Comparing ovarian reserve after laparoscopic excision of endometriotic cysts and hemostasis achieved either by bipolar coagulation or suturing: a randomized clinical trial.
OBJECTIVE
This study aimed to compare ovarian reserve between laparoscopic suturing and bipolar coagulation techniques in women with unilateral endometrioma.


METHODS
In a prospective randomized clinical trial, 109 patients with unilateral endometrioma underwent laparoscopic cystectomy. Patients were then randomized to undergo hemostasis with either bipolar coagulation (n = 57) or suturing (n = 52) technique. We evaluated the impact of surgery and hemostasis techniques on ovarian reserve using serum levels of anti-Mullerian hormone (AMH) and follicle-stimulating hormone (FSH) that were measured preoperatively and at 3 months postoperatively.


RESULTS
Baseline characteristics such as age and preoperative AMH and FSH levels were similar between the two study groups. At 3-month follow-up, in both groups, postoperative AMH levels were significantly lower and FSH levels were significantly higher than before surgery. The decline rate of AMH levels was significantly greater in the bipolar coagulation (53.42 ± 15.28) group than in the suturing group (15.94 ± 18.55). Furthermore, patients in the suturing group had higher AMH and lower FSH as compared with the other group (p < 0.001).


CONCLUSIONS
After laparoscopic stripping of endometrioma, intracorporeal suturing showed less damage on ovarian reserve as compared with bipolar electrocoagulation. Therefore, hemostatic suturing technique may be considered as a better choice after laparoscopic ovarian cystectomy.
Department of Obstetrics and Gynecology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Zahra
Z
Asgari
Department of Obstetrics and Gynecology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. s_rouholamin@med.mui.ac.ir.|Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Beheshti Hospital, Isfahan, Iran. s_rouholamin@med.mui.ac.ir.
Safoura
S
Rouholamin
Department of Obstetrics and Gynecology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Reihaneh
R
Hosseini
Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
Mahdi
M
Sepidarkish
Department of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Leila
L
Hafizi
Department of Obstetrics and Gynecology, School of Medicine, Shahid Sadughi University of Medical Sciences, Yazd, Iran.
Atiyeh
A
Javaheri
D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood; D001777:Blood Coagulation; D015653:Cystectomy; D003560:Cysts / Q000601:surgery*; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D005500:Follow-Up Studies; D006487:Hemostasis; D006489:Hemostatic Techniques; D006490:Hemostatics; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000601:surgery*; D065851:Ovarian Reserve; D011184:Postoperative Period; D011446:Prospective Studies; D013536:Suture Techniques; D013537:Sutures
D006490:Hemostatics; D054304:Anti-Mullerian Hormone; D005640:Follicle Stimulating Hormone
AMH levels; Bipolar electrocoagulation; Endometrioma; Ovarian reserve; Suture