Effect of complex use of argon plasma surgery and fibrin cryoprecipitate on the functional state of ovaries in patients with endometrioid cysts

Gynecology, Obstetrics and Perinatology - Gynecology, Obstetrics and Perinatology - 2016 volume 15 issue 6 Effect of complex use of argon plasma surgery and fibrin cryoprecipitate on the functional state of ovaries in patients with endometrioid cysts Authors / Institutions Alexander N. Strizhakov / Aleksandr I. Davydov / Irina V. Ignatko / Anastasiya A. Churganova / A.B.Li / The objective. To optimize the technique of surgical treatment of patients of reproductive age with endometrioid ovarian cysts aimed at preservation of ovarian reserve. Patients and methods. The examination included 94 patients with ovarian endometriomas aged 20 to 33 years. Depending on a method of surgical haemostatis 4 groups were singled out: in group 1 (n = 22) cystectomy with suture ligatures was performed; in 2 (n = 21) – cystectomy with monopolar electrosurgery, in 3 (n = 24) – cyst capsule destruction by bipolar electrosurgery; in 4 (n = 27) – cyst capsule destruction by plasma surgery and application of fibrin cryoprecipitate. In all observations, diagnosis was verified by histological examination. The functional state of the ovaries after surgery was assessed by 2D- and 3D-transvaginal ultrasound scanning (ovarian volume, number of antral follicles), power Doppler; detection of FSH, anti-Muellerian hormone (AMH), and inhibin B levels. Results. As analysis of the obtained results has shown, the «classical»-type clinical symptoms of disease fully disappeared within three months. The menstrual cycle restored in all women within 56–65 days from the last intake of hormones. No case of renewed dysmenorrhoea was noted. Three months after surgery all parameters of ovarian reserve were significantly higher in patients of groups 3 and 4. Average AMH values in the group of patients who received bipolar destruction of endometriod cyst capsule or by plasma energy were higher than the minimal reference value (1.9 ± 0.1 and 2.0 ± 0.2 ng/ml). Whereas in patients after cystectomy average AMH values did not exceed 1. After 5–8 months, pregnancy occurred in 10 (41.6%) women in group 3, in 4 – in 17 (62.9%), in 1 – in 4 (18%), and these were women, in whom additional haemostasis was not used during surgery. In group 2 of the examined women, no pregnancies were observed. In 25 patients, repeat surgery was performed due to relapse of endometrioid ovarian cysts. The size of newly developed endometrioid cysts did not exceed 20 mm in diameter. Conclusion. In patients with endometrioid ovarian cysts it is not necessary to seek full separation of tumour capsule. The most favourable results with respect to preservation of follicle reserve are noted in using high frequency current generation argon plasma in combination with FC applications. Key words: high surgical energies, ovarian reserve, fibrin cryoprecipitate, ovarian endometriosis. For citation: Strizhakov A.N., Davydov A.I., Ignatko I.V., Churganova A.A., Li A.B. Effect of complex use of argon plasma surgery and fibrin cryoprecipitate on the functional state of ovaries in patients with endometrioid cysts. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2016; 15(6): 5–11. (In Russian). DOI: 10.20953/1726-1678-2016-6-5-11 Patients and methods. The examination included 94 patients with ovarian endometriomas aged 20 to 33 years. Depending on a method of surgical haemostatis 4 groups were singled out: in group 1 (n = 22) cystectomy with suture ligatures was performed; in 2 (n = 21) – cystectomy with monopolar electrosurgery, in 3 (n = 24) – cyst capsule destruction by bipolar electrosurgery; in 4 (n = 27) – cyst capsule destruction by plasma surgery and application of fibrin cryoprecipitate. In all observations, diagnosis was verified by histological examination. The functional state of the ovaries after surgery was assessed by 2D- and 3D-transvaginal ultrasound scanning (ovarian volume, number of antral follicles), power Doppler; detection of FSH, anti-Muellerian hormone (AMH), and inhibin B levels. Results. As analysis of the obtained results has shown, the «classical»-type clinical symptoms of disease fully disappeared within three months. The menstrual cycle restored in all women within 56–65 days from the last intake of hormones. No case of renewed dysmenorrhoea was noted. Three months after surgery all parameters of ovarian reserve were significantly higher in patients of groups 3 and 4. Average AMH values in the group of patients who received bipolar destruction of endometriod cyst capsule or by plasma energy were higher than the minimal reference value (1.9 ± 0.1 and 2.0 ± 0.2 ng/ml). Whereas in patients after cystectomy average AMH values did not exceed 1. After 5–8 months, pregnancy occurred in 10 (41.6%) women in group 3, in 4 – in 17 (62.9%), in 1 – in 4 (18%), and these were women, in whom additional haemostasis was not used during surgery. In group 2 of the examined women, no pregnancies were observed. In 25 patients, repeat surgery was performed due to relapse of endometrioid ovarian cysts. The size of newly developed endometrioid cysts did not exceed 20 mm in diameter. Conclusion. In patients with endometrioid ovarian cysts it is not necessary to seek full separation of tumour capsule. The most favourable results with respect to preservation of follicle reserve are noted in using high frequency current generation argon plasma in combination with FC applications. Key words: high surgical energies, ovarian reserve, fibrin cryoprecipitate, ovarian endometriosis. For citation: Strizhakov A.N., Davydov A.I., Ignatko I.V., Churganova A.A., Li A.B. Effect of complex use of argon plasma surgery and fibrin cryoprecipitate on the functional state of ovaries in patients with endometrioid cysts. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2016; 15(6): 5–11. (In Russian). DOI: 10.20953/1726-1678-2016-6-5-11