[Impact on ovarian reserve function by different homostasis methods during laparoscopic cystectomy in treatment of ovarian endometrioma].

OBJECTIVE: To investigate the impact on ovarian reserve function by different hemostasis methods during laparoscopic surgery in treatment of ovarian endometrioma.

METHODS: From September 2008 to February 2010, 162 cases with ovarian endometrioma undergoing laparoscopic surgery in Shandong Provincial Hospital were enrolled in this study. At the 3rd day of the menstrual cycle before surgery and the 1st, 3rd, 6th and 12th cycle after surgery, serum FSH and anti-mullerian hormone (AMH) and ultrasound basal antral follicle count (AFC) and peak systolic velocity (PSV) were examined and compared. Based on hemostasis method, those patients were divided into 3 groups, including 54 cases in bipolar hemostasis, 54 cases in ultrasonic scalpel hemostasis and suture after excision of endometrioma.

RESULTS: (1) Before surgery: no significant different factors among three groups before surgery were observed, including age, size of endometrioma, the level of FSH, AMH, AFC, PSV(P > 0.05). (2) Ovarian reserve function after surgery: 1) FSH: at the 1st, 3rd, 6th and 12th month follow-up, the FSH in the bipolar group was (11.7 ± 4.0), (9.9 ± 4.0), (9.5 ± 4.3), (9.5 ± 3.9) U/L, and the FSH in ultrasonic scalpel group was (11.4 ± 4.3), (9.7 ± 4.0), (9.2 ± 3.7), (9.9 ± 4.6) U/L, were significantly higher than (9.3 ± 3.8), (6.7 ± 3.0), (6.5 ± 3.2), (6.4 ± 2.2) U/L in suture group respectively (all P < 0.05). 2) AMH: at the 1st, 3rd, 6th and 12th month follow-up, the AMH in the bipolar group was (1.8 ± 0.9), (1.8 ± 1.0), (1.9 ± 1.0), (2.0 ± 1.0) µg/L, and the AMH in the ultrasonic scalpel group was (1.6 ± 0.8), (1.8 ± 1.0), (2.0 ± 1.1), (2.1 ± 1.0) µg/L, which were significantly lower than (2.8 ± 1.7), (2.9 ± 1.6), (3.0 ± 1.3), (3.2 ± 1.5) µg/L in suture group, respectively (all P < 0.05). 3) AFC: there was no significant difference of APC among the three groups in the 1st month after surgery. However, at the 3rd, 6th and 12th month follow-up, the AFC of 4.8 ± 1.4, 5.9 ± 1.5, 6.1 ± 1.5 in the suture group was significant higher than 3.7 ± 1.4, 4.1 ± 1.4, 4.0 ± 1.5 in bipolar group and 3.6 ± 1.3, 4.0 ± 1.1, 3.9 ± 1.5 in ultrasonic group, respectively (all P < 0.05). 4) PSV: at the 1st, 3rd, 6th and 12th month follow-up, the PSV of the bipolar group (7.9 ± 3.5), (8.1 ± 3.3), (8.4 ± 3.1), (8.6 ± 3.0) cm/s in bipolar group and (8.1 ± 3.5), (8.0 ± 3.0), (7.9 ± 3.2), (8.0 ± 2.9) cm/s in ultrasonic group were significant lower than (10.9 ± 3.3), (12.0 ± 3.2), (11.8 ± 3.0), (12.1 ± 4.1) cm/s in suture group, respectively. (all P < 0.05).

CONCLUSIONS: Bipolar or ultrasonic scalpel hemostasis during laparoscopic excision of ovarian endometrioma is associated with a significant reduction in ovarian reserve. Electrocoagulation of the ovarian tissue should be avoided.