The Impact on Ovarian Reserve of Different Hemostasis Methods in Laparoscopic Cystectomy: A Systematic Review and Meta-analysis.

Clara Micalli Ferruzzi Baracat,Raquel Silveira Da Cunha Araujo,Wanderley Marques Bernando,Paulo Ayroza Ribeiro,Helizabet Salomão Ayroza Abdalla-Ribeiro

doi:10.1055/s-0039-1692697

Abstract

The objective of this review was to analyze the impact on ovarian reserve of the different hemostatic methods used during laparoscopic cystectomy. The studies were identified by searching electronic databases (MEDLINE, Embase, Cochrane, LILACS) and scanning reference lists of articles. We selected clinical trials that assessed the influence of hemostatic techniques on ovarian reserve in patients with ovarian cysts with benign sonographic appearance submitted to laparoscopic cystectomy by stripping technique. The included trials compared different laparoscopic hemostatic techniques: suture, bipolar electrocoagulation, ultrasonic energy and hemostatic sealants. The outcomes evaluated were level of serum anti-Mullerian hormone (AMH) and antral follicle count (AFC). The possibility of publication bias was evaluated by funnel plots. Twelve trials involving 1,047 patients were evaluated. Laparoscopic suture was superior to bipolar coagulation when evaluating serum AMH and AFC, in the 1st, 3rd, 6th and 12th month after surgery. In the comparison between bipolar and hemostatic sealants, the results favored the use of hemostatic agents. The use of ultrasonic energy was not superior to the use of bipolar energy. We recommend suture for hemostasis during laparoscopic cystectomy.

Highlights

Ovarian cysts are a common gynecological situation, occurring in 6.6% of women between 25 and 40 years old.[1]
Seleção dos estudos Selecionamos ensaios clínicos que avaliaram a influência das técnicas hemostáticas na reserva ovariana em pacientes com cistos ovarianos com aspecto ultrassonográfico benigno submetidos à ooforoplastia laparoscópica pela técnica de tração e contra-tração
One trial was excluded from the meta-analyses (Coric et al, 2011)[16] because it measured the outcome in a different way that could not be adapted to the outcomes reviewed in this paper

Summary

Introduction

Ovarian cysts are a common gynecological situation, occurring in 6.6% of women between 25 and 40 years old.[1] When its surgical removal is indicated, stripping the ovarian cyst wall by laparoscopic approach is the technique of choice.[2,3] surgical treatment may cause detrimental effects on ovarian reserve, which could occur because of removal of healthy ovarian tissue or by thermal damage to normal follicles during bleeding control.[4]. Ovarian reserve is marked as the size and quantity of the remaining ovarian follicular pool at any given time.[5] It can be estimated by different methods, and the level of serum antiMullerian hormone (AMH) is considered one of the best endocrinologic marker.[6] This hormone is a glycoprotein that is produced by the granulosa cells of the ovarian follicles, and it predicts the number of responsive follicles. The antral follicles count (AFC) may be used, but it carries the inconvenience of only being able to be measured during a specific phase of the menstrual cycle.[7]

Methods

Results

Discussion

Conclusion