Laparoscopic Ovarian Cystectomy Research Articles

Impact of hemostatic methods on ovarian reserve and fertility in laparoscopic ovarian cystectomy.

Impact of hemostatic methods, electrocoagulation versus suture, on ovarian reserve and fertility in laparoscopic ovarian cystectomy was investigated. Eighty patients with bilateral ovarian cysts who underwent laparoscopic ovarian cystectomy were randomly divided into 2 groups based on the hemostatic methods: 40 in suture group and another 40 in electrocoagulation group. Blood samples were drawn from all patients at roughly three time points: Before the surgery, 1 month and 6 months after the surgery. Radioimmunoassay was performed to measure the serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and anti-Mullerian hormone (AMH). Moreover, the vaginal ultrasound examination was performed to obtain the ovarian size, peak systolic velocity (PSV) of ovarian stromal blood flow, and antral follicle count (AFC). In terms of postoperative ovarian reserve, the levels of E2 and AMH slightly decreased while the FSH level slightly increased in the suture group at both 1 and 6 months after surgery. In the electrocoagulation group, however, the levels of E2 and AMH decreased significantly while the FSH level increased significantly at 1 month after surgery. Six months after surgery, these levels all returned slightly showing some recovery of ovarian reserve. In comparison between the suture group and the electrocoagulation group, the differences in levels of E2, FSH and AMH were all statistically significant at both 1 and 6 months after surgery (P<0.05). Six months after surgery, the differences in AFC and PSV between the suture group and the electrocoagulation group were statistically significant (P<0.05). In laparoscopic ovarian cystectomy, hemostatic electrocoagulation had a more negative impact on ovarian reserve than hemostatic suture. The use of electrocoagulation for hemostasis should be minimized during the operation, and the suture method should be adopted for hemostasis and shaping of the ovarian wound.

Live birth following laparoscopic fertility-sparing surgery for papillary thyroid carcinoma arising from mature ovarian cystic teratoma: A case report.

Papillary thyroid carcinoma arising from ovarian mature cystic teratoma is clinically rare. We herein present a case of live birth following two laparoscopic surgeries for papillary thyroid carcinoma arising in a mature ovarian cystic teratoma. A 30-year-old female patient, gravida 1 para 1, was treated by laparoscopic bilateral ovarian cystectomy for suspicion of bilateral mature cystic teratoma. The diagnosis of papillary thyroid carcinoma arising from right ovarian mature cystic teratoma was established based on postoperative pathological examination of the tumor. Such rare neoplasms may be difficult to diagnose preoperatively based on radiological examinations alone. The patient underwent laparoscopic fertility-preserving unilateral (right) salpingo-oophorectomy. Following an extensive discussion with the patient and her family, appropriate informed consent was obtained for the treatment option and the patient and her family chose to preserve her fertility. She could have a baby following the treatment and no evidence of disease for 6 years. Gynecologists should be aware of the possibility of such rare cases, and the available surgical interventions should be fully discussed with patients who wish to preserve their fertility. Laparoscopic fertility-sparing surgery may be a feasible option when encountering such a rare condition.

The Impact of Laparoscopic Ovarian Cystectomy on Ovarian Reserve in Cases of Endometrioma

Background: An endometrioma is one of the most common manifestations of endometriosis. Laparoscopic cystectomy is the preferred approach to managing bengin ovarian cysts in adolescents and adults, but unfortunately it affects the ovarian reserve. Aim of the work: This study was aimed to evaluate the effects of laparoscopic cystectomy on ovarian reserve in patients with endometriomas. Patients and methods: This prospective study was conducted on 44 cases suffering from ovarian endometriomas and subjected to laparoscopic cystectomy. The patients in the study were selected from the Outpatient Clinic in Sayed Galal University Hospital and EL-Gala Maternity Teaching Hospital. This study was conducted between April 2017and March 2018. Serum anti-mullerian hormone (AMH), FSH and E2, as well as the antral follicle count (AFC) were measured preoperatively and 3 months postoperatively. Main outcome measures: Ovarian reserve based on the comparison of AMH alterations. The secondary end points are changes in FSH, E2 and AFC. Results: There was a statistically significant reduction in postoperative median, values of AFC, serum, AMH, serum E2 and serum E2: FSH ratio, and a statistically significant rise in postoperative median serum FSH, when compared to preoperative measurements in included women. Conclusion: The AMH level decreased and the FSH level increased after laparoscopic cystectomy for endometriomas, especially in older patients and those with bilateral cysts.

The Impact of Laparoscopic Ovarian Cystectomy on Ovarian Reserve in Cases of Endometrioma

The Impact of Laparoscopic Ovarian Cystectomy on Ovarian Reserve in Cases of Endometrioma

Ovarian Reserve Following Laparoscopic Ovarian Cystectomy vs Cyst Deroofing for Endometriomas

Because laparoscopic ovarian cystectomy of endometriomas is known to adversely impact patient ovarian reserve, the search for other techniques of surgical management is ongoing. The present study was undertaken to evaluate laparoscopic cyst deroofing as a feasible alternative. Prospective, randomized clinical trial (Canadian Task Force classification I). University maternity hospital. Women diagnosed with unilateral or bilateral ovarian endometriomas. Patients were managed with either laparoscopic ovarian cystectomy or cyst deroofing. A total of 122 women with endometriomas were randomized to either laparoscopic cystectomy (group 1) or laparoscopic cyst deroofing (group 2). The primary endpoint was the effect on ovarian reserve based on changes in anti-Müllerian hormone (AMH) values. At 1 month postsurgery, anti-Müllerian hormone values were significantly decreased (p < .001) from preoperative values, from 4.25 ± 0.87 ng/mL to 1.66 ± 1.02 ng/mL in group 1 and from 4.2 ± 1.69 ng/mL to 2.15 ± 1.48 ng/mL in group 2. In addition, antral follicle count and ovarian volume decreased significantly (p < .001) in both groups by 1 month postsurgery. The decreases in these 3 parameters were more significant (p < .001) in group 1 than in group 2. Laparoscopic cyst deroofing of endometriomas appears to be a promising alternative to laparoscopic cystectomy, with less postoperative decrease in ovarian reserve; however, the higher rate of endometrioma recurrence warrants future clinical research to determine the optimal surgical management of endometriomas.

Laparoscopic ovarian cystecomy for a huge ovarian cystic mass : A case report and review of literature

Introduction: Huge ovarian cystic lesions are rarely encountered in modern practice due to the marked development in health care services and technology on both the diagnostic and therapeutic levels, in addition to the continuous rise of awareness of women's health issues. Laparoscopic management seems to be the ideal line of intervention.Case Report: An 18-year-old, virgin female, was presented with abdominal distension. Physical examination and ultrasonography revealed a huge pelvi-abdominal cystic mass. A laparoscopic ovarian cystectomy was performed. A follow up for 12 months and was unremarkable. The technique of the operation as well as tips in such a heroic surgery were described.Conclusion: Huge ovarian cysts might be successfully and safely treated by laparoscopic excision. There seem to be no size-related limits for laparoscopic intervention for ovarian cysts; however, experience is a crucial factor.

Recurrent Bilateral Mucinous Cystadenoma: Laparoscopic Ovarian Cystectomy with Review of Literature.

The second most common epithelial tumor of the ovary is the mucinous tumors, and it constitutes about 8-10% of all ovarian tumors. The recurrence of mucinous cystadenoma is very rare after complete excision. Few cases have been reported. The case presented had initial surgery for adenxal mass diagnosed as mucinous tumor, performed by laparotomy and was followed up. After recurrence, the patient underwent laparoscopic evaluation and bilateral ovarian cystectomy was performed as a fertility preservation for the patient young age. The histopathological diagnosis was mucinous cystadenoma, the same as the initial one. Management in young patients is challenging, especially in the case of recurrence. Follow-up of these patients is very important and transvaginal ultrasound seems to be currently the most effective diagnostic tool for the follow-up of young patients treated with cystectomy for benign mucinous cystadenomas. Total hysterectomy and bilateral salpingo-oophorectomy is recommended after completing family size or reaching age of 35 for fear of progression or incompliance.

Laparoscopic Management of Inferior epigastric vessel injury

A 18 years young adult female diagnosed as left ovarian dermoid cyst underwent laparoscopic ovarian cystectomy. There was evidence of a hematoma at the Verres needle entry at Palmers point which slowly got extended to the midline. Local cauterization with bipolar current and a local stitch could not arrest the hemorrhage. Hence the epigastric vessel was traced to the origin and a haemostatic intracorporeal polygalactin suture of no 1 polygalactin 910 was taken at the reflection of the vessels over the anterior abdominal wall and the hemorrhage was controlled. The patient received antibiotics analgesics antacids and low molecular weight heparin and made an uneventful recovery. This technique of tackling inferior epigastric vessel bleeds proves to be helpful in refractory cases of inferior epigastric vessel bleeding during laparoscopy

A case of reoperation due to abdominal bleeding after total laparoscopic ovarian cystectomy.

A case of reoperation due to abdominal bleeding after total laparoscopic ovarian cystectomy.

Usefulness of hemostatic sealants for minimizing ovarian damage during laparoscopic cystectomy for endometriosis.

We aimed to evaluate the impact of topical hemostatic sealants and bipolar coagulation during laparoscopic ovarian endometriotic cyst resection on ovarian reserve by comparing the rates of decrease in anti-Müllerian hormone (AMH). A randomized prospective data collection was made on women aged 19-45 years who planned to have laparoscopic ovarian cystectomy at one of two institutions (n = 80), Kangbuk Samsung Hospital, Seoul, Korea or National Health Insurance Service Ilsan Hospital, Goyang, Korea, from January 2014 to April 2016. Patients were randomly divided into two groups treated with either a topical hemostatic sealant or bipolar coagulation for hemostasis. The hemostatic group was randomized to the FloSeal or TachoSil subgroups. Preoperative and 3-month postoperative AMH levels were checked and the rates of decrease of AMH were compared. All patients enrolled were treated with dienogest (Visanne) for 6-12 months. None were lost to follow-up at postoperative 3 months, but about one-third of the patients had been lost to follow-up by 6-12 months. AMH was significantly decreased in both groups 3 months postoperatively; however, the rate of decrease in the bipolar coagulation group was greater than that in the hemostatic sealant group, 41.9% (interquartile range [IQR], 22.29-65.24) versus 18.1% (IQR, 10.94-29.90), P = 0.007. Between the two hemostatic subgroups, there was no significant difference in AMH decrease rate, 14.95% (IQR, 11.34-21.21) versus 18.1% (IQR 9.76-40.70), P = 0.204. Hemostatic sealants may be an alternative to bipolar coagulation for preservation of ovarian reserve after laparoscopic ovarian cystectomy for endometriosis.

Round Ligament Adenomyoma

A 45-year-old woman presented with a history of dull aching right lower quadrant pain on and off for 6 months. In 1996 she had undergone laparoscopic left ovarian endometriotic cystectomy after which she conceived. She then had 2 normal vaginal deliveries, but in 2005 during her second delivery she had a subtotal hysterectomy for severe postpartum hemorrhage. In 2013 she underwent a laparoscopic right adnexectomy with left salpingectomy for endometriosis.

Transvaginal natural orifice transluminal endoscopic surgery: a new approach to ovarian cystectomy

To demonstrate a new approach for performing an ovarian cystectomy via transvaginal natural orifice transluminal endoscopic surgery (vNOTES) as an alternative for a laparoscopic ovarian cystectomy. Stepwise explanation of the technique using original video footage. Hospital. Fourteen patients who provided informed consent and were treated transvaginally to remove a benign ovarian cyst. The patient was placed in the lithotomy position under general anaesthesia. A 2.5-cm posterior colpotomy was made. The pouch of Douglas was opened and a transvaginal natural orifice transluminal endoscopic surgery (vNOTES) port was inserted transvaginally. A pneumoperitoneum was created, and the ovarian cyst was identified. Conventional endoscopic instruments and a standard endoscope were inserted transvaginally through the vNOTES port. The ovarian cortex was incised over the cyst using cold scissors. The cyst was dissected from the ovarian cortex by a combination of blunt and sharp dissection. Ovarian hemostasis was achieved using bipolar forceps. The ovarian cyst was removed through the colpotomy in an endobag. The vNOTES port was removed, and the colpotomy was sutured using a resorbable suture. The following data were collected: age, body mass index, parity, number of previous abdominal procedures, ovarian cyst diameter, operating time, length of hospital stay, and visual analog scale score. Successful minimally invasive ovarian cystectomy via vNOTES without abdominal scars. An ovarian cystectomy was successfully completed in all patients without conversions to standard laparoscopy, and no complications occurred. A fertility sparing cystectomy was performed via vNOTES in all patients; no ovariectomies were performed. All patients were discharged within 30hours, and nine patients were discharged within 12hours. Benign ovarian cysts can be treated by vNOTES through a posterior colpotomy via the pouch of Douglas. In a low-resource setting, a self-constructed gloveport and standard reusable endoscopic instruments can be used. In a first-world setting the surgical time can be reduced using a commercially available vNOTES port. Transvaginal natural orifice transluminal endoscopic surgery provides a new, less invasive approach for performing an ovarian cystectomy. This first IDEAL (idea, development, exploration, assessment, long-term study) stage 1 study confirms the feasibility of vNOTES ovarian cystectomy although it remains a novel approach that requires further investigation. It can provide improved patient comfort and better cosmetic results.

Expression of AMH in the serum of patients with ovarian endometriosis cyst and its clinical significance

Objective To investigate the expression of anti mullerian hormone (AMH) in the serum of patients with ovarian endometriosis cyst and its clinical significance. Methods Fifty-one cases of ovarian endometriosis cyst from March 2014 to June 2016 in Maternal and Child Health Hospital Affiliated to Southern Medical University (observation group) and thirty-five cases of normal women who were diagnosed through physical examination (control group) were selected as the research objects.The observation group patients received laparoscopic ovarian endometriosis cystectomy treatment, enzyme-linked immunosorbent assay (ELISA) was applied to detect and analyze serum AMH in the control group at physical examination and in the observation group before surgery and at 1 month, 3 months after surgery. Results (1) The preoperative serum AMH level of the observation group was significantly lower than that of the control group, the difference was statistically significant ( (2.45±0.68) μg/L vs.(3.75±0.80) μg/L, t=7.8604, P=0.0000). (2) Serum AMH level in the groups where the ages were above 35years was significantly lower than that of the age less than 35 group ( (1.76±0.57) μg/L vs.(3.61±0.88) μg/L, t=9.1249, P=0.0000); the preoperative serum AMH level in the group where disease course was more than 12 months was significantly lower than that of the disease course less than 12 months group ( (2.03±0.64) μg/L vs.(3.98±0.91) μg/L, t=8.1408, P=0.0000); the preoperative serum AMH level in patients with dysmenorrhea was significantly lower than that of patients without dysmenorrhea ( (1.65±0.53) μg/L vs.(3.91±0.84) μg/L, t=11.7861, P=0.0000), the preoperative serum AMH level in the bilateral lesion group was significantly lower than that of the unilateral lesion ( (2.01±0.68) μg/L vs.(2.84±0.72) μg/L, t=4.2174, P=0.0001); there was no significant difference in the preoperative serum AMH level between patients with<5.0 cm diameter cyst and patients with smaller cyst ( (2.52 + 0.81) μg/L vs.(2.39 + 0.50) μg/L, t=0.8411, P=0.4029). The serum AMH level in the observation group at 3 months after surgery was significantly lower than that before surgery ( (2.45±0.68) μg/L vs.(1.81±0.55) μg/L, t=24.3657, P=0.0000). Conclusion The expression of serum AMH level in patients with ovarian endometriosis is low, and it is closely related to the age, course of disease, history of dysmenorrhea and the location of the lesion.Laparoscopic ovarian cystectomy may reduce ovarian reserve capacity in patients with ovarian endometriosis. Key words: Ovarian Endometriosis Cyst; Anti Mullerian Hormone; Laparoscopy; Ovarian Cystectomy; Enzyme Linked Immunosorbent Assay

Comparison of Arterial Oxygenation Following Head-Down and Head-Up Laparoscopic Surgery.

BackgroundRegarding the role of gas entry in abdomen and cardiorespiratory effects, the ability of anesthesiologists would be challenged in laparoscopic surgeries. Considering few studies in this area and the relevance of the subject, this study was performed to compare the arterial oxygen alterations before operation in comparison with after surgery between laparoscopic cholecystectomy and ovarian cystectomy.MethodsIn this prospective cohort, 70 consecutive women aged from 20 to 60 years who were candidate for laparoscopic cholecystectomy (n = 35) and ovarian cystectomy (n = 35) with reverse (20 degrees) and direct (30 degrees) Trendelenburg positions, respectively, with ASA class I or II were enrolled. After intubation and before operation, for the first time, the arterial blood gas from radial artery in supine position was obtained for laboratory assessment. Then, the second blood sample was collected from radial artery in supine position and sent to the lab to be assessed with the same device after 30 minutes from surgery termination. The measured variables from arterial blood gas were arterial partial pressure of oxygen (PaO2) and Oxygen saturation (SpO2) alterations.ResultsTotal PaO2 was higher in the first measurement. The higher values of PaO2 in cholecystectomy (upward) than in ovarian cystectomy (downward) were not significant in univariate (P = 0.060) and multivariate analysis (P = 0.654). Furthermore, higher values of SpO2 in cholecystectomy (upward) than in ovarian cystectomy (downward) were not significant in univariate (P = 0.412) and multivariate analysis (P = 0.984).ConclusionsIn general, based on the results of this study, the values of PaO2 in cholecystectomy (upward) were not significantly higher than the values in cystectomy (downward) in laparoscopic surgeries when measured 30 minutes after surgery.

Effect of dexmedetomidine-induced anesthesia on the postoperative cognitive function of elder patients after laparoscopic ovarian cystectomy.

ObjectiveTo investigate the effect of dexmedetomidine at maintenance dose on the postoperative function of elder patients after general anesthesia for laparoscopic ovarian cystectomy.MethodsWe enrolled a total of 96 elder patients who were admitted to this hospital for laparoscopic ovarian cystectomy under general anesthesia between March 2015 and March 2017, and divided them into two groups, Group A (n = 48) and B (n = 48). Patients in both groups received the same methods for anesthesia induction and maintenance drugs. At the beginning of operation, patients in Group A received the intravenous injection of dexmedetomidine (0.8 μg/kg) followed by maintenance dose [0.5 μg/(kg h)] to the end of operation, while those in Group B underwent intravenous injection of 0.9% normal saline at the same rate, during which blood pressure, heart rate, oxyhemoglobin saturation and dosage of anesthetics at T1 (5 min after being delivered into the operation room), T2 (immediately after anesthesia induction), T3 (immediately after intubation), T4 (immediately after operation), T5 (immediately after end of operation) and T6 (immediately after extubation). Then, the levels of NSE, IL-6, CRP and HMGB1 were compared between two groups at 24 h before the operation, at the end, 24 h, 3 d and 7 d after operation. Besides, we also compared the postoperative cognitive functions and incidence of adverse reactions at 1 d before, 1, 2, 3 and 7 d after operation through MOCA scales.ResultsAt T3, T4 and T6, comparisons of the average arterial pressure and heart rate showed that the differences between the two groups had statistical significance (p < .05). At the end of operation, and at 24 h, 3 d and 7 d after operation, we found that the levels of IL-6 and CRP in patients of two groups were all significantly elevated when compared with those before operation; at the end of operation and at 24 h and 3 d after operation, the levels of IL-6 and CRP in the Group B were higher than those in the Group A, and the differences had statistical significance (p < .05). At the end of operation and at 24 h and 3 d after operation, the levels of NSE and HMGB1 in two group were higher than those before operation, and a more significant elevation was identified in Group B with statistically significant differences (p < .05); at 7 d after operation, a decreasing trend was found in the level of HMGB1, which, however, remained higher than the preoperative level, and the level in Group B was still higher than that in Group A with statistically significant differences (p < .05). At 2 d after operation, we found that the scores of MOCA in the Group B were remarkably decreased in comparison with the scores in Group A with a statistically significant difference (p < .05). Moreover, the incidence rate of postoperative cognitive dysfunction (POCD) in the Group A was significantly lower than that in the Group B, and the difference had statistical significance (p < .05).ConclusionDexmedetomidine can ameliorate the postoperative cognitive functions of elder patients who received the laparoscopic ovarian cystectomy under general anesthesia, and effectively decrease the incidence rate of POCD without any obvious or severe adverse reaction. Thus, it can serve as a kind of adjuvant drug for general anesthesia in clinical practice.

Clinical retrospective control study of single-port laparoendoscopic and multi-port laparoscopic ovarian cystectomy

Objective: To investigate clinical outcomes of laparoendoscopic single-site ovarian cystectomy compared with traditional multi-port laparoscopic ovarian cystectomy. Methods: Data of 81 patients with ovarian cystectomy from January 2016 to May 2017, the single-site group (n=40) and the multi-port group (n=41) in Peking Union Medical College Hospital were retrospectively collected. The outcomes of single-site and multi-port groups were analyzed and compared, including: postoperative fever, operation time, blood loss, hemoglobin change, surgical complications, postoperative pain score, postoperative analgesic requirements, body image scale and cosmetic score, length of hospital stay, postoperative total cost. Results: No complication was found in two groups. No difference was found in postoperative fever, blood loss, hemoglobin change, postoperative pain score, length of hospital stay, and total cost between the two groups (all P>0.05). Operation time was (50±20) minutes in single-site group, and (40±15) minutes in multi-port group; postoperative analgesic requirements was 28%(11/40) in single-site group, and 7%(4/41) in multi-port group; cosmetic score was 22.6±2.6 in single-site group, and 17.3±2.6 in multi-port group; body image scale was 5.7±1.2 in single-site group, and 6.2±1.2 in multi-port group; these four clinical parameters were statistical differences (all P<0.05). Conculsion: Laparoendoscopic single-site ovarian cystectomy is feasible and safe, although it could't relieve the postoperative pian, it do offer a higher cosmetic satisfaction.

Possibility of using superoxide dismutase and glutathione peroxidase as endometriosis biomarkers.

ObjectiveTo study the possibility of using superoxide dismutase (SOD) and glutathione peroxidase (GPx) as combined preoperative biomarkers for endometriosis.Participants and methodsFemale patients aged between 18 and 45 years old who came to the Gynecology outpatient clinic, Thammasat University Hospital, during September 2013–2016 with the complaint of gynecologic symptoms suspected of endometriosis, and who were positively diagnosed with endometriosis, were included in this study. All patients underwent conservative laparoscopic ovarian cystectomy with histopathological report. The control group consisted of healthy females of reproductive age who came to the outpatient clinic. The plasma SOD and GPx were measured from blood samples with commercial kits. A receiver operating characteristic curve was generated for plasma activity of SOD, GPx, and combined tests. The cutoff values were selected at the most appropriate sensitivity and specificity.ResultAll 36 cases were included in this study. Mean ages of patients in the patient and control groups were 33.1 and 28.6 years old, respectively. SOD and GPx activities of disease and control group were 6.15 and 8.11, 463.9 and 472.34 nmole/min/mL unit, respectively. The sensitivity and 1–specificity of the combined test were calculated at 0.78, with sensitivity, specificity, accuracy, positive predictive value, and negative predictive value being 68.75, 80.77, 76.50, 69.23, and 80.33, respectively.ConclusionA combination testing of SOD and GPx can possibly be used as preoperative biomarker for endometriosis.

Impact of Laparoscopic Ovarian Cystectomy on Ovarian Reserve

Objective: The aim of this research was to determine the impact of laparoscopic ovarian cystectomy on ovarian reserve. Materials and Methods: This was a prospective observational study carried out on 15 women, 15–40 years of age, who underwent laparoscopic ovarian cystectomy for symptomatic benign ovarian cysts of size >7 cm in the Department of Obstetrics and Gynaecology at Pt. B.D. Sharma Postgraduate Institute of Medical Sciences, in Rohtak, Haryana, India, a tertiary care center of north India. Bipolar electrocoagulation was used for hemostasis on the ovarian bed during surgery. Serum anti-Müllerian hormone (AMH) was measured 1 day prior to surgery (D0), on postoperative day 7 (D7), and on day 90 (D90), using an enzyme-linked immunosorbent assay. The data were analyzed using SPSS 16. Results: The mean age in the study was 27 ± 6.92 years and 13 (86.66%) women were under age 35. Three (20%) women had presented with infertility, and the remaining (80%) with dull abdominal pain. A declining trend of mean AMH levels with increasing age and cyst size was noted in the study. Nine (60%) women had AMH values between 2.1 and 5 ng/mL preoperatively, while 6 (40%) had values between 5.1 and 9 ng/mL. However, on D7, 9 women (60%) had values between 1 and 3 ng/mL on D7, suggesting a decline in AMH values in some women who had higher levels earlier. All women in the study had preoperative AMH values >2 ng/mL, indicating optimal ovarian reserve, while 5 (33.33%) women on D7 and 2 (13.33%) women on D90 had AMH levels <2 ng/mL, suggesting some recovery in 3 cases. A significant fall in mean AMH levels was seen between D0 and D7 (38.78%; p < 0.001) and between D0 and D90 (46.73%, p < 0.001) in the study. Conclusions: Laparoscopic ovarian cystectomy using bipolar coagulation causes a significant continuous decline in ovarian reserve as measured by serum AMH. (J GYNECOL SURG 33:129)

Effect of menstrual phase on the surgical treatment of ovarian cysts

This study aimed to determine whether the menstrual cycle affects operative bleeding and postoperative ovarian reserve in patients undergoing laparoscopic ovarian cystectomy. A total of 155 patients who had undergone laparoscopic ovarian cystectomy were classified into the follicular phase (n = 84) and luteal phase (n = 71) of the menstrual cycle. The primary outcome measures were operative blood loss and the rate of decline in ovarian reserve, as calculated by measuring serial serum anti-Müllerian hormone (AMH) levels preoperatively and 3 months postoperatively. No significant difference in the baseline demographics, operative blood loss (p = .984), the rate of decline in ovarian reserve (p = .945), and other surgical outcomes were observed between both the groups. These results demonstrate that the menstrual cycle had no influence on the operative blood loss and ovarian reserve during laparoscopic ovarian cystectomy. Therefore, the menstrual cycle is not an important factor to determine the optimal timing of ovarian cystectomy.Impact statementWhat is already known on this subject?: The menstrual cycle results in periodic changes in haemostasis and blood flow in the reproductive organs.What do the results of this study add?: These results demonstrate that the menstrual cycle had no influence on the operative blood loss and ovarian reserve during laparoscopic ovarian cystectomy.What are the implications of these findings for clinical practice and/or further research?: The menstrual cycle is not an important factor to determine the optimal timing of ovarian cystectomy.

Laparoscopic Ovarian Cystectomy in A Patient With Vetriculoperitoneal Shunt: a case report

Ventriculoperitoneal shunt (VPS) is often the best treatment modality for neurologic disorders such as hydrocephalus and pseudotumor cerebri. In recent years, laparoscopic surgery has emerged as a preferred method of accessing and treating a variety of abdominopelvic pathology. Laparoscopic procedures were previously contraindicated in patients of hydrocephalus having a Ventriculoperitoneal (VP) shunt due to shunt obstruction, shunt malfunction, infection and acute elevation of intracranial pressure. Now, conclusive evidence indicating that it is safe to perform laparoscopic surgery in a patient with VP shunt using routine anaesthetic monitoring and without any shunt manipulation. We report a case of successfully performing laparoscopic ovarian cystectomy in a patient with VP shunt.