Innovative Ovarian Suspension With Micro‑Dose Glubran 2 Cyanoacrylate Glue During Laparoscopic Endometriosis Surgery: A First‑in‑Human Series

Background: Deep infiltrating endometriosis (DIE) often involves the pelvic sidewall, where the ovary obstructs retroperitoneal access. Conventional ovarian suspension using sutures or clips may cause cortical trauma, prolong operating time, and promote adhesions. Glubran 2 (n-butyl-2-cyanoacrylate) is a surgical adhesive with rapid polymerization and biodegradation. Authors describe the first-in-human application of micro-dose Glubran 2 for atraumatic, reversible ovarian suspension. Methods: In this prospective pilot (March-July 2025), five women (median age 31 years) with ASRM stage IV DIE underwent laparoscopic excision. Each ovary was suspended with three 0.0125 mL droplets (total 0.0375 mL) of Glubran 2 applied to the antimesenteric cortex and secured to the pelvic sidewall. Application time was ~ 15s per ovary. After sidewall dissection, blunt sweeping released the ovary. Primary outcomes were technical feasibility and incremental time. Secondary outcomes were ovarian reserve measured by serum anti-Müllerian hormone (AMH, pmol/L) at baseline and 6 weeks. Results: All ovaries were successfully suspended and atraumatically released. No cortical injury or bleeding occurred. Suspension required 15 s per ovary, adding minimal time. Median operative time was 118 min (95-145). Baseline median AMH was 22 pmol/L (18-25) and 21 pmol/L (18-24) at 6 weeks, showing no significant decline (p=0.89). Conclusion: Micro-dose Glubran 2 enables rapid, safe, and reversible ovarian suspension, improving pelvic sidewall access without compromising ovarian reserve. This report represents the first global clinical application of Glubran 2 for ovarian suspension in endometriosis surgery.