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

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

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Brasil

Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

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

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

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

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.

Palavras-chave:
laparoscopia; reserva ovariana; cisto ovariano; revisão sistemática; meta-análise

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).