Minilaparoscopic ovarian biopsy performed under conscious sedation in women with premature ovarian failure.
OBJECTIVE
To evaluate the feasibility of a bilateral multiple ovarian biopsy through minilaparoscopy under local anesthesia and conscious sedation and to assess the efficacy of this technique as compared to the traditional laparoscopic approach.


METHODS
Twenty-five infertile women with premature ovarian failure underwent bilateral ovarian biopsy plus chromoperturbation. Twelve patients were treated with minilaparoscopy (minilap group) and preoperatively received mepivacaine for subcutaneous local anesthesia and midazolam plus fentanyl for conscious sedation. Following minilaparoscopy, 40 mL of 0.5% intraperitoneal subdiaphragmatic lidocaine and 5 mL of ropivacaine, 7.5 mg/mL, for infiltration of the trocar insertion sites were administered. Thirteen women (control group) were treated with the traditional laparoscopic approach under general anesthesia. If necessary, ketoprofene or intramuscular ketorolac was administered following surgery. Postoperative pain score was evaluated by a 1-10 visual analogic scale immediately after surgery and in the following 24 hours; in addition, the quantity of ovarian biopsy material for the pathologist and the discharge and operative times were evaluated.


RESULTS
The minilap group had lower postoperative pain scores postoperatively. Operative time was similar in both groups. The rate of discharge two hours after surgery was significantly higher in the minilap group. In all cases the amount of ovarian tissue was sufficient for diagnosis. Twenty-one patients were affected by premature menopause and four by resistant ovary syndrome. The need for postoperative analgesics was significantly higher in the control group.


CONCLUSIONS
Minilap allows the performance of bilateral, multiple ovarian biopsy under local anesthesia and conscious sedation in association with chromoperturbation and the obtaining a sufficient amount of ovarian tissue for histopathologic diagnosis. Intraperitoneal lidocaine administration and ropivacaine infiltration of the trocar sites were beneficial for patients undergoing operative minilap in a day-surgery setting. The effect of these drugs was obviously temporary; however, low postoperative pain scores and low additional analgesic requirement permitted early discharge, within two hours after surgery.
Pellicano
M
M
Department of Obstetrics, Gynecology and Reproductive Medicine, University of Naples Federico II, Italy. pellican@unina.it
Zullo
F
F
Cappiello
F
F
Di Carlo
C
C
Cirillo
D
D
Nappi
C
C
D000328:Adult; D000556:Ambulatory Surgical Procedures; D000779:Anesthetics, Local; D001706:Biopsy; D016292:Procedural Sedation; D005260:Female; D005283:Fentanyl; D006801:Humans; D010535:Laparoscopy; D008619:Mepivacaine; D008874:Midazolam; D010053:Ovary / Q000473:pathology*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D016649:Primary Ovarian Insufficiency / Q000473:pathology*; D016896:Treatment Outcome
D000779:Anesthetics, Local; D008619:Mepivacaine; D008874:Midazolam; D005283:Fentanyl