A randomized controlled trial of ovarian reserve preservation and hemostasis during ovarian cystectomy

Soo Jin Park, Aeran Seol, Nara Lee, Seungmee Lee, Hee Seung Kim, PRAHA Study Group, Eunji Lee, Ga Won Yim, Haerin Paik, Hyunji Lim, Jae‐Weon Kim, Jaehee Mun, Junhwan Kim
Scientific reports · 2021 · vol. 11(1) , pp. 8495 · doi:10.1038/s41598-021-87965-7 · PMID:33875738 · W3153685877
article OA: gold CC0 ⤵ 7 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This randomized trial found hemostatic agents were non-inferior to bipolar coagulation for preserving ovarian reserve and hemostasis during laparoendoscopic single-site ovarian cystectomy, especially in endometriosis patients.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This single-blinded, single-center randomized controlled trial compared oxidized cellulose polymer (as a hemostatic agent) versus bipolar coagulation during laparoendoscopic single-site ovarian cystectomy in women with unilateral ovarian cysts, assessing hemostasis and ovarian reserve via hemoglobin, serum anti-Müllerian hormone (AMH), and ovarian volume measured before surgery and at 2 days, 1 week, and 3 months postoperatively. Across all participants, hemostasis timing and success, operative outcomes, and time-dependent changes in Hb, AMH, and ovarian volume did not differ between groups, but the AMH decline ratio at 3 months was greater in the coagulation group than in the hemostatic agent group (median ITT −36.7% vs −13.3%; P < 0.05). The AMH decline ratio difference was observed only in endometriosis patients, with no difference in non-endometriosis patients, and ovarian cyst recurrence was not reported during the 3-month follow-up. The paper explicitly reports limitations including relatively small sample size and a restricted follow-up duration of 3 months. This paper is centrally about endometriosis — it reports a subgroup-specific AMH preservation benefit of oxidized cellulose polymer over bipolar coagulation specifically among patients with endometriosis undergoing ovarian cystectomy.

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Abstract

The preservation of ovarian reserve during laparoendoscopic single-site (LESS) ovarian cystectomy is crucial for reproductive-age women. This study was a single-blinded, single-center, and randomized controlled trial to evaluate the effect of hemostatic agents on the preservation of ovarian reserve and hemostasis during LESS ovarian cystectomy. Patients with unilateral ovarian cyst were randomized to the hemostatic agent and coagulation groups according to the hemostasis method. Afterwards, the patients underwent LESS ovarian cystectomy, and hemostasis was performed after ovarian cyst excision according to the assigned hemostasis method. If hemostasis was not completed within 10 min. After discharge, the patients were followed until 3 months after surgery. We compared the hemoglobin, anti-Müllerian hormone (AMH) levels, and ovarian volumes before surgery, and 2 days, 1 week, and 3 months after surgery (3 M-POST), and the decline ratio between the two groups. The decline ratio of serum AMH levels was greater at 3 M-POST in the coagulation than in the hemostatic agent group (median intention-to-treat [ITT], - 36.7 vs. - 13.3%; per-protocol [PP], - 36.8 vs. - 13.3%; P < 0.05). Notably, the difference of the decline ratio of serum AMH levels was only shown in endometriosis patients (median; ITT, - 50.7 vs. - 14.4%; PP, - 50.7% vs. - 14.4%; P < 0.05), while there was no difference in non-endometriosis patients. In conclusion, Hemostatic agents may be non-inferior to bipolar coagulation for preserving ovarian reserve and hemostasis during LESS ovarian cystectomy, in particular, for endometriosis patients. (Trial registry: ClinicalTrials.gov Identifier NCT03374397).

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Condition tags

mesh:D004715endometriosis

MeSH descriptors

Blood Coagulation Endometriosis Hemostatics Ovarian Cysts Ovarian Reserve Ovariectomy Adolescent Adult Blood Coagulation Endometriosis Endometriosis Female Hemostatics Humans Middle Aged Ovarian Cysts Ovarian Cysts Ovariectomy Single-Blind Method Young Adult

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