Can ovarian damage be reduced using hemostatic matrix during laparoscopic endometrioma surgery? A prospective, randomized study

Purpose To compare the effect of hemostatic matrix (HM) and electrosurgical bipolar coagulation (EBC) on ovarian reserve in patients undergoing endometrioma surgery.

Thirty patients with single ovarian endometrioma ≥4 cm were randomized to two groups. Ovarian reserve after laparoscopic excision of endometrioma was assessed by serum anti-Müllerian hormone (AMH); preoperatively and in postoperative months 1 and 3.

The preoperative AMH levels were similar between the groups. Intra-group comparisons: the AMH levels were significantly lower in the first and third postoperative months as compared to basal levels in both groups. In each group, AMH levels were significantly higher in the third postoperative month as compared to first postoperative month. Inter-group comparisons: AMH levels were significantly lower in the EBC as compared to the HM at 1st postoperative month (1.64 ± 0.93 vs. 2.72 ± 1.49 ng/mL). However, the AMH levels were increased and became similar at 3rd postoperative month.

Although acute ovarian damage was more in EBC group, ovarian reserve was compensated at 3rd month. Further studies with long-term follow-up will clarify the importance of these findings. Access this article We’re sorry, something doesn't seem to be working properly. Please try refreshing the page. If that doesn't work, please contact support so we can address the problem. Similar content being viewed by others

Kitajima M, Defrère S, Dolmans MM et al (2011) Endometriomas as a possible cause of reduced ovarian reserve in women with endometriosis. Fertil Steril 96:685–691 Mohamed ML, Nouh AA, El-Behery MM, Mansour SA (2011) Effect on ovarian reserve of laparoscopic bipolar electrocoagulation versus laparotomic hemostatic sutures during unilateral ovarian cystectomy. Int J Gynaecol Obstet 114:69–72 Raffi F, Metwally M, Amer S (2012) The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis. J Clin Endocrinol Metab 97(9):3146–3154 Celik HG, Dogan E, Okyay E, Ulukus C, Saatli B, Uysal S, Koyuncuoglu M (2012) Effect of laparoscopic excision of endometriomas on ovarian reserve: serial changes in the serum antimullerian hormone levels. Fertil Steril 97:1472–1478 Ebert AD, Hollauer A, Fuhr N, Langolf O, Papadopoulos T (2009) Laparoscopic ovarian cystectomy without bipolar coagulation or sutures using a gelantine-thrombin matrix sealant (FloSeal): first support of a promising technique. Arch Gynecol Obstet 280:161–165 Angioli R, Muzii L, Montera R et al (2009) Feasibility of the use of novel matrix hemostatic sealant (FloSeal) to achieve hemostasis during laparoscopic excision of endometrioma. J Minim Invasive Gynecol. 16(2):153–156 Ferrero S, Venturini PL, Gillott DJ et al (2012) Hemostasis by bipolar coagulation versus suture after surgical stripping of bilateral ovarian endometriomas: a randomized controlled trial. J Min Inv Gynecol 19:722–730 Biacchiardi CP, Piane LD, Camanni M et al (2011) Laparoscopic stripping of endometriomas negatively affects ovarian follicular reserve even if performed by experienced surgeons. Reprod Biomed Online 23:740–746 Hwu YM, Wu FSY, Li SH et al (2011) The impact of endometrioma and laparoscopic cystectomy on serum anti-Müllerian hormone levels. Reprod Biol Endocrinol 9:80 Ercan CM, Duru NK, Karasahin KE et al (2011) Ultrasonographic evaluation and anti-mullerian hormone levels after laparoscopic stripping of unilateral endometriomas. Eur J Obstet Gynecol Reprod Biol 158:280–284 Hirokawa W, Iwase A, Goto M et al (2011) The post-operative decline in serum anti-Mullerian hormone correlates with the bilaterality and severity of endometriosis. Hum Reprod 26–4:904–910 Lee DY, Kim NY, Kim MJ et al (2011) Effects of laparoscopic surgery on serum anti-mullerian hormone levels in reproductive-aged women with endometrioma. Gynecol Endocrinol 27(10):733–736 Iwase A, Hirokawa W, Goto M et al (2010) Serum anti-Mullerian hormone level is a useful marker for evaluating the impact of laparoscopic cystectomy on ovarian reserve. Fertil Steril 94:2846–2849 Ercan CM, Sakıncı M, Duru NK et al (2010) Antimullerian hormone levels after laparoscopic endometrioma stripping surgery. Gynecol Endocrinol 26(6):468–472 Tsolakidis D, Pados G, Vavilis D et al (2010) The impact on ovarian reserve after laparoscopic ovarian cystectomy versus three-stage management in patients with endometriomas: a prospective randomized study. Fertil Steril 94:71–77 Chang HJ, Han SH, Lee JR et al (2010) Impact of laparoscopic cystectomy on ovarian reserve: serial changes of serum anti-Mullerian hormone levels. Fertil Steril 94:343–349 Somigliana E, Berlanda N, Benaglia L et al (2012) Surgical excision of endometriomas and ovarian reserve: a systematic review on serum anti mullerian hormone level modifications. Fertil Steril 98:1531–1538 Almog B, Shehata F, Suissa S et al (2011) Age-related normograms of serum antimüllerian hormone levels in a population of infertile women: a multicenter study. Fertil Steril 95:2359–2363 Nardo LG, Gelbaya TA, Wilkinson H et al (2009) Circulating basal anti-Mullerian hormone levels as predictor of ovarian response in women undergoing ovarian stimulation for in vitro fertilization. Fertil Steril 92:1586–1593 Themmen AP (2005) Anti-Mullerian hormone: its role in follicular growth initiation and survival and as an ovarian reserve marker. J Natl Cancer Inst Monogr 34:18–21 Durlinger ALL, Kramer P, Karels B et al (1999) Control of primordial follicle recruitment by anti- Mullerian hormone in the mouse ovary. Endocrinology 140:5789–5796 Durlinger AL, Gruijters MJ, Kramer P et al (2002) Anti-Müllerian hormone inhibits initiation of primordial follicle growth in the mouse ovary. Endocrinology 143:1076–1084 Carlsson IB, Scott JE, Visser JA, Ritvos O, Themmen AP, Hovatta O (2006) Anti-Müllerian hormone inhibits initiation of growth of human primordial ovarian follicles in vitro. Hum Reprod 21:2223–2227 Parrott JA, Skinner MK (1999) Kit-ligand/stem cell factor induces primordial follicle development and initiates folliculogenesis. Endocrinology 140:4262–4271 Vitt UA, McGee EA, Hayashi M, Hsueh AJW (2000) In vivo treatment with GDF9 stimulates primordial and primary follicle progression and theca cell marker CYP17 in ovaries of immature rats. Endocrinology 141:3814–3820 Nilsson E, Parrott JA, Skinner MK (2001) Basic fibroblast growth factor induces primordial follicle development and initiates folliculogenesis. Mol Cell Endocrinol 25:123–130 Dissen GA, Romero C, Hirshfield AN, Ojeda SR (2001) Nerve growth factor is required for early follicular development in the mammalian ovary. Endocrinology 142:2078–2086 Sonmezer M, Gungor M, Ensari A, Ortac F (2004) Prognostic significance of tumor angiogenesis in epithelial ovarian cancer: in association with transforming growth factor beta and vascular endothelial growth factor. Int J Gynecol Cancer 14:82–88 Barboni B, Turriani M, Galeati G et al (2000) Vascular endothelial growth factor production in growing pig antral follicles. Biol Reprod 63:858–864 Bianco F, Basini G, Grasselli F (2005) Angiogenic activity of swine granulosa cells: effects of hypoxia and vascular endothelial growth factor Trap R1R2, a VEGF blocker. Domest Anim Endocrinol 28:308–319 Yoshino O, Osuga Y, Koga K et al (2003) Upregulation of interleukin-8 by hypoxia in human ovaries. Am J Reprod Immunol 50:286–290 Koga K, Osuga Y, Tsutsumi O et al (2000) Evidence for the presence of angiogenin in human follicular fluid and the up-regulation of its production by human chorionic gonadotropin and hypoxia. J Clin Endocrinol Metab 85:3352–3355 Bedaiwy M, El-Nashar S, El-Saman A et al (2008) Reproductive outcome after transplantation of ovarian tissue: a systematic review. Hum Reprod 23:2709–2717 Bianco F, Basini G, Grasselli F (2005) Angiogenic activity of swine granulosa cells: effects of hypoxia and vascular endothelial growth factor Trap R1R2, a VEGF blocker. Domest Anim Endocrinol 28:308–319 Yoshino O, Osuga Y, Koga K et al (2003) Upregulation of interleukin-8 by hypoxia in human ovaries. Am J Reprod Immunol 50:286–290 Koga K, Osuga Y, Tsutsumi O et al (2000) Evidence for the presence of angiogenin in human follicular fluid and the up-regulation of its production by human chorionic gonadotropin and hypoxia. J Clin Endocrinol Metab 85:3352–3355 Conflict of interest None of the authors have a conflict of interest. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Sönmezer, M., Taşkın, S., Gemici, A. et al. Can ovarian damage be reduced using hemostatic matrix during laparoscopic endometrioma surgery? A prospective, randomized study. Arch Gynecol Obstet 287, 1251–1257 (2013). https://doi.org/10.1007/s00404-012-2704-9 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00404-012-2704-9