Minilaparoscopic ovarian drilling under local anesthesia in patients with polycystic ovary syndrome.
OBJECTIVE
To assess pain control in patients with polycystic ovary syndrome (PCOS) who are undergoing ovarian drilling during minilaparoscopy under local anesthesia and conscious sedation and to evaluate the efficacy of this protocol compared with the traditional approach in terms of operative and discharge times, subsequent ovulation, and pregnancy.


METHODS
Prospective randomized study.


METHODS
University hospitals and private day-surgery unit.


METHODS
Sixty-two infertile women with PCOS.


METHODS
Group A underwent minilaparoscopic ovarian drilling under local anesthesia and conscious sedation. Group B (control group) was treated with traditional ovarian drilling by laparoscopy under general anesthesia.


METHODS
Intraoperative pain score in group A. Hormonal profile before and after surgery, operative and discharge times, postoperative analgesic requirements, and reproductive follow-up in both groups.


RESULTS
Group A showed a good intraoperative pain score. The hormonal profile after surgery did not differ between groups A and B. Operative times were also similar for both groups. The number of patients discharged within 2 hours after surgery was significantly higher in group A. The need for postoperative analgesics was significantly higher in group B. No statistically significant differences were noted between the groups in terms of pregnancy and ovulation rates.


CONCLUSIONS
Intraoperative and postoperative local anesthesia plus conscious sedation allows outpatient bilateral ovarian drilling by minilaparoscopy to be performed without general anesthesia. The high pregnancy rates, the simplicity of the method, and the faster discharge time offer a new option for patients with PCOS who are resistant to clomiphene citrate. Moreover, ovarian cauterization can be performed simultaneously with a diagnostic minilaparoscopy and integrated into the infertility workup of these patients.
Endogyn Service, Private Endoscopic Associates, Naples, Italy.
F
F
Zullo
M
M
Pellicano
E
E
Zupi
M
M
Guida
P
P
Mastrantonio
C
C
Nappi
D000328:Adult; D000772:Anesthesia, Local; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D010535:Laparoscopy / Q000379:methods*; D007986:Luteinizing Hormone / Q000097:blood; D010060:Ovulation; D010149:Postoperative Pain / Q000188:drug therapy; D017699:Pelvic Pain / Q000188:drug therapy; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000601:surgery*; D018873:Pregnancy Rate; D011446:Prospective Studies
D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone