Epinephrine minimizes the use of bipolar coagulation and preserves ovarian reserve in laparoscopic ovarian cystectomy: a randomized controlled trial

Eun Young Park, Kyu-Hee Hwang, Ji‐Hee Kim, San Hui Lee, Kyu‐Sang Park, Seong Jin Choi, Seung‐Kuy Cha
In: Scientific Reports · 2020 · vol. 10(1) , pp. 20911 · doi:10.1038/s41598-020-77781-w · PMID:33262411 · W3107210964
article OA: gold CC0 ⤵ 1 in-corpus citation
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

Epinephrine compression (Epi-pledget) during laparoscopic ovarian cystectomy significantly reduced the need for bipolar coagulation and better preserved ovarian reserve and function compared to coagulation alone.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

This randomized controlled trial studied whether epinephrine-soaked pledget compression (Epi-pledget) during laparoscopic ovarian cystectomy with stripping better preserves ovarian function than bipolar coagulation, including a third arm combining Epi-pledget and subsequent coagulation. Across 179 participants, serum anti-Müllerian hormone (AMH) and antral follicle count (AFC) were measured after surgery, and a mouse incision-injury model assessed tissue damage and fibrosis using histopathology. AMH and AFC declined more in the bipolar coagulation group than in the Epi-pledget group, and AMH decline was especially greater with endometrioma when comparing coagulation vs Epi-pledget; Epi-pledget also showed ameliorated fibrotic and necrotic findings in mice versus bipolar coagulation. A key limitation stated in the paper is that outcomes for cyst subtypes showed insignificant differences in some analyses, and efficacy was compared within the specific hemostasis approaches tested. This paper is centrally about endometriosis — it reports a subgroup finding that AMH decline was greater with bipolar coagulation than with Epi-pledget specifically in patients with endometriotic ovarian cysts.

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Abstract

We propose a novel method, the epinephrine compression method (Epi-pledget), as a hemostasis method for ovarian cystectomy. A total of 179 patients undergoing laparoscopic ovarian cystectomy with stripping were randomly allocated into three groups: the bipolar coagulation group, the Epi-pledget group, and the coagulation after Epi-pledget (Epi & Coagulation) group. Serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) by ultrasonography were measured to determine the preservation of ovarian function. To evaluate the postoperative ovarian cellular proliferative activity and tissue damage in a mouse model, we operated on the ovaries of mice with an artificial incision injury and applied two hemostatic methods: coagulation and Epi-pledget. Eight weeks after surgery, the AMH rate significantly decreased in the bipolar coagulation group compared with the Epi-pledget group. The AFC decline rate was also significantly greater in the coagulation group than the Epi-pledget group. Specifically, patients with endometrioma had a significantly greater decline of serum AMH in the coagulation group than the Epi-pledget group. In a histopathological analysis in mice, the Epi-pledget group showed ameliorated fibrotic changes and necrotic findings in the injured lesion compared with the bipolar coagulation group. The Epi-pledget method for ovarian stripping has an additional benefit of maximizing the preservation of the ovarian reserve, especially for the endometriotic ovarian cyst type.

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endometrioma

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