Laparoscopic Excision Of Ovarian Cysts Research Articles

Ovarian reserve in women with endometriosis under total cystectomy compared to partial cystectomy: A randomized clinical trial.

Background The standard procedure for ovarian endometriosis is laparoscopic excision of ovarian cysts and complete removal of the cyst capsule using the striping technique. Owing to the possibility of reducing ovarian reserve, and in some cases, the premature ovarian failure, the safety remains to be known.Objective To compare the ovarian reserve in women with endometriosis who underwent total cystectomy with partial cystectomy.Materials and Methods In this randomized clinical trial, 56 women with endometriosis who were referred to the Research and Clinical Center for Infertility and Shahid Sadoughi Hospital, Yazd, Iran between January and February 2020 were randomly assigned into two groups (n = 25/each); group I (total cystectomy) and group II (partial cystectomy). To assess the ovarian reserves, the anti-Müllerian hormone (AMH) level before and three months after surgery was measured and compared between the two groups.ResultsNo significant difference was observed in the AMH levels before and after surgery (p = 0.52, p = 0.32, respectively). However, the mean reduction of AMH in total cystectomy group was significantly higher than the partial cystectomy (p = 0.001).ConclusionCystectomy in women with endometriosis reduces ovarian reserve and can help maintain some ovarian reserve by performing partial instead of total cystectomy.

COMPARATIVE STUDY BETWEEN LAPAROSCOPIC AND OPEN OVARIAN CYSTECTOMY ON OVARIAN RESERVE

Objective: To investigate the impact of electrocoagulation on ovarian reserve after laparoscopic excision of ovarian cysts and the possible mechanisms. Design: A prospective study. Setting: Obstetrics and Gynecology Department of a university hospital. Patient(s): 100 patients with benign ovarian cysts undergoing ovarian cystectomy. Intervention(s): Laparoscopic ovarian cystectomy using bipolar electrocoagulation and laparotomic ovarian cystectomy using sutures after the excision of ovarian cysts. Main Outcome Measure(s): Follicle-stimulating hormone (FSH & AMH) assays and transvaginal ultrasound evaluating basal antral follicle number, mean ovarian diameter, and ovarian stromal blood flow velocity at cycles 1, 3 and 6 after surgery. Result(s): When comparing the bipolar group with the suture group, a statistically significant increase of the mean FSH value was found in bilateral-cyst patients at 1-, 3- and 6-month follow- up evaluations and in unilateral-cyst patients at the 1-month follow-up evaluation. When comparing the bipolar group with the suture group, a statistically significant decrease of the mean AMH value was found in bilateral-cyst patients at 1-, 3- and 6-month follow- up evaluations and in unilateral-cyst patients at the 1-month follow-up evaluation. Statistically significant decreases of basal antral follicle number and mean ovarian diameter were found during the 3-, 6-month follow-up evaluations as well as statistically significant decreases of peak systolic velocity at all of the follow-up evaluations. Conclusion(s): Electrocoagulation after laparoscopic excision of ovarian cysts is associated with a statistically significant reduction in ovarian reserve, which is partly a consequence of the damage to the ovarian vascular system. Key Words: Ovarian cysts, laparoscopic ovarian cystectomy, electrocoagulation, ovarian reserve

Laparoscopic Management of Large Ovarian Cysts

The aim of this study was to describe a new technique for laparoscopic removal of large ovarian cystic masses. The authors performed a retrospective study during the period January 2008 to December 2009 in the Second Department of Obstetrics and Gynecology of Aretaieion University Hospital; 19 women with large ovarian cysts were included in the study. During the study period, 53 women underwent laparoscopic excision of ovarian cysts. Among them, 19 had very large complex ovarian cysts with a mean diameter of 8.4 cm. The mean age of the patients was 32.1 years. Ultrasound examination revealed findings suggestive of benign disease in all patients. In 8 out of 19 patients CA-125 levels were elevated, ranging from 40.5 to 194.7 IU/mL. A 5-mm suprapubic trocar was directly inserted into the cyst and fluid contents aspirated, so the decompressed cyst could fit in a 5-cm laparoscopic bag. The cyst wall was carefully detached from the healthy ovarian tissue and placed in the bag without any spillage. The remaining cyst wall was removed from the peritoneal cavity with the laparoscopic bag. The mean operative time was 45 minutes. No operative or postoperative complications were noted. There was no conversion to laparotomy. Mean hospital stay was 1 day. Pathology revealed 7 endometriomas, 3 mucinous cystadenomas, 3 serous cystadenomas, 3 serous cysts, and 3 teratomas. Direct trocar insertion within the ovarian cyst followed by aspiration of the fluid contents is a safe and feasible method for the laparoscopic management of large ovarian cysts.

Oxidative stress status in normal ovarian cortex surrounding ovarian endometriosis

Expression levels of 8-hydroxydeoxyguanosine, a sensitive indicator of DNA damage resulting from oxidative stress, were significantly higher in samples of normal ovarian cortex surrounding endometriotic cysts when compared with ovarian cortex surrounding dermoid and serous ovarian cysts. These findings suggest that the normal ovarian cortex surrounding endometriotic tissues is more severely affected by oxidative stress than ovarian cortex adjacent to other benign ovarian cysts.

The impact of laparoscopic ovarian cystectomy on ovarian reserve as assessed by antral follicle count and serum AMH levels

OBJECTIVE: Laparoscopic excision of ovarian cysts particularly endometrioma and dermoid cysts are commonly performed in women of reproductive age. We aimed to objectively determine if such a surgical procedure had any negative impact on ovarian reserve. DESIGN: A prospective study. MATERIALS AND METHODS: Of 16 patients (mean age ± [SE] 29.5 ± 1.9) enrolled in the study 12 had unilateral, one had bilateral endometriomas, and 3 had unilateral dermoid cysts. Ovarian reserve was determined with antral follicle count (AFC) and serum antimullerian hormone (AMH) levels measured before and one month postoperatively. Removed cysts were histologically examined for the presence of ovarian cortex and the follicles. RESULTS: The duration of the operation (mean age ± [SE]) was 44.7 ± 3.6 minutes. The mean cyst diameter was 52.5 ± 5.4 mm for endometriomas and 58.1 ± 8.5 mm for dermoid cysts. The cysts were removed completely in all patients. Pre and postoperative AFCs were similar (6.4 ± 0.6 vs. 6.7 ± 0.6 p>0.05, respectively). Serum AMH levels declined postoperatively, however, the difference was not statistically significant (3.7 ± 0.5 vs. 2.7 ± 0.4 p>0.05). Preoperative AMH levels were positively correlated with AFC (r=0.50, p<0.05) but this correlation was lost postoperatively (r=0.46, p>0.05). Both AMH and AFC were negatively correlated with age (r=-0.59 p<0.05, r=-0.61 p<0.05, respectively). On histological examination one antral follicle in one section from a patient and some clusters of primordial follicles in the others did not cause any significant decline in AMH levels postoperatively. CONCLUSIONS: Our results indicate that laparoscopic removal of ovarian cysts using a standard atraumatic technique does not adversely affect the AFC. AMH levels decreased postoperatively but the difference did not reach statistical significance, perhaps due to the small number of patients in the study. The impact of cystectomy on ovarian reserve should be assessed objectively in larger number of patients in order to reach definitive conclusions.

The impact of electrocoagulation on ovarian reserve after laparoscopic excision of ovarian cysts: a prospective clinical study of 191 patients

To investigate the impact of electrocoagulation on ovarian reserve after laparoscopic excision of ovarian cysts and the possible mechanisms. A prospective study. Obstetrics and Gynecology Department of a university hospital. 191 patients with benign ovarian cysts undergoing ovarian cystectomy. Laparoscopic ovarian cystectomy using bipolar or ultrasonic scalpel electrocoagulation and laparotomic ovarian cystectomy using sutures after the excision of ovarian cysts. Follicle-stimulating hormone (FSH) assay and transvaginal ultrasound evaluating basal antral follicle number, mean ovarian diameter, and ovarian stromal blood flow velocity at day 3 of menstrual cycles 1, 3, 6, and 12 after surgery. When comparing the bipolar group and ultrasonic scalpel group with the suture group, a statistically significant increase of the mean FSH value was found in bilateral-cyst patients at 1-, 3-, 6-, and 12-month follow-up evaluations and in unilateral-cyst patients at the 1-month follow-up evaluation. Statistically significant decreases of basal antral follicle number and mean ovarian diameter were found during the 3-, 6-, 12-month follow-up evaluations as well as statistically significant decreases of peak systolic velocity at all of the follow-up evaluations. Electrocoagulation after laparoscopic excision of ovarian cysts is associated with a statistically significant reduction in ovarian reserve, which is partly a consequence of the damage to the ovarian vascular system.

Suture of ovary after laparoscopic excision of ovarian cysts preserves more ovarian function than bipolar electro-coagulation

Suture of ovary after laparoscopic excision of ovarian cysts preserves more ovarian function than bipolar electro-coagulation

Laparoscopic excision of ovarian cysts does not result in antiovarian humoral autoimmunity

To determine whether the ovarian trauma consequent to the laparoscopic removal of a cyst could result in the development of a humoral immunity, antiovarian antibodies were assayed in serum samples obtained from 40 women before and after cystectomy.

Ovarian recovery after laparoscopic enucleation of ovarian cysts: Insights from echographic short-term postsurgical follow-up

Study objective To evaluate damage to ovarian reserve following laparoscopic cystectomy of benign ovarian cysts. Design Prospective study (Canadian Task Force classification II-3). Setting Tertiary gynecologic endoscopic unit at a university-affiliated hospital. Patients Thirty-one patients who underwent excision of monolateral (n = 25) or bilateral (n = 6) benign ovarian cysts. Interventions Serial transvaginal ultrasound examinations during the first and third postsurgical menstrual cycles. The following ovarian echographic variables were evaluated: antral follicle count, ovarian volume, stromal blood flow, and side of ovulation. Two types of statistical analysis were performed: a paired analysis comparing operated and intact ovaries of the same patient and a prospective analysis comparing ecographic characteristics of the operated gonad at first and second evaluation. Measurements and main results Antral follicle count and stromal blood flow were not significantly affected by surgery. While ovarian volume was similar in the operated and in the contralateral intact gonad at the first ultrasound evaluation, the volume of the operated ovary was significantly reduced at the second assessment. The median (interquartile range) of the percentage of this reduction was 33% (18%–81%). This progressive reduction was confirmed by prospectively analyzing the operated ovaries. An increased probability of ovulation in the intact gonad was observed at both assessments. Conclusion Laparoscopic excision of ovarian cysts is associated with damage to ovarian reserve, at least immediately after surgery. This effect does not appear to be consequent to an injury to ovarian vascularization.

Does laparoscopic excision of ovarian cysts significantly affect ovarian reserve? insights from in vitro fertilization cycles

Objective: Residual ovarian function after laparoscopic excision of ovarian cysts is a major and still unsolved topic. Ultrasonographic evaluation of ovarian response to ovulation stimulation represents a simple and still poorly employed tool to assess residual ovarian function of an operated ovary. The few currently available studies on this topic have produced conflicting results. The aim of the present study was to evaluate the response to ovarian stimulation in patients who previously underwent monolateral excision of ovarian cysts.

Laparoscopic excision of ovarian cysts: is the stripping technique a tissue-sparing procedure?

Objective: To determine whether the stripping technique by laparoscopy is a tissue-sparing procedure. Design: Prospective study. Setting: University hospital. Patient(s): Forty-two women, 21 to 35 years of age, who had a unilateral ovarian cyst (26 endometriomas, 7 serous, 6 dermoid, and 3 mucinous cysts). Intervention(s): Laparoscopic excision of ovarian cysts by using the stripping technique. Main Outcome Measure(s): Histologic analysis of the excised specimens was done to evaluate the presence and nature of ovarian tissue adjacent to the cyst wall. Result(s): Recognizable ovarian tissue adjacent to the cyst wall was present in 15 of 42 excised specimens (36%). A significant difference was present for endometriomas versus nonendometriosis cysts (ovarian tissue was present in 14 of 26 specimens [54%] vs. 1 of 16 specimens [6%]; P<.005). No specimen showed the normal follicular pattern observed in healthy ovaries. Conclusion(s): The stripping technique appears to be a tissue-sparing procedure. In 36% of the cysts, ovarian tissue is excised together with the cyst wall, but this tissue does not show the morphologic characteristics observed in normal ovarian tissue.