Which Should Be the Preferred Technique During Laparoscopic Ovarian Cystectomy: Hemostatic Sutures or Bipolar Electrocoagulation? A Randomized Controlled Prospective Study of Long-Term Ovarian Reserve

Abstract

The aim of the present study was to determine the long-term effects of different laparoscopic hemostatic techniques on ovarian reserve after ovarian cystectomy. Ninety patients with unilateral ovarian cysts were recruited and randomly distributed into 2 groups. Laparoscopic stripping cystectomy was performed in all patients. Afterward cystectomy hemostasis was achieved via hemostatic suture or bipolar electrocoagulation. Serum levels of anti-Mullerian hormone (AMH) were determined preoperatively and postoperatively at 1 3 and 12 months and patients were evaluated for residual ovarian volume antral follicle count and pregnancy. The statistical difference was determined between the 2 groups in terms of AMH levels at 3 months (hemostatic suture group = 3.17 +/- 3.40 vs bipolar electrocoagulation group = 2.38 +/- 2.57 P = .006) and 12 months (hemostatic suture group = 3.71 +/- 3.09 vs bipolar electrocoagulation group = 2.78 +/- 2.85 P = .005). In addition in the hemostatic suture group there was no statistically significant difference between preoperative and postoperative AMH levels (P = .165) and between the postoperative antral follicle count (P = .779) and the residual ovarian volume (P = .248) whereas in the bipolar electrocoagulation group postoperative AMH levels were lower than preoperative levels (P = .028) and postoperative residual ovarian volumes at 3 and 12 months were lower than those at 1 month (P = .001). Nonetheless pregnancy rates were not significantly different (P = .546). Bipolar electrocoagulation is more destructive compared with hemostatic suture. However the ovarian reserve does not decrease further during the follow-up period.