Ovarian reserve and recurrence 1 year post-operatively after using haemostatic sealant and bipolar diathermy for haemostasis during laparoscopic ovarian cystectomy

Reprod Biomed Online. 2021 Aug;43(2):310-318. doi: 10.1016/j.rbmo.2021.05.003. Epub 2021 May 15.

Abstract

Research question: Is there a difference in the ovarian reserve 1 year post-operatively in those who used a haemostatic sealant or bipolar diathermy for haemostasis during laparoscopic ovarian cystectomy for ovarian endometriomas?

Design: This was an extended follow-up observational study of a previous randomized controlled trial where women aged 18 to 40 years with 3-8 cm unilateral or bilateral endometriomas were randomized to receive haemostasis by a haemostatic sealant or bipolar diathermy following ovarian cystectomy. The primary outcome was the ovarian reserve as assessed by antral follicle count (AFC) 1 year post-operatively. Secondary outcomes included the recurrence rate of ovarian endometrioma, the change in anti-Müllerian hormone (AMH) and FSH concentrations, and reproductive outcomes.

Results: The significant increase in AFC at 3 months after initial surgery (P = 0.025) in the haemostatic sealant group compared with the diathermy group was sustained at 1 year (P = 0.024) but there was no difference in AMH or FSH concentrations between the groups throughout the follow-up period. The recurrence rate in the FloSeal group was 7.7% (n = 3/39) compared with 22.2% (n = 8/36) in the diathermy group (P = 0.060). The recurrence rate in women who had bilateral lesions was significantly higher than those with unilateral lesions (risk ratio 5.33, interquartile range 1.55-18.38). No difference in reproductive outcomes was found between the two groups.

Conclusions: Applying haemostatic sealant after laparoscopic cystectomy of ovarian endometriomas produces a significantly greater improvement in AFC, which was apparent at 3-month follow-up, and was sustained at 1-year follow-up without compromising the recurrence rate.

Keywords: FloSeal; Haemostatic sealant; Laparoscopic ovarian cystectomy; Ovarian endometrioma; Ovarian reserve; Recurrence.

Publication types

  • Observational Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Diathermy / methods*
  • Endometriosis / pathology
  • Endometriosis / physiopathology
  • Endometriosis / therapy
  • Female
  • Follow-Up Studies
  • Gelatin Sponge, Absorbable / therapeutic use*
  • Hemostatic Techniques
  • Hemostatics / therapeutic use
  • Hong Kong
  • Humans
  • Laparoscopy / methods
  • Neoplasm Recurrence, Local* / pathology
  • Neoplasm Recurrence, Local* / physiopathology
  • Ovarian Cysts / pathology
  • Ovarian Cysts / physiopathology
  • Ovarian Cysts / therapy*
  • Ovarian Diseases / pathology
  • Ovarian Diseases / physiopathology
  • Ovarian Diseases / therapy
  • Ovarian Reserve* / drug effects
  • Postoperative Period
  • Treatment Outcome
  • Young Adult

Substances

  • FloSeal Matrix
  • Hemostatics