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

Baracat, Clara Micalli Ferruzzi; Abdalla-Ribeiro, Helizabet Salomão Ayroza; Araujo, Raquel Silveira da Cunha; Bernando, Wanderley Marques; Ribeiro, Paulo Ayroza

doi:10.1055/s-0039-1692697

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Ginecologia e Obstetrícia

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Brasil

Español English

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Sumário

Review Article • Rev. Bras. Ginecol. Obstet. 41 (06) • June 2019 • https://doi.org/10.1055/s-0039-1692697 copy

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

Impacto das diferentes técnicas hemostáticas empregadas na ooforoplastia videolaparoscópica sobre a reserva ovariana: revisão sistemática e meta-análise

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

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 suturewas superior to bipolar coagulationwhen evaluating serum AMHand AFC, in the 1st, 3rd, 6th and 12thmonth 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.

Keywords:
laparoscopy; ovarian reserve; ovarian cyst; systematic review; meta-analysis

Author, year	n	Outcome measured	Measurement period	JADAD
Bipolar x Hemostatic agent
Kang et al (2015)¹⁸18 Kang JH, Kim YS, Lee SH, Kim WY. Comparison of hemostatic sealants on ovarian reserve during laparoscopic ovarian cystectomy. Eur J Obstet Gynecol Reprod Biol 2015;194:64-67. Doi: 10.1016/j.ejogrb.2015.08.010 https://doi.org/10.1016/j.ejogrb.2015.08...	129	AMH	3 months	NR
Song et al (2014)¹⁹19 Song T, Lee SH, Kim WY. Additional benefit of hemostatic sealant in preservation of ovarian reserve during laparoscopic ovarian cystectomy: a multi-center, randomized controlled trial. Hum Reprod 2014;29(08):1659-1665. Doi: 10.1093/humrep/deu125 https://doi.org/10.1093/humrep/deu125...	100	AMH	3 months	3
Sönmezer et al (2013)²⁰20 Sönmezer M, Taskin S, Gemici A, et al. Can ovarian damage be reduced using hemostatic matrix during laparoscopic endometrioma surgery? A prospective, randomized study. Arch Gynecol Obstet 2013;287(06):1251-1257. Doi: 10.1007/s00404-012-2704-9 https://doi.org/10.1007/s00404-012-2704-...	30	AMH	1 and 3 months	3
Bipolar x Suture
Zhang et al (2016)¹⁷17 Zhang CH, Wu L, Li PQ. Clinical study of the impact on ovarian reserve by different hemostasis methods in laparoscopic cystectomy for ovarian endometrioma. Taiwan J Obstet Gynecol 2016;55 (04):507-511. Doi: 10.1016/j.tjog.2015.08.026 https://doi.org/10.1016/j.tjog.2015.08.0...	207	AMH and AFC	1, 3, 6, 12 months	2
Sahin et al (2017)²¹21 Sahin C, Akdemir A, Ergenoglu AM, et al. Which should be the preferred technique during laparoscopicovarian cystectomy. Reprod Sci 2017;24(03):393-399. Doi: 10.1177/1933719116657195 https://doi.org/10.1177/1933719116657195...	90	AMH and AFC	1, 3, 12 months	3
Asgari et al (2016)²²22 Asgari Z, Rouholamin S, Hosseini R, Sepidarkish M,Hafizi L, Javaheri A. Comparing ovarian reserve after laparoscopic excision of endometriotic cysts and hemostasis achieved either by bipolar coagulation or suturing: a randomized clinical trial. Arch Gynecol Obstet 2016;293(05):1015-1022. Doi: 10.1007/s00404-015-3918-4 https://doi.org/10.1007/s00404-015-3918-...	109	AMH	3 months	3
Song et al (2015)²³23 Song T, Kim WY, Lee KW, Kim KH. Effect on ovarian reserve of hemostasis by bipolar coagulation versus suture during laparoendoscopic single-site cystectomy for ovarian endometriomas. J Minim Invasive Gynecol 2015;22(03):415-420. Doi: 10.1016/j.jmig.2014.11.002 https://doi.org/10.1016/j.jmig.2014.11.0...	125	AMH	3 months	NR
Tanprasertkul et al (2014)²⁴24 Tanprasertkul C, Ekarattanawong S, Sreshthaputra O, Vutyavanich T. Impact of hemostasis methods, electrocoagulation versus suture, in laparoscopic endometriotic cystectomy on the ovarian reserve: a randomized controlled trial. J Med Assoc Thai 2014;97 (Suppl 8):S95-S101	50	AMH	1, 3, 6 months	2
Özgönen et al (2013)²⁵25 Özgönen H, Erdemoglu E, Günyeli I, Güney M, Mungan T. Comparison of the effects of laparoscopic bipolar electrocoagulation and intracorporeal suture application to ovarian reserve in benign ovarian cysts. Arch Gynecol Obstet 2013;287(04):729-732. Doi: 10.1007/s00404-012-2638-2 https://doi.org/10.1007/s00404-012-2638-...	60	AFC	1 e 3 month	2
Takashima et al (2013)²⁶26 Takashima A, Takeshita N, Otaka K, Kinoshita T. Effects of bipolar electrocoagulation versus suture after laparoscopic excision of ovarian endometrioma on the ovarian reserve and outcome of in vitro fertilization. J Obstet Gynaecol Res 2013;39(07):1246-1252. Doi: 10.1111/jog.12056 https://doi.org/10.1111/jog.12056...	44	AMH and AFC	3 months	1
Ferrero et al (2012)²⁷27 Ferrero S, Venturini PL, Gillott DJ, Remorgida V, Leone Roberti Maggiore U. Hemostasis by bipolar coagulation versus suture after surgical stripping of bilateral ovarian endometriomas: a randomized controlled trial. J Minim Invasive Gynecol 2012;19 (06):722-730. Doi: 10.1016/j.jmig.2012.08.001 https://doi.org/10.1016/j.jmig.2012.08.0...	100	AMH	3, 6, 12 months	3
Coric et al (2011)¹⁶16 Coric M, Barisic D, Pavicic D, Karadza M, Banovic M. Electrocoagulation versus suture after laparoscopic stripping of ovarian endometriomas assessed by antral follicle count: preliminary results of randomized clinical trial. Arch Gynecol Obstet 2011; 283(02):373-378. Doi: 10.1007/s00404-010-1676-x https://doi.org/10.1007/s00404-010-1676-...	50	AFC	2, 4, 6 months	3
Bipolar x Ultrasonic energy
Zhang et al (2016)¹⁷17 Zhang CH, Wu L, Li PQ. Clinical study of the impact on ovarian reserve by different hemostasis methods in laparoscopic cystectomy for ovarian endometrioma. Taiwan J Obstet Gynecol 2016;55 (04):507-511. Doi: 10.1016/j.tjog.2015.08.026 https://doi.org/10.1016/j.tjog.2015.08.0...	207	AMH and AFC	1, 3, 6, 12 months	2

Anti-Mullerian hormone
Author, year	1m	3m	6m	12m	1m	3m	6m	12m
	Bipolar energy				Suture
Sahin et al (2017)²¹21 Sahin C, Akdemir A, Ergenoglu AM, et al. Which should be the preferred technique during laparoscopicovarian cystectomy. Reprod Sci 2017;24(03):393-399. Doi: 10.1177/1933719116657195 https://doi.org/10.1177/1933719116657195...	2.32 ± 2.01	2.38 ± 2.57	−	2.78 ± 2.85	3.24 ± 3.01	3.17 ± 3.40	−	3.71 ± 3.09
Zhang et al (2016)¹⁷17 Zhang CH, Wu L, Li PQ. Clinical study of the impact on ovarian reserve by different hemostasis methods in laparoscopic cystectomy for ovarian endometrioma. Taiwan J Obstet Gynecol 2016;55 (04):507-511. Doi: 10.1016/j.tjog.2015.08.026 https://doi.org/10.1016/j.tjog.2015.08.0...	1.90 ± 0.70	1.80 ± 1.0	1.90 ± 0.80	2.0 ± 0.90	2.90 ± 1.80	3.0 ± 1.8	3.0 ± 1.5	3.1 ± 1.6
Asgari et al (2016)²²22 Asgari Z, Rouholamin S, Hosseini R, Sepidarkish M,Hafizi L, Javaheri A. Comparing ovarian reserve after laparoscopic excision of endometriotic cysts and hemostasis achieved either by bipolar coagulation or suturing: a randomized clinical trial. Arch Gynecol Obstet 2016;293(05):1015-1022. Doi: 10.1007/s00404-015-3918-4 https://doi.org/10.1007/s00404-015-3918-...	−	1.25 ± 0.84	−	−	−	2.10 ± 0.88	−	−
Tanprasertkul et al (2014)²⁴24 Tanprasertkul C, Ekarattanawong S, Sreshthaputra O, Vutyavanich T. Impact of hemostasis methods, electrocoagulation versus suture, in laparoscopic endometriotic cystectomy on the ovarian reserve: a randomized controlled trial. J Med Assoc Thai 2014;97 (Suppl 8):S95-S101	1.76 ± 1.50	2.09 ± 1.66	2.11 ± 1.84	−	2.09 ± 1.62	1.96 ± 1.68	1.72 ± 1.68	−
Takashima et al (2013)²⁶26 Takashima A, Takeshita N, Otaka K, Kinoshita T. Effects of bipolar electrocoagulation versus suture after laparoscopic excision of ovarian endometrioma on the ovarian reserve and outcome of in vitro fertilization. J Obstet Gynaecol Res 2013;39(07):1246-1252. Doi: 10.1111/jog.12056 https://doi.org/10.1111/jog.12056...	−	3.16 ± 1.27	−	−	−	2.88 ± 0.83	−	−
Ferrero et al (2012)²⁷27 Ferrero S, Venturini PL, Gillott DJ, Remorgida V, Leone Roberti Maggiore U. Hemostasis by bipolar coagulation versus suture after surgical stripping of bilateral ovarian endometriomas: a randomized controlled trial. J Minim Invasive Gynecol 2012;19 (06):722-730. Doi: 10.1016/j.jmig.2012.08.001 https://doi.org/10.1016/j.jmig.2012.08.0...	−	1.85 ± 1.67	1.75 ± 1.94	1.75 ± 1.82	−	2.65 ± 2.42	2.25 ± 1.53	2.30 ± 1.77
	Bipolar energy				Hemostatic agent
Song et al (2014)¹⁹19 Song T, Lee SH, Kim WY. Additional benefit of hemostatic sealant in preservation of ovarian reserve during laparoscopic ovarian cystectomy: a multi-center, randomized controlled trial. Hum Reprod 2014;29(08):1659-1665. Doi: 10.1093/humrep/deu125 https://doi.org/10.1093/humrep/deu125...	−	2.04 ± 0.64	−	−	−	2.67 ± 0.95	−	−
Sönmezer et al (2013)²⁰20 Sönmezer M, Taskin S, Gemici A, et al. Can ovarian damage be reduced using hemostatic matrix during laparoscopic endometrioma surgery? A prospective, randomized study. Arch Gynecol Obstet 2013;287(06):1251-1257. Doi: 10.1007/s00404-012-2704-9 https://doi.org/10.1007/s00404-012-2704-...	1.64 ± 0.93	2.84 ± 1.12	−	−	2.72 ± 1.49	3.07 ± 1.43	−	−
	Bipolar energy				Ultrasonic energy
Zhang et al (2016)¹⁷17 Zhang CH, Wu L, Li PQ. Clinical study of the impact on ovarian reserve by different hemostasis methods in laparoscopic cystectomy for ovarian endometrioma. Taiwan J Obstet Gynecol 2016;55 (04):507-511. Doi: 10.1016/j.tjog.2015.08.026 https://doi.org/10.1016/j.tjog.2015.08.0...	1.9 ± 0.7	1.8 ± 1.0	1.9 ± 0.8	2.0 ± 0.9	1.5 ± 0.9	1.8 ± 0.9	1.9 ± 1.0	2.0 ± 1.0
Decline rate of serum AMH
	Bipolar energy				Suture
Asgari et al (2016)²²22 Asgari Z, Rouholamin S, Hosseini R, Sepidarkish M,Hafizi L, Javaheri A. Comparing ovarian reserve after laparoscopic excision of endometriotic cysts and hemostasis achieved either by bipolar coagulation or suturing: a randomized clinical trial. Arch Gynecol Obstet 2016;293(05):1015-1022. Doi: 10.1007/s00404-015-3918-4 https://doi.org/10.1007/s00404-015-3918-...	53.42 ± 15.28				15.94 ± 18.55
Song et al (2015)²³23 Song T, Kim WY, Lee KW, Kim KH. Effect on ovarian reserve of hemostasis by bipolar coagulation versus suture during laparoendoscopic single-site cystectomy for ovarian endometriomas. J Minim Invasive Gynecol 2015;22(03):415-420. Doi: 10.1016/j.jmig.2014.11.002 https://doi.org/10.1016/j.jmig.2014.11.0...	42.2 ± 9.12				24.6 ± 6.35
	Bipolar energy				Hemostatic agent
Kang et al (2015)¹⁸18 Kang JH, Kim YS, Lee SH, Kim WY. Comparison of hemostatic sealants on ovarian reserve during laparoscopic ovarian cystectomy. Eur J Obstet Gynecol Reprod Biol 2015;194:64-67. Doi: 10.1016/j.ejogrb.2015.08.010 https://doi.org/10.1016/j.ejogrb.2015.08...	41.2 ± 8.92				15.4 ± 6.1
Song et al (2014)¹⁹19 Song T, Lee SH, Kim WY. Additional benefit of hemostatic sealant in preservation of ovarian reserve during laparoscopic ovarian cystectomy: a multi-center, randomized controlled trial. Hum Reprod 2014;29(08):1659-1665. Doi: 10.1093/humrep/deu125 https://doi.org/10.1093/humrep/deu125...	41.2 ± 9.32				16.1 ± 9.1
Number of antral follicles
Author, year	1m	3m	6m	12m	1m	3m	6m	12m
	Bipolar energy				Suture
Zhang et al (2016)¹⁷17 Zhang CH, Wu L, Li PQ. Clinical study of the impact on ovarian reserve by different hemostasis methods in laparoscopic cystectomy for ovarian endometrioma. Taiwan J Obstet Gynecol 2016;55 (04):507-511. Doi: 10.1016/j.tjog.2015.08.026 https://doi.org/10.1016/j.tjog.2015.08.0...	3.2 ± 1.6	3.6 ± 1.3	3.9 ± 1.4	4.2 ± 1.5	3.1 ± 1.4	4.7 ± 1.3	6.0 ± 1.9	6.3 ± 2.0
Sahin et al (2017)²¹21 Sahin C, Akdemir A, Ergenoglu AM, et al. Which should be the preferred technique during laparoscopicovarian cystectomy. Reprod Sci 2017;24(03):393-399. Doi: 10.1177/1933719116657195 https://doi.org/10.1177/1933719116657195...	4.26 ± 4.12	5.30 ± 4.59	−	5.86 ± 4.53	6.79 ± 4.54	7.48 ± 5.02	−	7.55 ± 5.23
Takashima et al (2013)²⁶26 Takashima A, Takeshita N, Otaka K, Kinoshita T. Effects of bipolar electrocoagulation versus suture after laparoscopic excision of ovarian endometrioma on the ovarian reserve and outcome of in vitro fertilization. J Obstet Gynaecol Res 2013;39(07):1246-1252. Doi: 10.1111/jog.12056 https://doi.org/10.1111/jog.12056...	−	2.7 ± 0.9	−	−	−	1.7 ± 0.7	−	−
Özgönen et al (2013)²⁵25 Özgönen H, Erdemoglu E, Günyeli I, Güney M, Mungan T. Comparison of the effects of laparoscopic bipolar electrocoagulation and intracorporeal suture application to ovarian reserve in benign ovarian cysts. Arch Gynecol Obstet 2013;287(04):729-732. Doi: 10.1007/s00404-012-2638-2 https://doi.org/10.1007/s00404-012-2638-...	6.9 ± 1.04	8.63 ± 1.21	−	−	7.23 ± 1.38	8.60 ± 1.24	−	−
	Bipolar energy				Ultrasonic energy
Zhang et al (2016)¹⁷17 Zhang CH, Wu L, Li PQ. Clinical study of the impact on ovarian reserve by different hemostasis methods in laparoscopic cystectomy for ovarian endometrioma. Taiwan J Obstet Gynecol 2016;55 (04):507-511. Doi: 10.1016/j.tjog.2015.08.026 https://doi.org/10.1016/j.tjog.2015.08.0...	3.2 ± 1.6	3.6 ± 1.3	3.9 ± 1.4	4.2 ± 1.5	3.0 ± 1.7	3.6 ± 1.4	3.9 ± 1.3	4.0 ± 1.2

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[1] Address for correspondence
Clara Micalli Ferruzzi Baracat, MD, Rua Dr. Cesário Mota Júnior, 112, 01221-020, São Paulo, SP, Brasil (e-mail: claraferruzzi@hotmail.com).