Comparison of hemostatic sealants on ovarian reserve during laparoscopic ovarian cystectomy.
OBJECTIVE
To determine whether different methods of hemostasis and pathologic subtypes would lead to significant differences regarding ovarian reserve after laparoscopic ovarian cystectomy.


METHODS
Data were prospectively collected from 129 patients who underwent laparoscopic ovarian cystectomy with either a hemostatic sealant (FloSeal or TachoSil) or bipolar coagulation to achieve hemostasis. Serum anti-Müllerian hormone (AMH) levels as measured by enzyme immunoassay. Measurements were made preoperatively and at 3 months postsurgery in each group [bipolar coagulator group (n=43), FloSeal group (n=46), and TachoSil group (n=40)].


RESULTS
Age, BMI, parity, sociodemographic variables, and preoperative AMH levels were similar between the three groups of patients. At 3 months post-surgery, the AMH decline rate was significantly greater in the bipolar coagulation group compared with the two hemostatic sealant groups (41.2% [IQR, 16.7-52.4] vs. 15.4% [IQR, 5.2-41.9], respectively; P=0.003). However, the AMH decline rates of the two hemostatic sealant groups (FloSeal and TachoSil) were not significantly different (15.4% [IQR, 7.8-44.6] vs. 15.9% [IQR, 0.7-41.1], P=0.962). Also, subgroup analysis according to ovarian cyst type revealed no significant differences in the rate of serum AMH decline regardless of the hemostatic method (bipolar group, P=0.30; FloSeal group, P=0.47, and TachoSil group, P=0.79).


CONCLUSIONS
The two hemostatic sealants (FloSeal and Tachosil) did not exhibit any significant differences regarding the preservation of ovarian reserve regardless of ovarian cyst type.
Department of Obstetrics & Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Jun Hyeok
JH
Kang
Department of Obstetrics & Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Yong Seok
YS
Kim
Department of Obstetrics & Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.
San Hui
SH
Lee
Department of Obstetrics & Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: obgykim@gmail.com.
Woo Young
WY
Kim
D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood; D015653:Cystectomy; D004338:Drug Combinations; D005260:Female; D005340:Fibrinogen / Q000627:therapeutic use*; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use*; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D010048:Ovarian Cysts / Q000601:surgery*; D065851:Ovarian Reserve; D011446:Prospective Studies; D013917:Thrombin / Q000627:therapeutic use*
D004338:Drug Combinations; C411004:FloSeal Matrix; C518955:TachoSil; D054304:Anti-Mullerian Hormone; D005340:Fibrinogen; D013917:Thrombin
Hemostatic sealant; Ovarian cystectomy; Ovarian reserve; Pathologic type; Serum AMH level