Adhesion formation after microlaparoscopic and laparoscopic ovarian coagulation for polycystic ovary disease.
OBJECTIVE
To compare the effects of microlaparoscopy and decreased CO2 exposure on peritoneal microcirculation and potential adhesion formation after ovarian surgery with those of conventional operative laparoscopy.


METHODS
Prospective, randomized study (Canadian Task Force classification I).


METHODS
Teaching hospital.


METHODS
Eighteen women with polycystic ovary disease.


METHODS
Microlaparoscopic or laparoscopic ovarian coagulation of the ovaries.


RESULTS
Approximately 10 to 12 coagulation points were applied to each ovary. Two to 3 weeks after the initial surgery second-look microlaparoscopy was performed to determine the extent of adhesions in both groups. The frequency of adhesion formation and changes in glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), catalase (CAT), and glutathione (GSH) levels were studied in homogenized peritoneal tissues obtained during surgery in each group.


RESULTS
Clinical profiles were similar between groups. Mean exposure, amount, and pressure of CO2 were significantly less in the microlaparoscopy group (p <0.05). The laparoscopy group had significantly more adhesions than the microlaproscopy group (24% vs 48%, p <0.05). The GSH-Px, SOD, CAT, and GSH levels were significantly lower in the laparoscopy group (0. 425 micromol, 1.2 ng, 37.55 micromol, and 0.9 nmol vs 0.755 micromol, 2.l ng, 625 micromol, and 2.6 nmol, respectively).


CONCLUSIONS
Reduced exposure to and amount of CO2 during microlaparoscopy may result in decreased adhesion formation compared with conventional laparoscopy. This effect may possibly be due to lack of or minimal adverse effects on peritoneal microcirculation and cell-protective systems, which are proposed mechanisms for adhesion formation and closely related to peritoneal injury. In addition, microlaparoscopy may be a cost-effective alternative to conventional laparoscopy. (J Am Assoc Gynecol Laparosc 6(2):159-163, 1999)
Taskin
O
O
Department of Obstetrics and Gynecology, Inonu University Medical School, Malatya, Turkey.
Sadik
S
S
Onoglu
A
A
Gokdeniz
R
R
Yilmaz
I
I
Burak
F
F
Wheeler
J M
JM
D000328:Adult; D002245:Carbon Dioxide / Q000008:administration & dosage; D004564:Electrocoagulation / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011085:Polycystic Ovary Syndrome / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D000267:Tissue Adhesions / Q000453:epidemiology / Q000209:etiology*; D016896:Treatment Outcome
D002245:Carbon Dioxide