A new approach to avoid ovarian failure as well function-impairing adhesion formation in endometrioma infertility surgery

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Combining endometrioma stripping with a plant-based hemostatic and antiadhesion product may prevent ovarian failure and reduce adhesion formation following surgery.

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This short paper proposes a surgical approach for deep ovarian endometriosis (endometrioma) infertility surgery aimed at reducing both intraoperative ovarian tissue damage and periovarian adhesion formation. Using the gold-standard minimal-access endometrioma stripping technique, the authors report that they avoided the need for intraoperative periovarian coagulation after excision by applying a purely plant-based polysaccharide medical product with hemostatic and antiadhesion barrier properties. The paper concludes that endometrioma stripping plus the polysaccharide agent could preserve tubo-ovarian function and avoid ovarian failure while lowering adhesion formation, while explicitly encouraging other groups to investigate middle- and long-term effects. This paper is centrally about endometriosis — it focuses on a new combined technique to reduce ovarian reserve loss and adhesion formation during endometrioma infertility surgery.

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Abstract

PurposeDeep ovarian endometriosis surgery is likely to be associated with diffuse bleeding, intraoperative ovarian tissue destruction and perioperative adhesion formation. A new surgical approach is hereby proposed to avoid the negative short-term impact of classic laparoscopic cystectomy on ovarian reserve.ResultsThe need for intraoperative periovarian coagulation after endometrioma excision was avoided by combining the gold standard minimal-access endometrioma stripping technique with a purely plant-based medical product with high-hemostatic and antiadhesion barrier properties.ConclusionEndometrioma stripping followed by the application of a polysaccharide agent could avoid ovarian failure and at same time could reduce adhesion formation, thereby preserving tubo-ovarian function in endometrioma surgery. We encourage other surgically working groups to investigate middle- and long-term effects of this combined technique.
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Abstract

Purpose Deep ovarian endometriosis surgery is likely to be associated with diffuse bleeding, intraoperative ovarian tissue destruction and perioperative adhesion formation. A new surgical approach is hereby proposed to avoid the negative short-term impact of classic laparoscopic cystectomy on ovarian reserve.

Results

The need for intraoperative periovarian coagulation after endometrioma excision was avoided by combining the gold standard minimal-access endometrioma stripping technique with a purely plant-based medical product with high-hemostatic and antiadhesion barrier properties.

Conclusion

Endometrioma stripping followed by the application of a polysaccharide agent could avoid ovarian failure and at same time could reduce adhesion formation, thereby preserving tubo-ovarian function in endometrioma surgery. We encourage other surgically working groups to investigate middle- and long-term effects of this combined technique.

References

Asgari Z, Rouholamin S, Hosseini R, Sepidarkish M, Hafizi L, Javaheri A (2016) Comparing ovarian reserve after laparoscopic excision of endometriotic cyst and hemostasis achieved either by bipolar coagulation or suturing: a randomized clinical trial. Arch Gynecol Obstet 293:1015–1022. https://doi.org/10.1007/s00404-015-3918-4 Hirschelmann A, Tchartchian G, Wallwiener M, Hackethal A, Wilde De RL (2012) A review of the problematic adhesion prophylaxis in gynaecological surgery. Arch Gynecol Obstet 285:1089–1097. https://doi.org/10.1007/s00404-011-2097-1 Korell M, Ziegler N, Wilde De RL (2016) Use of modified polysaccharide 4DryField (®) PH for adhesion prevention and hemostasis in gynecological surgery: a two-center observational study by second-look laparoscopy. Biomed Res Int 1–9 https://doi.org/10.1155/2016/3029264 Hart RJ, Hickey M, Maouris P, Buckett W (2008) Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev 2:CD004992. https://doi.org/10.1002/14651858.CD004992 Funding The funding was provided by PlanTec Medical GmBH (Germany) (Grant No. 2018). Author information Authors and Affiliations Contributions All authors contributed to the paper conception and design. The first draft of the manuscript was written by LATR and RD and all authors commented on and reviewed the following versions of the manuscript. All authors read and approved the final manuscript. Corresponding author Ethics declarations Conflict of interest Dr. De Wilde reports personal fees from PlanTec Medical GmbH, Bad Bevesen, Germany, outside the submitted work. The authors have received a reimbursement travel by PlanTec Medical GmBH, Bad Bevensen, Germany, to present these data during an international congress. However, the financial support for this work did not influence its outcome. Ethical approval Procedures performed involving human participants were in accordance with the ethical standards of the institution. Informed consent Informed consent was obtained from individual participants prior to surgery. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions About this article Cite this article Torres-de la Roche, L.A., Devassy, R., de Wilde, M.S. et al. A new approach to avoid ovarian failure as well function-impairing adhesion formation in endometrioma infertility surgery. Arch Gynecol Obstet 301, 1113–1115 (2020). https://doi.org/10.1007/s00404-020-05483-9 Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-020-05483-9

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Condition tags

endometriosisendometriomainfertility

MeSH descriptors

Endometriosis Infertility Ovarian Diseases Ovarian Reserve Tissue Adhesions Endometriosis Female Humans Infertility Ovarian Diseases Ovarian Reserve Tissue Adhesions

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