The potential damage of laparoscopic electrocoagulation on ovarian reserve in endometriomas reduced in benign ovarian cysts: A systematic review and meta-analysis

Tsung‐Hsien Lee, Yu‐Hsuan Lin, L HSIA, Yun-Yao Huang, Hao‐Jung Chang
In: Authorea Inc. · 2024 · doi:10.22541/au.171395665.57550624/v1 · W4395074082
review OA: gold CC0
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Nonthermal hemostatic methods preserve ovarian reserve better than bipolar electrocoagulation for endometriomas but not benign ovarian cysts during laparoscopic surgery.

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Abstract

Background Laparoscopic cystectomy for ovarian endometriomas and benign ovarian cysts often involves the use of hemostatic methods, with electrocoagulation using bipolar energy as a common approach. This study aimed to assess the impact of electrocoagulation compared to nonthermal hemostatic methods on ovarian reserve during such surgeries. Objectives To evaluate the influence of electrocoagulation using bipolar energy versus nonthermal hemostatic methods on ovarian reserve in patients undergoing laparoscopic cystectomy for endometriomas and benign ovarian cysts. Search Strategy A systematic review with meta-analysis was conducted by searching the Cochrane Library, PubMed, EMBASE, and Web of Science databases. Entry terms associated with MeSH terms, such as “ovarian cysts,” “laparoscopy,” “electrocoagulation,” and “anti-Müllerian hormone” or “antral follicle count” were used for articles published before October 2022. Selection Criteria Randomized controlled trials (RCTs) comparing the impact of nonthermal hemostatic methods with electrocoagulation on ovarian reserve during laparoscopic cystectomy were included. The Cochrane Risk of Bias Tool for Randomized Controlled Trials (ROB 2.0) was utilized to assess the quality of included studies. Data Collection and Analysis Thirteen RCTs involving 1043 patients were included in the meta-analysis. Postoperative serum anti-Müllerian hormone (AMH) levels and antral follicle counts (AFC) were analyzed using Review Manager ver. 5.4. Main Results In patients with endometriomas, the nonthermal hemostatic group exhibited significantly higher postoperative AMH levels at one, three, six, and 12 months compared to the bipolar group. Conversely, no significant differences in AMH levels were observed in patients with benign ovarian cysts. Similarly, the AFC levels showed no significant differences, except for a lower postoperative AFC in the electrocoagulation group for endometrioma cases. Conclusions Nonthermal hemostatic methods are associated with better preservation of ovarian reserve compared to bipolar electrocoagulation in laparoscopic cystectomy for ovarian endometriomas. However, no significant impact on ovarian reserve was observed with bipolar electrocoagulation in patients with benign ovarian cysts.

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Condition tags

endometrioma

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References (35)

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