Oxidized Cellulose Polymer Outperforms Traditional Hemostasis in Preserving Ovarian Reserve During LESS Cystectomy: A Prospective Comparative Study

Oxidized Cellulose Polymer Outperforms Traditional Hemostasis in Preserving Ovarian Reserve During LESS Cystectomy: A Prospective Comparative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Oxidized Cellulose Polymer Outperforms Traditional Hemostasis in Preserving Ovarian Reserve During LESS Cystectomy: A Prospective Comparative Study Ning Xu, Meng-Xi Li, Min Li, Yuan-Qin Gou, Zhi-Gui Luo, Yuan-Hong Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7555056/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Feb, 2026 Read the published version in Archives of Gynecology and Obstetrics → Version 1 posted 7 You are reading this latest preprint version Abstract Objective: Preserving ovarian reserve function during single-port laparoscopic ovarian cystectomy is crucial for women of reproductive age. This study aimed to evaluate the hemostatic efficacy and impact on ovarian reserve of three different hemostatic methods in LESS (laparoendoscopic single-site) ovarian cystectomy. Methods: Patients with unilateral ovarian cysts were divided into three groups based on hemostatic methods: the oxidized cellulose polymer group, the suture group, and the bipolar coagulation group. All participants underwent standardized LESS ovarian cystectomy. Intraoperative hemostatic effects within 10 minutes, intraoperative blood loss, and postoperative hemoglobin reduction were observed. Blood samples were collected before surgery, 1 month and 6 months after surgery to measure anti-Müllerian hormone (AMH) levels via radioimmunoassay. Vaginal ultrasound was performed preoperatively and 6 months postoperatively to obtain ovarian stromal peak systolic velocity (PSV) and antral follicle count (AFC). Results: All three hemostatic methods demonstrated equivalent hemostatic efficacy (P>0.05). However, significant differences emerged in ovarian reserve outcomes, at 6-month evaluation, oxidised cellulose polymer demonstrated superior preservation: AMH decline was 5.9% (Δ–0.22 ng/mL) with a 15.4% advantage over bipolar coagulation (mean difference Δ–0.80 ng/mL; P<0.001). Although there was no statistically significant difference in the decline of anti-Müllerian hormone (AMH) levels between the oxidized cellulose polymer group and the suture group (P = 0.749), the suture group still exhibited a greater reduction compared to the oxidized cellulose polymer group (Δ–0.27 ng/mL). However, in the endometriosis subgroup, the suture group demonstrated a significantly greater decline in AMH levels compared to the oxidized cellulose polymer group (P=0.006). Oxidized cellulose polymer again demonstrated superior preservation over suturing in AFC (mean decline ratio 0.11, 95% CI 0.10-0.14) and PSV (mean decline ratio 0.051, 95% CI 0.043 - 0.062), particularly in endometriosis patients where these differences were statistically significant (P<0.05). Conclusion: In LESS ovarian cystectomy, while bipolar coagulation, suturing, and oxidized cellulose polymer show equivalent hemostatic efficacy, the oxidized cellulose polymer demonstrates superior preservation of ovarian reserve function (AMH, AFC, and PSV parameters) with significantly less surgical trauma and greater technical simplicity. These findings strongly support the preferential use of oxidized cellulose polymer, particularly for fertility-preserving procedures in reproductive-age women, with added benefits for endometriosis patients who show heightened vulnerability to ovarian reserve compromise. (Clinical Trial Registration: ChiCTR2500102270) Haemostasis haemostatic sealant oxidized cellulose polymer bipolar coagulation suture laparoendoscopic single-site (LESS) ovarian cystectomy ovarian reserve Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 14 Feb, 2026 Read the published version in Archives of Gynecology and Obstetrics → Version 1 posted Editorial decision: Accepted 28 Jan, 2026 Reviews received at journal 28 Dec, 2025 Reviewers agreed at journal 09 Dec, 2025 Reviewers invited by journal 28 Sep, 2025 Editor assigned by journal 08 Sep, 2025 Submission checks completed at journal 08 Sep, 2025 First submitted to journal 07 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7555056","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":526747781,"identity":"093d3b1a-981b-41ef-ade7-7bdb7af36265","order_by":0,"name":"Ning Xu","email":"","orcid":"","institution":"Chengdu First People’ s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ning","middleName":"","lastName":"Xu","suffix":""},{"id":526747782,"identity":"d679dfc1-2110-4dda-a7ef-7916f6967c13","order_by":1,"name":"Meng-Xi Li","email":"","orcid":"","institution":"Chengdu First People’ s 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Study","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-gynecology-and-obstetrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arch","sideBox":"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/arch/default.aspx","title":"Archives of Gynecology and Obstetrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Haemostasis, haemostatic sealant, oxidized cellulose polymer, bipolar coagulation, suture, laparoendoscopic single-site (LESS) ovarian cystectomy, ovarian reserve","lastPublishedDoi":"10.21203/rs.3.rs-7555056/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7555056/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e Preserving ovarian reserve function during single-port laparoscopic ovarian cystectomy is crucial for women of reproductive age. This study aimed to evaluate the hemostatic efficacy and impact on ovarian reserve of three different hemostatic methods in LESS (laparoendoscopic single-site) ovarian cystectomy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Patients with unilateral ovarian cysts were divided into three groups based on hemostatic methods: the oxidized cellulose polymer group, the suture group, and the bipolar\u0026nbsp;coagulation group. All participants underwent standardized LESS ovarian cystectomy. Intraoperative hemostatic effects within 10 minutes, intraoperative blood loss, and postoperative hemoglobin reduction were observed. Blood samples were collected before surgery, 1 month and 6 months after surgery to measure anti-Müllerian hormone (AMH) levels via radioimmunoassay. Vaginal ultrasound was performed preoperatively and 6 months postoperatively to obtain ovarian stromal peak systolic velocity (PSV) and antral follicle count (AFC).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u0026nbsp;\u003c/strong\u003eAll three hemostatic methods demonstrated equivalent hemostatic efficacy (P\u0026gt;0.05). However, significant differences emerged in ovarian reserve outcomes, at\u0026nbsp;6-month evaluation, oxidised cellulose polymer demonstrated superior preservation: AMH decline was 5.9% (Δ–0.22 ng/mL) with a 15.4% advantage over bipolar coagulation (mean difference Δ–0.80 ng/mL; P\u0026lt;0.001). Although there was no statistically significant difference in the decline of anti-Müllerian hormone (AMH) levels between the oxidized cellulose polymer group and the suture group (P\u0026nbsp;= 0.749), the suture group still exhibited a greater reduction compared to the oxidized cellulose polymer group\u0026nbsp;(Δ–0.27 ng/mL). However, in the endometriosis subgroup,\u0026nbsp;the suture group demonstrated a significantly greater decline in AMH levels compared to the oxidized cellulose polymer group (P=0.006). Oxidized cellulose polymer again demonstrated superior preservation over suturing in AFC (mean decline ratio 0.11, 95% CI 0.10-0.14) and PSV (mean decline ratio 0.051, 95% CI 0.043 - 0.062), particularly in endometriosis patients where these differences were statistically significant (P\u0026lt;0.05).\u003cbr\u003e\n\u003cstrong\u003eConclusion: \u003c/strong\u003eIn LESS ovarian cystectomy, while bipolar coagulation, suturing, and oxidized cellulose polymer show equivalent hemostatic efficacy, the oxidized cellulose polymer\u0026nbsp;demonstrates superior preservation of ovarian reserve function (AMH, AFC, and PSV parameters) with significantly less surgical trauma and greater technical simplicity. These findings strongly support the preferential use of oxidized cellulose polymer, particularly for fertility-preserving procedures in reproductive-age women, with added benefits for endometriosis patients who show heightened vulnerability to ovarian reserve compromise. 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