Laparoscopic Cystectomy For Ovarian Endometriomas Research Articles

Effect of vasopressin injection technique on ovarian reserve during laparoscopic cystectomy of ovarian endometriomas: a systematic review and meta-analysis of randomized controlled trials.

To evaluate the effect of injecting vasopressin during laparoscopic excision of ovarian endometriomas on ovarian reserve. Four different databases (PubMed, Cochrane Library, Scopus, and ISI Web of Science) were searched to identify relevant studies in March 2023. We selected randomized controlled trials (RCTs) that compared vasopressin injection in the intervention group versus no injection of vasopressin in the control group among women undergoing laparoscopic cystectomy of ovarian endometriomas. The main outcomes were the amount of bleeding, number of coagulation events, and levels of serum anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH). The available data were extracted and analyzed in a meta-analysis model using RevMan software. Seven RCTs, involving a total number of 478 patients, were included in our study. The vasopressin group had significantly reduced blood loss amount and number of coagulation events compared to the control group (P=0.004 and P=0.005). There was a significant improvement in the AMH levels within 6 months after surgery in the vasopressin group (MD=0.52, 95% CI: 0.11, 0.93, P=0.01). In addition, the FSH levels within 6 months after laparoscopic cystectomy were significantly reduced with vasopressin injection. Vasopressin injection during laparoscopic cystectomy of ovarian endometriomas is effective in reducing blood loss amount and frequency of coagulation, as well as protecting the ovarian reserve. More trials are encouraged to confirm our findings.

Effect of dienogest on serum anti-Mullerian hormone level after laparoscopic cystectomy of ovarian endometrioma

ObjectiveThis comparative study aimed to evaluate the effect of postoperative dienogest treatment on serum anti-Mullerian hormone (AMH) levels in patients undergoing laparoscopic cystectomy of ovarian endometriomas. Materials and methodsA total of 71 patients with ovarian endometriomas treated at our department were enrolled. After surgery, 54 patients received oral dienogest 2 mg daily continuously for 6 months (dienogest group). The other 17 patients did not receive postoperative medical treatment (control group). Serum AMH levels were measured before surgery, at 3-month period after surgery, and at the end of 6-month follow-up period. Serial changes of AMH levels were compared between the two groups. ResultsThe age, endometrioma size, and serum AMH level before surgery were comparable between the dienogest group and the control group. The AMH levels decreased significantly at 3-month period after surgery in the dienogest group (a decrease of 65.5%; p < 0.001) and the control group (a decrease of 64.8%; p = 0.018). The AMH levels increased gradually from the nadir at 3-month period after surgery and recovered partially at the end of 6-month follow-up period in both groups. There were no statistically significant differences in the rate of reduction of serum AMH levels between the two groups (p = 0.707). ConclusionLaparoscopic cystectomy of ovarian endometrioma causes a significant decrease in serum AMH levels. The rates of reduction of AMH levels are similar regardless of dienogest treatment. Postoperative dienogest treatment for 6 months has no rescue effect on serum AMH levels in these patients.

Effect of early inflammatory reaction on ovarian reserve after laparoscopic cystectomy for ovarian endometriomas

This study aimed to investigate the effect of early inflammatory reaction on ovarian reserve of patients with ovarian endometriomas after laparoscopic cystectomy. Our retrospective case series included 112 patients with ovarian endometriomas that underwent the laparoendoscopic single-site cystectomy. Interleukin-6 (IL-6), hs-CRP, tumour necrosis factor-α (TNF-α), interleukin-17A (IL-17A) and AMH level were detected during perioperative and postoperative period. In our study, ovarian endometriomas with low AMH group were found having higher level of IL-6 than the normal AMH group in the preoperative status. On the 3rd day after operation, the change of AMH level was inversely proportional to the IL-6 level. During the follow-up within one year, it was found that the bilateral nature of the cyst and the postoperative IL-6 increased level were the risk factors for AMH not returning to baseline level. Our results suggested that inflammatory reaction is indeed involved in the damage of ovarian reserve during laparoscopic cystectomy. Hence, the negative impact of inflammatory injury should be fully considered before operation, especially young women with bilateral ovarian endometriomas. Impact Statement What is already known on this subject? Ovarian reserve in women always was reduced after the laparoscopic cystectomy. It is reported that it may be related to the use of energy instruments, haemostatic methods or the size of cysts in minimally invasive surgery. What do the results of this study add? Inflammatory reaction is indeed involved in the damage of ovarian reserve during LESS cystectomy. Interleukin-6 (IL-6) may act as the most main inflammatory factor aggravating damage of the ovarian reserve. Moreover, increased IL-6 level after surgery and bilateral cyst burden are the two risk factors for AMH not returning to baseline level within one year after surgery. What are the implications of these findings for clinical practice and/or further research? In clinic, the negative impact of inflammatory injury on ovarian reserve should be fully considered before operation, especially young women with bilateral ovarian endometriomas. Moreover, this is also the clinical basis for further study on the mechanism of inflammatory ovarian injury or the method of blocking the inflammatory response to reduce the damage of ovarian reserve after surgery.

Surgical Techniques to Optimize Ovarian Reserve during Laparoscopic Cystectomy for Ovarian Endometrioma

Surgical Techniques to Optimize Ovarian Reserve during Laparoscopic Cystectomy for Ovarian Endometrioma

Ovarian reserve and recurrence 1 year post-operatively after using haemostatic sealant and bipolar diathermy for haemostasis during laparoscopic ovarian cystectomy

Research questionIs there a difference in the ovarian reserve 1 year post-operatively in those who used a haemostatic sealant or bipolar diathermy for haemostasis during laparoscopic ovarian cystectomy for ovarian endometriomas? DesignThis was an extended follow-up observational study of a previous randomized controlled trial where women aged 18 to 40 years with 3–8 cm unilateral or bilateral endometriomas were randomized to receive haemostasis by a haemostatic sealant or bipolar diathermy following ovarian cystectomy. The primary outcome was the ovarian reserve as assessed by antral follicle count (AFC) 1 year post-operatively. Secondary outcomes included the recurrence rate of ovarian endometrioma, the change in anti-Müllerian hormone (AMH) and FSH concentrations, and reproductive outcomes. ResultsThe significant increase in AFC at 3 months after initial surgery (P = 0.025) in the haemostatic sealant group compared with the diathermy group was sustained at 1 year (P = 0.024) but there was no difference in AMH or FSH concentrations between the groups throughout the follow-up period. The recurrence rate in the FloSeal group was 7.7% (n = 3/39) compared with 22.2% (n = 8/36) in the diathermy group (P = 0.060). The recurrence rate in women who had bilateral lesions was significantly higher than those with unilateral lesions (risk ratio 5.33, interquartile range 1.55–18.38). No difference in reproductive outcomes was found between the two groups. ConclusionsApplying haemostatic sealant after laparoscopic cystectomy of ovarian endometriomas produces a significantly greater improvement in AFC, which was apparent at 3-month follow-up, and was sustained at 1-year follow-up without compromising the recurrence rate.

Comparison of effect of preoperative dienogest and gonadotropin-releasing hormone agonist administration on laparoscopic cystectomy for ovarian endometriomas.

To compare the effects of preoperative dienogest (DNG) and gonadotropin-releasing hormone (GnRH) agonist administration on the improvement of preoperative symptoms and surgical outcomes in patients who underwent laparoscopic cystectomy for ovarian endometriomas. Seventy patients who were scheduled for laparoscopic surgery were enrolled in the study. They were divided into two groups: 35 patients who received DNG for 4months preoperatively (group D) and 35 patients who received low-dose sustained-release goserelin acetate for 4months preoperatively (group G). Preoperative outcomes, including pain score associated with endometriosis, using the numerical rating scale (NRS), adverse events of hormonal therapy and Kupperman index (KI) before and after treatment, surgical outcomes including total surgical duration and blood loss, and postoperative recurrence of endometrioma were compared between the two groups. Regarding preoperative symptoms, NRS and KI at 4months after preoperative hormonal therapy were significantly lower in group D than in group G (NRS, 5.3 ± 5.5 vs. 2.7 ± 3.9; P = 0.01; KI, 16.0 ± 11.0 vs. 9.2 ± 7.6; P = 0.006). Regarding adverse events, the incidence of hot flashes was significantly lower in group D than in group G (P < 0.001). Meanwhile, the incidence of breast pain and metrorrhagia was significantly higher in group D than in group G (P = 0.04 and P < 0.001, respectively). The total surgical duration and blood loss were not significantly different between the groups. At 12months after surgery, ovarian endometrioma did not recur in either group. Preoperative administration of DNG is more valuable for patients with endometriosis and scheduled for laparoscopic surgery to improve symptoms with good efficacy and tolerability than the administration of GnRH agonist.

Serum antimullerian hormone before and after laparoscopic excision of ovarian endometrioma

Background Surgery of ovarian endometrioma may have a detrimental effect on ovarian reserve. This study aims to evaluate the effect of laparoscopic cystectomy on serum antimullerian hormone (AMH) in patients with endometrioma. Materials and methods A prospective study was performed at El-Galaa Maternity Teaching Hospital where 60 women with endometriomas underwent laparoscopic cystectomy. Serum AMH, follicle-stimulating hormone (FSH), luteinizing hormone, estradiol, and antral follicle count (AFC) were measured preoperatively and at 3 months postoperatively. Outcome measures The ovarian reserve was measured based on the change of AMH level before and after surgery. Moreover, the secondary end point was to detect the changes in FSH, luteinizing hormone, estradiol, and AFC. Results Serum AMH decreased significantly from the baseline (4.12 ± 3.41) to 3 months postoperatively (2.62 ± 2.7). The AFC increased significantly from the baseline to 3 months after the operation. Conclusion Laparoscopic cystectomy of ovarian endometriomas causes a significant decline in serum AMH level and a significant increase in the level of FSH.

The impact of laparoscopic cystectomy on ovarian reserve in patients with unilateral and bilateral endometrioma.

To evaluate the effects of laparoscopic cystectomy on serum anti-Müllerian hormone (AMH) level as a marker of ovarian reserve in patients with endometrioma. A prospective observational study enrolled patients aged younger than 40years who were referred to a tertiary center in Tehran, Iran, between January 1, 2013 and December 31, 2014 to undergo laparoscopic cystectomy for ovarian endometriomas at least 30mm in diameter, or regardless of size for patients with infertility, dysmenorrhea, dyspareunia, or dyschezia. Baseline and 6-month post-operative AMH levels were compared. Data from 70 patients were included in the analyses. Among patients with unilateral endometriomas, lower pre-operative AMH levels were observed in patients with endometriomas at least 50 mm in diameter (P=0.027), whereas cyst size was not associated with differences in pre-operative AMH level in patients with bilateral endometriomas (P=0.227). Across the entire study population, post-operative AMH levels were lower than the baseline (P=0.008). Greater post-operative decreases in AMH were associated with bilateral cysts compared with unilateral cysts (P=0.046), cysts being at least 50 mm in diameter among patients with unilateral cysts (P=0.028), and both cysts being at least 50 mm in diameter among patients with bilateral cysts (P=0.025). Laparoscopic cystectomy was associated with post-operative decreases in serum AMH, particularly with bilateral involvement and endometriomas at least 50mm in diameter.

Analysis of pregnancy outcome and decline of anti-Müllerian hormone after laparoscopic cystectomy for ovarian endometriomas.

Excision of ovarian endometrioma (OE) may induce the reduction of ovarian reserve. We evaluated pregnancy outcomes after laparoscopic cystectomy (LC), and the pre- and postoperative levels of anti-Müllerian hormone (AMH) to consider the ovarian reserve. We enrolled 40 women with OE and 16 women with benign ovarian tumors who hoped to have a child and who underwent LC. To evaluate the ovarian reserve of 40 patients (OE group, n = 24; non-OE group, n = 16), we measured serum AMH levels before and after the surgery. In the 40 women who underwent LC for OE, the cumulative pregnancy rate was 50%. Prior to the cystectomy, serum AMH levels in the OE group, especially in patients over the age of 35, were significantly lower than those in the non-OE group. Rate of decline in serum AMH in the OE group was significant compared with that in the non-OE group 6 months after surgery. In patients over the age of 35 in the OE group, AMH levels 1 year after surgery decreased noticeably. LC for OE could be a preferred surgical approach, but effective therapeutic strategies will have to be developed to prevent damage to the ovarian reserve, especially for older patients.

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

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.

Evaluation of factors predicting diminished ovarian reserve before and after laparoscopic cystectomy for ovarian endometriomas: a prospective cohort study.

BackgroundOvarian endometriomas affect a substantial proportion of women of reproductive age who may have a potential risk of diminished ovarian reserve (DOR) after ovarian cystectomy. Here, we investigated the risk factors for pre-surgical DOR in patients with ovarian endometriomas and for DOR after laparoscopic ovarian cystectomy for endometriomas and evaluated the feasibility of the pre-surgical prediction of post-surgical DOR based on the Bologna criteria.MethodsA total of 143 patients with ovarian endometriomas who underwent laparoscopic cystectomy from January 2009 to May 2015 at our hospital were prospectively enrolled and evaluated. Serum anti-Müllerian hormone (AMH) concentrations were measured pre-surgically and at 3 and 6 months after surgery. In accordance with the Bologna criteria, the patients whose AMH concentrations were <1.1 ng/mL before surgery and 3 or 6 months after surgery were classified into pre- and post-surgical adverse DOR (aDOR) groups, respectively.ResultsThirty-one (21.7 %) of 143 patients were classified as pre-surgical aDOR. Patient age and serum follicle-stimulating hormone level were significantly positively correlated with pre-surgical aDOR [odds ratios (ORs), 1.26 and 1.16; p < 0.001 and p = 0.003, respectively]. Among the remaining 112 patients, 38 patients (33.9 %) had post-surgical aDOR 3 and 6 months after surgery. Bilateral cystectomy was positively correlated with post-surgical aDOR (at 3 months: OR, 4.7; p = 0.001; at 6 months: OR, 3.71; p = 0.006); conversely, pre-surgical serum AMH concentrations were negatively correlated with post-surgical aDOR (at 3 months: OR, 0.65; p = 0.005; at 6 months: OR, 0.43; p < 0.001). The optimal cut-off point of pre-surgical AMH concentrations for predicting aDOR at 3 and 6 months in the patients undergoing unilateral cystectomy was 2.1 ng/mL. In contrast, the optimal cut-off points at 3 and 6 months in the patients undergoing bilateral cystectomy were 3.0 and 3.5 ng/mL, respectively.ConclusionsOur data suggest that the pre-surgical serum AMH concentrations and bilateral cystectomy are significant factors for the risk of aDOR following surgery and that predicting post-surgical aDOR according to the Bologna criteria could be feasible using pre-operative measurements of serum AMH concentrations.

Surgical excision of ovarian endometriomas: Does it truly impair ovarian reserve? Long term anti‐Müllerian hormone (AMH) changes after surgery

The long-term effects of laparoscopic cystectomy on ovarian reserve in patients with unilateral and bilateral ovarian endometriomas were evaluated. A total of 22 patients undergoing laparoscopic cystectomy for unilateral endometrioma (n = 10) and bilateral endometriomas (n = 12) were included in the study. Serum anti-Müllerian hormone (AMH) levels significantly decreased from the baseline value (3.98 ± 3.27 ng/mL) one (1.67 ± 1.56 ng/mL), three (2.01 ± 1.70 ng/mL), and six months (2.43 ± 2.39 ng/mL) postoperatively. There was no difference between preoperative and 12 month postoperative AMH levels (4.01 ± 3.39 ng/mL) (P > 0.05). Patients with bilateral endometriomas had a significantly higher rate of decline in AMH levels 12 months after surgery than patients with monolateral endometriomas (P = 0.035), but in both groups there was no difference in AMH levels at one and 12 months postoperatively (P > 0.05). AMH levels temporarily decreased after laparoscopic cystectomy for ovarian endometriomas, with complete recovery of preoperative AMH values at 12 months postoperatively. This pattern was equal in patients with bilateral and unilateral ovarian involvement. Patients with bilateral cysts have higher rates of decline of AMH levels compared to patients with unilateral affection.

腹腔鏡下卵巣チョコレート嚢胞摘出術後の再発リスク因子についての検討

Objective: To evaluate risk factors associated with ovarian endometrioma recurrence after laparoscopic cystectomy.Design: A retrospective study.Setting: Minoh City Hospital.Patients: This study included 81 women who underwent laparoscopic cystectomy for ovarian endometrioma and were followed up postoperatively for more than 4 months. Interventions: Laparoscopic cystectomy and postoperative medical treatment.Main outcomes: Eighteen variables (age at surgery, body mass index, age at menarche, parity, infertility, pain, previous surgery for ovarian endometriosis, previous medical treatment of endometriosis, tumor marker, size of the largest cyst, single or multiple cysts, unilateral or bilateral involvement, laterality [left or right], revised American Society for Reproductive Medicine [r-ASRM] score, r-ASRM stage, uterine myoma, postoperative medical treatment, and postoperative pregnancy) were evaluated to assess their effects on the risk of ovarian endometrioma recurrence.Results: The recurrence rate was 12.3% (10/81 patients). The 5-year cumulative recurrence rate was 37%. The size of the largest cyst, presence of multiple cysts, and previous medical treatment were associated with ovarian endometrioma recurrence. The recurrence rate was significantly lower in the women who received postoperative medical treatment (3.3%) than in the women who did not receive medication (20.6%).Conclusion: In this study, the size of the largest cyst and the presence of multiple cysts were associated with ovarian endometrioma recurrence after laparoscopic cystectomy. The continuous postoperative medical treatment decreased the risk of ovarian endometrioma recurrence.

Comparison of the outcome of in vitro fertilization after laparoscopic laser ablation surgery versus laparoscopic cystectomy for endometrioma

Abstract Objective To compare the influence of laparoscopic ablation surgery or cystectomy for endometrioma on the ovaries with respect to the results of in vitro fertilization (IVF). Materials and Methods Fifteen patients who had not achieved spontaneous pregnancy following KTP laser ablation surgery for ovarian endometrioma and who wanted to undergo IVF formed the ablation group. Another 12 infertile women who failed to achieve spontaneous pregnancy following laparoscopic cystectomy for ovarian endometrioma and underwent IVF formed the cystectomy group. Both groups of patients were reviewed retrospectively. Results The fertilization rate was significantly lower in the ablation group compared with the cystectomy group. The percentage of good-quality embryos and the implantation rate were also lower, although not significantly, in the ablation group than the cystectomy group. Even though the number of embryos transferred was higher, the pregnancy rate was lower in the ablation group. Conclusion These results suggest that the quality of oocytes may be lower in the ablation group than the cystectomy group.

Effects on Ovarian Reserve of Laparoscopic Cystectomy for Ovarian Endometrioma That Performs Hemostatic Suturing after Stripping and Electrocoagulation after Stripping by Vasopressin Injection

To examine the effects on ovarian reserve of laparoscopic cystectomy for ovarian endometrioma that performs hemostatic suturing after stripping and electrocoagulation after stripping by vasopressin injection.

Effect of laparoscopic excision of endometriomas on ovarian reserve: serial changes in the serum antimüllerian hormone levels

To investigate the effect of laparoscopic endometrioma stripping on serum antimüllerian hormone (AMH) and the correlation between the clinicopathologic factors. Prospective study. University hospital. Sixty-five women with endometriomas. All patients underwent laparoscopic cystectomy. Serum AMH, FSH, LH, E(2), and antral follicle count (AFC) were measured preoperatively, at 6 weeks, and at 6 months postoperatively. Specimens were analyzed histopathologically. The primary end point was to assess the ovarian reserve damage based on alterations of AMH and the secondary end point was to detect the changes in FSH, LH, E(2), and AFC. Serum AMH decreased significantly at the sixth month (61%) postoperatively. The FSH level increased significantly at the sixth week, but returned to normal at the sixth month. The AFC increased significantly at the sixth week and at the sixth month. The AMH level decrease was more evident in patients with the cyst <5 cm (65.7% vs. 41.3%). The AMH decrease was more in bilateral compared with unilateral endometriomas (67% versus 57%, respectively). No correlation was detected between the histopathologic analyses and tAMH level. Initially the AMH level was the only independent factor affecting the AMH decrease (odds ratio, 3.68; 95% confidence interval 1.66-8.14). Laparoscopic cystectomy of ovarian endometriomas causes a significant and progressive decline in serum AMH levels.

Follicle loss after laparoscopic treatment of ovarian endometriotic cysts

Objective To evaluate follicle loss and its associated factors during laparoscopic cystectomy for ovarian endometrioma. Method Between October 2008 and December 2009, 140 patients with ovarian cysts undergoing laparoscopic cystectomy at Peking Union Medical Hospital were enrolled: 74 had ovarian endometrioma with no preoperative hormonal therapy (group A), 40 had ovarian endometrioma pretreated with GnRHa (group B), and 26 had non-endometriotic cysts (group C). Pre-, peri- , and postoperative clinical data were collected, and cyst specimens were evaluated histologically. Results The number of capsules showing follicles and the mean number of follicles per capsule were lower in group C than in group A or B ( P < 0.05). Fewer type IIC than type IIB endometriomas showed follicles ( P < 0.05). The number of follicles per cyst was related negatively to disease duration but positively to pain severity. Women in group A with unilateral endometrioma had a lower mean dysmenorrhea score after the surgery ( P < 0.05), but no change in basal follicle-stimulating hormone (FSH). Conclusion The type of cyst, disease duration, and severity of dysmenorrhea were associated with ovarian follicle loss during laparoscopic excision of endometrioma. Laparoscopic unilateral cystectomy for endometrioma was effective in relieving pain but had little effect on serum FSH, which might reflect the remaining ovarian reserve.

Ovarian cystectomy versus laser vaporization in the treatment of ovarian endometriomas: a randomized clinical trial with a five-year follow-up

To investigate the effect of two laparoscopic techniques for treatment of ovarian endometriomas on recurrence rate. Prospective randomized clinical trial. University teaching hospital. Ninety women with ovarian endometriomas. Patients were randomly selected to undergo either laparoscopic cystectomy (group 1) or laser vaporization (group 2) of ovarian endometrioma. Recurrence, evaluated by ultrasound scan examination, was assessed at 12 and 60 months of follow-up. Endometrioma recurrence rate was higher, though not significantly different, in group 2 at 60 months of follow-up. Nevertheless, at 12 months of follow-up recurrences were statistically higher in group 2. The comparison between laparoscopic laser ablation and laparoscopic cystectomy for ovarian endometriomas after long-term follow-up showed earlier recurrences and a higher recurrence rate in the laser group, although at 5 years of follow-up there were no statistically significant differences.

Laparoscopic Cystectomy for Ovarian Endometrioma - A Simple Stripping Technique Should not be Used

Surgery remains the best treatment for deep endometriosis. The surgical technique is essential to adequately manage the disease; however, the technique is rarely taught and reported in detail. Laparoscopic cystectomy for the treatment of ovarian endometrioma has been classically reported as a simple stripping technique; however, a meticulous technique appears to be necessary to adequately manage ovarian endometriomas, based on the natural history of the cyst. This paper reports in detail our current technique for laparoscopic cystectomy for ovarian endometrioma and all the tricks to permit reproduction, and even improvement of the technique by other surgeons.

The Vasopressin Injection Technique for Laparoscopic Excision of Ovarian Endometrioma: A Technique to Reduce the Use of Coagulation

Study Objective To estimate the efficacy of the vasopressin injection technique for laparoscopic cystectomy of ovarian endometriomas with regard to operative time and coagulation events. Design Prospective study (Canadian Task Force Classification II-1) Setting Osaka Central Hospital in Osaka, Japan Patients Fifteen women with single lobular similarly-sized ovarian endometrioma. Interventions Women who planned to undergo laparoscopic cystectomy of endometrioma were allocated randomly to 3 groups: (1) ordinary laparoscopic cystectomy without injection, (2) laparoscopic cystectomy with the injection of saline solution, and (3) laparoscopic cystectomy with the vasopressin injection technique. Measurements and Main Results Reviewing the video, we counted the number of pinpoint bipolar coagulations on the normal ovarian cortex that were required from the beginning of stripping until hemostasis had been achieved, as well as the times required to achieve hemostasis. The group with the vasopressin injection technique required significantly fewer coagulation events (p = .041) to achieve hemostasis, as compared with the group receiving an ordinary cystectomy. Conclusion The vasopressin injection technique reduces the use of coagulation, in such a way as to suggest the possibility to protect ovarian reserves.