Abstract
BackgroundLaparoscopic cystectomy is currently considered the gold standard for the treatment of ovarian endometrioma, resulting in an improvement in symptoms, a lower recurrence rate, and a higher pregnancy rate among infertile patients. However, this treatment is not free from risk, since it is associated with a reduction in ovarian reserve. There is still controversy in the literature regarding whether the cause of the reduction in ovarian reserve is due to damage caused by the coagulation energy during hemostasis or whether the procedure itself is the cause of the damage irrespective of the hemostatic method used. The aim of this study is to compare the effects of different hemostatic methods on the ovarian function of women subjected to laparoscopic surgery for ovarian endometrioma.MethodsAn open-label randomized clinical trial to be conducted at the Lauro Wanderley University Hospital between December 2017 and August 2020. Eighty-four patients will be randomly allocated to three groups according to the hemostatic technique used during laparoscopic surgery for ovarian endometrioma: bipolar coagulation; laparoscopic suture; and hemostatic matrix. Ovarian function will be assessed by serum anti-Müllerian hormone measurement and by performing an antral follicle count using ultrasound before surgery and one, three, and six months after surgery. The internal review board of the Medical Sciences Center, Federal University of Paraíba approved the study protocol under reference CAAE 71621717.9.0000.8069.DiscussionBearing in mind the need for more randomized clinical trials to clarify this issue, we hope to contribute with data that will determine whether there is any difference between hemostatic methods despite the rational use of bipolar energy or whether the procedure itself explains the ovarian damage irrespective of the hemostatic technique used.Trial registrationClinicalTrials.gov, NTC03430609. Registered on XX.10/31/2017.ISRCTN Registry, ISRCTN11469394. Registered on XX.17/12/2017.Unique Protocol ID: U1111–1203-2508.
Highlights
Laparoscopic cystectomy is currently considered the gold standard for the treatment of ovarian endometrioma, resulting in an improvement in symptoms, a lower recurrence rate, and a higher pregnancy rate among infertile patients
There appears to be a similar decrease, irrespective of the etiology of the cyst [45,46,47]; this decrease is temporary, with a tendency to recover over subsequent months [39, 48,49,50,51,52]. In view of these considerations, the objective of the present study is to evaluate the effect on ovarian function of three different methods of hemostasis in patients submitted to oophoroplasty because of an endometrioma, with ovarian function being assessed by measuring anti-Müllerian hormone (AMH) and by performing antral follicle count (AFC)
Discussion laparoscopic cystectomy is the gold standard for the treatment of endometrioma, there are some risks associated with the procedure that may damage ovarian function, even when performed by experienced surgeons [17]
Summary
Laparoscopic cystectomy is currently considered the gold standard for the treatment of ovarian endometrioma, resulting in an improvement in symptoms, a lower recurrence rate, and a higher pregnancy rate among infertile patients. This treatment is not free from risk, since it is associated with a reduction in ovarian reserve. Laparoscopic cystectomy appears to be the ideal treatment option when surgery is required This procedure offers favorable results in terms of improving pelvic pain and reducing recurrence rates of the endometrioma [4, 6, 7]. The technique is not without risk and may result in damage to ovarian function, either from the inadvertent removal of healthy ovarian parenchyma or as a consequence of the thermal effect of coagulation on bleeding points [8,9,10,11,12,13]
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