Impact of Hemostasis Methods, Electrocoagulation versus Suture, in Laparoscopic Endometriotic Cystectomy on the Ovarian Reserve: A Randomized Controlled Trial
Chamnan Tanprasertkul MD*, Sophapun Ekarattanawong PhD**, Opas Sreshthaputra MD***, Teraporn Vutyavanich MD***
Affiliation : * Department of Obstetrics and Gynecology, Center of Excellence of Applied Epidemiology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand ** Division of Physiology, Department of Preclinical Sciences, Faculty of Medicine, Thammasat University, Pathumthani, Thailand *** Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Objective : To evaluate the impact on ovarian reserve between two different methods of hemostasis after laparoscopic ovarian
endometrioma excision.
Material and Method: A randomized controlled study was conducted from January to December 2013 in Thammasat
University Hospital, Thailand. Reproductive women, age 18-45 years who underwent laparoscopic ovarian cystectomy were
randomized in electrocoagulation and suture groups. Clinical baseline data and ovarian reserve outcome (anti-Mullerian
hormone (AMH)) were evaluated.
Results : Fifty participants were recruited and randomized in two groups. Electrocoagulation and suture groups consisted of
25 participants. Baseline characteristics between 2 groups (age, weight, BMI, height, cyst diameter, duration and estimated
blood loss) were not statistically different. There were no significant difference of AMH between electrocoagulation and suture
group at pre-operative (2.90+2.26 vs. 2.52+2.37 ng/ml), 1 week (1.78+1.51 vs. 1.99+1.71 ng/ml), 1 month (1.76+1.50 vs.
2.09+1.62 ng/ml), 3 months (2.09+1.66 vs. 1.96+1.68 ng/ml) and 6 months (2.11+1.84 vs 1.72+1.68 ng/ml), respectively.
However, mean AMH of both groups significantly decreased since the first week of operation. Effect of laparoscopic ovarian
surgery had significantly declined and sustained AMH level until 6 months.
Conclusion : Laparoscopic cystectomy of ovarian endometrioma has negative impact to ovarian reserve. Either electroco-
agulation or suture method had no different effects.
Keywords : Laparoscopic ovarian cystectomy, Anti-Mullerian hormone, Endometrioma
