Abstract
We propose a novel method, the epinephrine compression method (Epi-pledget), as a hemostasis method for ovarian cystectomy. A total of 179 patients undergoing laparoscopic ovarian cystectomy with stripping were randomly allocated into three groups: the bipolar coagulation group, the Epi-pledget group, and the coagulation after Epi-pledget (Epi & Coagulation) group. Serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) by ultrasonography were measured to determine the preservation of ovarian function. To evaluate the postoperative ovarian cellular proliferative activity and tissue damage in a mouse model, we operated on the ovaries of mice with an artificial incision injury and applied two hemostatic methods: coagulation and Epi-pledget. Eight weeks after surgery, the AMH rate significantly decreased in the bipolar coagulation group compared with the Epi-pledget group. The AFC decline rate was also significantly greater in the coagulation group than the Epi-pledget group. Specifically, patients with endometrioma had a significantly greater decline of serum AMH in the coagulation group than the Epi-pledget group. In a histopathological analysis in mice, the Epi-pledget group showed ameliorated fibrotic changes and necrotic findings in the injured lesion compared with the bipolar coagulation group. The Epi-pledget method for ovarian stripping has an additional benefit of maximizing the preservation of the ovarian reserve, especially for the endometriotic ovarian cyst type.
Highlights
We propose a novel method, the epinephrine compression method (Epi-pledget), as a hemostasis method for ovarian cystectomy
There was no difference in preoperative anti-Müllerian hormone (AMH) and antral follicle count (AFC) levels among the three groups (Table 1, Supplementary Table S1)
The present study demonstrates the beneficial effects of epinephrine pledget compression on an ovarian cystectomy lesion preserving ovarian reserve
Summary
We propose a novel method, the epinephrine compression method (Epi-pledget), as a hemostasis method for ovarian cystectomy. Laparoscopic ovarian cystectomy has been demonstrated to improve post-operative fecundability and reduce the recurrence rate compared with fenestration and coagulation of the cyst w all[1]. Balancing the surgical radicality between the success of treatment (reduction of pain and recurrence) and the ovarian reserve is a challenging issue Another crucial issue in laparoscopic ovarian cystectomy is how to reduce the damage and bleeding to preserve ovarian function. Many factors have been reported to affect the ovarian reserve, such as different surgical techniques for the excision (traditional stripping and combined excisional/ablative techniques)[3], mode of hemostasis (suture, compression, and cauterization)[4], operational method (cystectomy vs wedge resection), and cyst characteristics (size, location, and pathologic types)[5,6]. The present study evaluated the efficacy of the Epi-pledget on hemostasis to minimize subsequent complications including decreased ovarian reserve, tissue damage and bleeding in laparoscopic cystectomy
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