title: Effect on ovarian reserve of hemostasis by bipolar coagulation versus suture during laparoendoscopic single-site cystectomy for ovarian endometriomas.
abstract: OBJECTIVE
  To compare the postoperative decrease in ovarian reserve between hemostasis by bipolar coagulation and suture during laparoendoscopic single-site cystectomy (LESS-C) for ovarian endometriomas.
  
  
  METHODS
  Prospective comparative study (Canadian Task Force Classification II-1).
  
  
  METHODS
  University hospital.
  
  
  METHODS
  One hundred twenty-five patients with ovarian endometriomas.
  
  
  METHODS
  Patients with endometrioma were managed by hemostasis with either bipolar coagulation (n = 62) or suturing (n = 63) during LESS-C. We evaluated the impact of surgery on ovarian reserve using serum anti-Müllerian hormone (AMH) levels, which were measured before surgery and 3 months after surgery in all patients.
  
  
  RESULTS
  Baseline characteristics such as age, bilaterality of endometriomas, and preoperative AMH levels were similar between the 2 study groups. There were also no differences between the 2 groups in surgical outcomes, such as operative time, operative blood loss, or operative complications. In both study groups, postoperative AMH levels were lower than preoperative AMH levels (p < .001). The decline rate of AMH levels was significantly greater in the bipolar coagulation group than in the suture group (42.2% [interquartile range, 16.5%-53.0%] and 24.6% [interquartile range, 11.6%-37.0%], respectively, p = .001).
  
  
  CONCLUSIONS
  Hemostasis by bipolar coagulation after stripping of the endometrioma during LESS-C reduces ovarian reserve more than suturing does, as determined by serial AMH levels. Therefore, suturing may be a better hemostatic choice after stripping ovarian endometriomas.
authors.affiliation: Department of Obstetrics & Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Obstetrics & Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea. Electronic address: taejong.song@gmail.com.
authors.forename: Taejong
authors.initials: T
authors.lastname: Song
authors.affiliation: Department of Obstetrics & Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Woo Young
authors.initials: WY
authors.lastname: Kim
authors.affiliation: Department of Obstetrics & Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Kyo Won
authors.initials: KW
authors.lastname: Lee
authors.affiliation: Department of Obstetrics & Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Kye Hyun
authors.initials: KH
authors.lastname: Kim
mesh_terms: D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood*; D002170:Canada; D057186:Comparative Effectiveness Research; D004564:Electrocoagulation / Q000009:adverse effects / Q000379:methods; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D006489:Hemostatic Techniques; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D010049:Ovarian Diseases / Q000601:surgery*; D065851:Ovarian Reserve / Q000502:physiology*; D011184:Postoperative Period; D011446:Prospective Studies; D013536:Suture Techniques / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D054304:Anti-Mullerian Hormone
keywords: AMH; Bipolar coagulation; Ovarian cystectomy; Ovarian reserve; Suture