3rd month, 6th month, and 12th month follow up, FSH was higher in Group A and Group B than in Group C (p < 0.05). (3) AMH: AMH was significantly lower in Group A and Group B than in Group C (p < 0.05) during the same period. (4) AFC: no difference of AFC was observed at the 1st month and 3rd month (p > 0.05), whereas at the 6th month and 12th month, AFC in Group C was obviously higher than that in Group A and Group B (p < 0.05). (5) PSV: at the 1st month, 3rd month, 6th month, and 12th month follow up, PSV was significantly lower in Group A and in Group B than in Group C (p < 0.05). ConclusionUltrasonic scalpel or bipolar electrocoagulation hemostasis applied to laparoscopic cystectomy is associated with a significant reduction of ovarian reserve. Electrocoagulation of hemostasis should be used with caution.