title: Additional benefit of hemostatic sealant in preservation of ovarian reserve during laparoscopic ovarian cystectomy: a multi-center, randomized controlled trial.
abstract: OBJECTIVE
  Is hemostasis by hemostatic sealant superior to that achieved by bipolar coagulation in preserving ovarian reserve in patients undergoing laparoscopic ovarian cystectomy?
  
  
  CONCLUSIONS
  Post-operative ovarian reserve, determined by serial serum anti-Müllerian hormone (AMH) levels, was significantly less diminished after ovarian hemostasis when hemostatic sealant was used rather than bipolar coagulation.
  
  
  BACKGROUND
  Hemostasis achieved with bipolar coagulation at ovarian bleeding site results in damage to the ovarian reserve.
  
  
  METHODS
  A prospective, multi-center randomized trial was conducted on 100 participants with benign ovarian cysts, between December 2012 and October 2013.
  
  
  METHODS
  Participants were randomized to undergo hemostasis by use of either hemostatic sealant (FloSeal™) or bipolar coagulation during laparoendoscopic single-site (LESS) ovarian cystectomy. The primary end-point was the rate of decline of ovarian reserve calculated by measuring serum AMH levels preoperatively and 3 months post-operatively.
  
  
  RESULTS
  Age, parity, socio-demographic variables, preoperative AMH levels, procedures performed and histologic findings were similar between the two groups of patients. There were also no differences in operative outcomes, such as conversion to other surgical approaches, operative time, estimated blood loss, or perioperative complications between the two groups. In both study groups, post-operative AMH levels were lower than preoperative AMH levels (all P < 0.001). The rate of decline of AMH levels was significantly greater in the bipolar coagulation group than the hemostatic sealant group (41.2% [IQR, 17.2-54.5%] and 16.1% [IQR, 8.3-44.7%], respectively, P = 0.004).
  
  
  CONCLUSIONS
  Some caution is warranted because other ovarian reserve markers such as serum markers (basal FSH and inhibin-B) or sonographic markers were not assessed.
  
  
  CONCLUSIONS
  The present study shows that the use of a hemostatic sealant during laparoscopic ovarian cystectomy should be considered, as hemostatic sealant provides the additional benefit of preservation of ovarian reserve.
  
  
  BACKGROUND
  This study was supported by the Medical Research Funds from Kangbuk Samsung Hospital. No conflict of interest is declared.
  
  
  BACKGROUND
  www.clinicaltrials.gov, no. NCT01857466.
authors.affiliation: Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Taejong
authors.initials: T
authors.lastname: Song
authors.affiliation: Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.
authors.forename: San-Hui
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea obgykim@gmail.com.
authors.forename: Woo Young
authors.initials: WY
authors.lastname: Kim
mesh_terms: D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000009:adverse effects / Q000627:therapeutic use*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D006488:Hemostasis, Surgical / Q000009:adverse effects / Q000379:methods*; D006490:Hemostatics / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D010048:Ovarian Cysts / Q000601:surgery*; D065851:Ovarian Reserve; D016896:Treatment Outcome
chemical_list: C411004:FloSeal Matrix; D006490:Hemostatics; D054304:Anti-Mullerian Hormone
keywords: AMH; ovarian cystectomy; ovarian cysts; ovarian reserve