ABSTRACT
Currently, laparoscopic cystectomy is the first-line therapy for ovarian benign cysts that are resistant to current therapies. There are different studies that point to ovarian reserve damage due to laparoscopic cystectomy. In this study, we evaluate the ovarian damage following laparoscopic cystectomy for non-endometriosis cysts using ultrasound and pathology findings. This is a prospective cohort study conducted between 7rd month of 2011 and 10th month of 2012 in Women hospital affiliated to Tehran university of medical sciences.45 non-endometriosis cysts [17 teratoma,7 mucinous, 10 simple serous and 11 simple cysts] underwent laparoscopic cystectomy with stripping technique. Amount of excised parenchyma, number of lost oocytes and cyst wall fibrosis thickness were histopathologically studied. Before and 3 months after surgery antral follicle count was evaluated by ultrasound. AFC after cystectomy for teratoma and simple serous was significantly reduced P<0.05. By larger teratomas and more parenchyma inadvertently removed during their excision [1.64, 0.255] reduced AFC was seen and in simple serous cysts with more removed parenchyma amount [1.5] reduced AFC occurred. In our study simple cysts excision led to a loss in AFC that was not associated with any other cyst parameters. Mucinous cysts resection led to no specific ovarian reserve damage. Laparoscopic cystectomy for non-endometriosis leads to reduced ovarian reserve
ABSTRACT
The purpose of this study was to assess the vasopressin effect on operation time and the need for electrocauterization frequency and ovarian reserve during laparoscopic stripping of ovarian endometriomas. This was a randomized prospective clinical trial, in which twenty patients between 18-35 years with unilateral endometriomas were randomly divided in two groups of cases and controls. Laparoscopic cystectomy was performed by hydrodissection and stripping method in both groups with diluted vasopressin injected in cases, in comparison to only saline injection in controls. Ovarian hemostasis was achieved by bipolar electrocoagulation. The operation time and frequency of electrocoagulation were compared between two groups. The ovarian reserve was determined by ultrasound examination and laboratory assessment one month before and two months after surgery in two groups. Non parametric data was analyzed by Mann-Whitney test. The p-value less than 0.05 was considered statistically significant. The operation time was less in cases than control group, but the difference was not statistically significant [p=0.065]. The frequency of electrocoagulation for hemostasis was less in cases than controls but this difference was not statistically significant [p=0.132]. The antral follicle count decreased in both groups two months later, while no significant difference was found between two groups. This study shows that diluted vasopressin decreases operation time and electrocauterization frequency during laparoscopic stripping of ovarian endometriomas; however, the difference between case and control group is not statistically significant