Comparison of the impact of laparoscopic endometriotic cystectomy and vaporization on postoperative serum anti-Mullerian hormone levels.

INTRODUCTION: The aim of this study was to investigate the effect of laparoscopic endometriotic cystectomy and vaporization on ovarian reserve. METHODS: We prospectively analyzed the serum level of anti-Mullerian hormone (AMH) in 62 patients at four different time points- preoperatively and at 1 month, 6 months, and 1 year postoperatively. Among the 62 cases, a bilateral cystectomy was performed in 10, bilateral vaporization in 16, a unilateral cystectomy in 24, and unilateral vaporization in 12. RESULTS: The rate of AMH decline after unilateral cystectomy or bilateral cystectomy was higher than that after unilateral vaporization or bilateral vaporization. Age and bilaterality were associated with an AMH decline at 1 month, and age alone was associated with an AMH decline at 1 year. Moreover, being older than 38 years of age and having a revised American Society for Reproductive Medicine score >80 were independent risk factors for the non-recovery of AMH. CONCLUSION: The rate of AMH decline after laparoscopic endometriotic vaporization is significantly lower than that after cystectomy. Both methods, however, have the potential to lower ovarian reserve, especially in cases of severe endometriosis or in patients older than 38 years of age.

Compared with cystectomy, is ovarian vaporization of endometriotic cysts truly more effective in maintaining ovarian reserve?

STUDY OBJECTIVE: To evaluate how endometriotic cystectomy and vaporization affect ovarian reserve after conservative surgery. DESIGN: Prospective study (Canadian Task Force classification II-1). SETTING: Hokusetsu General Hospital. PATIENTS: Ninety-nine women who underwent conservative surgery to treat endometriotic cysts from June 2011 to July 2013. INTERVENTIONS: Vaporization with bipolar current was performed in nulligravid women, and cystectomy in those who had a child. In women with endometriotic cysts, bilateral cystectomy was performed in 28, bilateral vaporization in 15, unilateral cystectomy in 40, and unilateral vaporization in 16. In all patients, preoperative and postoperative serum anti-müllerian hormone (AMH) and follicle-stimulating hormone (FSH) concentrations at the early proliferative phase were assayed, and the change in concentrations was evaluated for each operation. MEASUREMENT AND MAIN RESULTS: In the bilateral cystectomy group, the mean (SD) postoperative FSH concentration (19.3 [21.8] IU/mL) was statistically higher than the preoperative concentration (9.0 [6.2] IU/mL) (p < .01). AMH significantly declined after all operations to treat endometriotic cysts, and the rate of decline in the AMH concentration was >50% compared with preoperative concentrations. CONCLUSION: Whether endometriotic cysts are unilateral or bilateral, both cystectomy and vaporization using bipolar current can lower ovarian reserve. Therefore, it is necessary to develop more effective surgical procedures to prevent ovarian damage.

The expression status of G protein-coupled receptor GPR30 is associated with the clinical characteristics of endometriosis.

INTRODUCTION: GPR30 is a seven-transmembrane G protein-coupled estrogen receptor that regulates endometrial cellular responses to estrogen. GPR30 is often highly expressed in cancer cells from aggressive tumors. The aim of this study was to evaluate the expression patterns of GPR30 in endometriosis during medical treatment. PATIENTS: A total of 38 females, 28 patients with endometriosis and 10 patients with leiomyoma who underwent laparoscopic surgery were included this study. INTERVENTION: Eutopic endometrial tissue sampling from women without endometriosis and ectopic endometrial tissue sampling from women with endometriosis. MAIN OUTCOME MEASURE: A quantitative real-time polymerase chain reaction analysis of the mRNA expression in eutopic and ectopic endometrial tissues with or without GnRH agonist treatment. The expression of GPR30 was confirmed by immunohistochemistry. RESULTS: There was an increased level of GPR30 mRNA in eutopic endometrium during the proliferative phase, whereas higher expression was observed in the ectopic endometrium during the secretory phase. Increased GPR30 mRNA was observed in ectopic endometrium in comparison to eutopic endometrium. GnRH agonist treatment before laparoscopic surgery decreased GPR30 mRNA in ectopic endometrium. The immunohistochemical analysis also revealed that GPR30 was strongly expressed in epithelial cells in ectopic endometrium, whereas GnRH agonist treatment decreased the GPR30 expression. CONCLUSION: High levels of GPR30 expression can play an important role in the progression of endometriosis.

Preoperative assessment by magnetic resonance imaging is useful for planning the treatment of an enlarged uterus by total laparoscopic hysterectomy.

AIM: The purpose of this study was to compare the intraoperative and postoperative parameters among the three approaches used to treat large uterine myomas: laparoscopic assisted vaginal hysterectomy (LAVH), total laparoscopic hysterectomy (TLH) and abdominal hysterectomy, and to evaluate the selection criteria for laparoscopic hysterectomy as determined by magnetic resonance imaging. MATERIAL AND METHODS: The medical records of 155 patients who underwent a hysterectomy between January 2007 and April 2010 were examined. We also compared the indications and outcomes of LAVH and TLH for myomas larger than 7 cm. RESULTS: Patients who underwent LAVH or TLH had a lower average intraoperative blood loss, less intense postoperative pain, and shorter hospital stays than patients in the TAH group, although the length of the operations in the laparoscopic groups were significantly longer. To evaluate the selection criteria for the large sized myomas, we compared the LAVH and TLH groups for the myomas larger than 7 cm. The greatest uterine transverse diameters and the weight of the uteri were not significantly different between the LAVH and TLH groups (94.7 ± 20.8 and 83.1 ± 17.6 mm, 371.6 ± 160.3 and 286.7 ± 158.0 g, respectively). The average intraoperative blood loss in the TLH group was significantly lower than that in the LAVH (121.3 ± 111.2 vs 379.3 ± 222.4 g, P < 0.001). CONCLUSION: Our data suggest that TLH is a better procedure for treating a large uterus no larger than 10 cm in its greatest transverse diameter. The preoperative total length of myoma nodules determined by MRI is a useful preoperative indicator of the uterine weight.

Dienogest increases the progesterone receptor isoform B/A ratio in patients with ovarian endometriosis.

BACKGROUND: The resistance of endometriotic tissue to progesterone can be explained by alterations in the distribution of progesterone receptor (PR) and estrogen receptor (ER) isoforms. The aims of this study were to examine the expressions of PR-A, PR-B, ERα and ERß in endometrioma and assess whether these expressions are affected by dienogest or leuprolide acetate (LA) treatment. METHODS: We enrolled 60 females, including 43 patients with endometriosis (14 who received no medical treatment, 13 who received dienogest and 16 who received LA before undergoing laparoscopic surgery) and 17 patients with leiomyoma. The expression levels of PR and ER isoforms in eutopic and ectopic endometrium were assayed with quantitative real-time PCR, and confirmed with immunohistochemistry. RESULTS: A decreased PR-B/PR-A ratio and an increased ERß/ERα ratio were demonstrated in ectopic endometrium derived from females with endometriosis compared with the ratios observed in eutopic endometrium obtained from females without endometriosis. Although LA treatment did not affect the PR-B/PR-A and ERß/ERα ratios, dienogest treatment increased the PR-B/PR-A ratio and decreased the ERß/ERα ratio in patients with endometriomas. CONCLUSIONS: Dienogest may improve progesterone resistance in endometriotic tissue by increasing the relative expressions of PR-B and PR-A, and decreasing the relative expressions of ERß and ERα.

Mature cystic teratoma of the fallopian tube.

OBJECTIVE: To report a case of mature cystic teratoma of the fallopian tube. DESIGN: Case report. SETTING: Medical college-affiliated hospital. PATIENT(S): A 31-year-old woman, gravida 0, visited our outpatient clinic with infertility. Hysterosalpingography (HSG) showed a swollen right fallopian tube whose patency was not confirmed. INTERVENTION(S): Laparoscopic right salpingectomy was perfomed for a solid-appearing mass ∼2 × 1.5 cm in diameter in the ampullary region. Histopathologic examination showed components from each germ cell layer; therefore, the diagnosis of a mature cystic teratoma of the right fallopian tube was confirmed. The patient became pregnant with IVF-ET and gave birth to a baby boy. CONCLUSION(S): In cases where hydrosalpinx is suspected, a careful assessment by either HSG or laparoscopy is necessary at the time of infertility examination.