Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2019 Jun;41(6):400-408.
doi: 10.1055/s-0039-1692697. Epub 2019 Jun 27.

The Impact on Ovarian Reserve of Different Hemostasis Methods in Laparoscopic Cystectomy: A Systematic Review and Meta-analysis

Clara Micalli Ferruzzi Baracat  1 , Helizabet Salomão Ayroza Abdalla-Ribeiro  1 , Raquel Silveira da Cunha Araujo  1 , Wanderley Marques Bernando  2 , Paulo Ayroza Ribeiro  1
Affiliations
Meta-Analysis

The Impact on Ovarian Reserve of Different Hemostasis Methods in Laparoscopic Cystectomy: A Systematic Review and Meta-analysis

Clara Micalli Ferruzzi Baracat et al. Rev Bras Ginecol Obstet. 2019 Jun.

Abstract
in English, Portuguese

Objective: The objective of this review was to analyze the impact on ovarian reserve of the different hemostatic methods used during laparoscopic cystectomy.

Data sources: The studies were identified by searching electronic databases (MEDLINE, Embase, Cochrane, LILACS) and scanning reference lists of articles.

Methods of study selection: We selected clinical trials that assessed the influence of hemostatic techniques on ovarian reserve in patients with ovarian cysts with benign sonographic appearance submitted to laparoscopic cystectomy by stripping technique. The included trials compared different laparoscopic hemostatic techniques: suture, bipolar electrocoagulation, ultrasonic energy and hemostatic sealants. The outcomes evaluated were level of serum anti-Mullerian hormone (AMH) and antral follicle count (AFC). The possibility of publication bias was evaluated by funnel plots.

Tabulation, integration and results: Twelve trials involving 1,047 patients were evaluated. Laparoscopic suture was superior to bipolar coagulation when evaluating serum AMH and AFC, in the 1st, 3rd, 6th and 12th month after surgery. In the comparison between bipolar and hemostatic sealants, the results favored the use of hemostatic agents. The use of ultrasonic energy was not superior to the use of bipolar energy.

Conclusion: We recommend suture for hemostasis during laparoscopic cystectomy.

Objetivo: O objetivo desta revisão foi comparar o impacto dos diferentes métodos hemostáticos na reserva ovariana durante a ooforoplastia laparoscópica.

Fontes de dados: Os estudos foram identificados através da pesquisa de bases de dados eletrônicas (MEDLINE, Embase, Cochrane, LILACS) e listas de referência de artigos. SELEçãO DOS ESTUDOS: Selecionamos ensaios clínicos que avaliaram a influência das técnicas hemostáticas na reserva ovariana em pacientes com cistos ovarianos com aspecto ultrassonográfico benigno submetidos à ooforoplastia laparoscópica pela técnica de tração e contra-tração. Os estudos incluídos compararam as técnicas hemostáticas: sutura, energia bipolar, energia ultrassônica e selantes hemostáticos.

Coleta de dados: Os desfechos avaliados foram o hormônio antimülleriano e a contagem de folículos antrais. A possibilidade de viés de publicação foi avaliada por gráficos de funil. SíNTESE DOS DADOS: Doze estudos envolvendo 1.047 pacientes foram avaliados. A sutura foi superior à coagulação bipolar, e, na comparação entre selantes e energia bipolar, os resultados favoreceram o uso do primeiro grupo. O uso de energia ultrassônica não foi superior ao uso da energia bipolar. CONCLUSãO: Em conclusão, recomendamos a sutura para hemostasia durante a ooforoplastia laparoscópica.

PubMed Disclaimer

Conflict of interest statement

The authors declare that there are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Study selection flowchart. Adapted from PRISMA.
Fig
Fig
. 2 Decline rate of serum anti-Mullerian hormone 3 months after surgery: bipolar versus hemostatic agents.
Fig. 3
Fig. 3
Serum anti-Mullerian hormone 3 months after surgery: bipolar versus suture, excluding the outlier.
Fig. 4
Fig. 4
Serum anti-Mullerian hormone 12 months after surgery: bipolar versus suture.
Fig. 5
Fig. 5
Antral follicle count 12 months after surgery: bipolar versus suture.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Borgfeldt C, Andolf E.Transvaginal sonographic ovarian findings in a random sample of women 25-40 years old Ultrasound Obstet Gynecol 19991305345–350.. Doi: 10.1046/j.1469-0705.1999.13050345.x - PubMed
    1. Hart R J, Hickey M, Maouris P, Buckett W.Excisional surgery versus ablative surgery for ovarian endometriomata Cochrane Database Syst Rev 200802CD004992. Doi: 10.1002/14651858.CD004992.pub3 - PubMed
    1. Brun J L, Fritel X, Aubard Yet al.Management of presumed benign ovarian tumors: updated French guidelines Eur J Obstet Gynecol Reprod Biol 201418352–58.. Doi: 10.1016/j.ejogrb.2014.10.012 - PubMed
    1. Alborzi S, Foroughinia L, Kumar P V, Asadi N, Alborzi S.A comparison of histopathologic findings of ovarian tissue inadvertently excised with endometrioma and other kinds of benign ovarian cyst in patients undergoing laparoscopy versus laparotomy Fertil Steril 200992062004–2007.. Doi: 10.1016/j.fertnstert.2008.09.014 - PubMed
    1. Iwase A, Hirokawa W, Goto Met al.Serum anti-Müllerian hormone level is a useful marker for evaluating the impact of laparoscopic cystectomy on ovarian reserve Fertil Steril 201094072846–2849.. Doi: 10.1016/j.fertnstert.2010.06.010 - PubMed