The potential damage of laparoscopic electrocoagulation on ovarian
reserve in endometriomas reduced in benign ovarian cysts: A systematic
review and meta-analysis
Abstract
Background Laparoscopic cystectomy for ovarian endometriomas
and benign ovarian cysts often involves the use of hemostatic methods,
with electrocoagulation using bipolar energy as a common approach. This
study aimed to assess the impact of electrocoagulation compared to
nonthermal hemostatic methods on ovarian reserve during such surgeries.
Objectives To evaluate the influence of electrocoagulation
using bipolar energy versus nonthermal hemostatic methods on ovarian
reserve in patients undergoing laparoscopic cystectomy for endometriomas
and benign ovarian cysts. Search Strategy A systematic review
with meta-analysis was conducted by searching the Cochrane Library,
PubMed, EMBASE, and Web of Science databases. Entry terms associated
with MeSH terms, such as “ovarian cysts,” “laparoscopy,”
“electrocoagulation,” and “anti-Müllerian hormone” or “antral
follicle count” were used for articles published before October 2022.
Selection Criteria Randomized controlled trials (RCTs)
comparing the impact of nonthermal hemostatic methods with
electrocoagulation on ovarian reserve during laparoscopic cystectomy
were included. The Cochrane Risk of Bias Tool for Randomized Controlled
Trials (ROB 2.0) was utilized to assess the quality of included studies.
Data Collection and Analysis Thirteen RCTs involving 1043
patients were included in the meta-analysis. Postoperative serum
anti-Müllerian hormone (AMH) levels and antral follicle counts (AFC)
were analyzed using Review Manager ver. 5.4. Main Results In
patients with endometriomas, the nonthermal hemostatic group exhibited
significantly higher postoperative AMH levels at one, three, six, and 12
months compared to the bipolar group. Conversely, no significant
differences in AMH levels were observed in patients with benign ovarian
cysts. Similarly, the AFC levels showed no significant differences,
except for a lower postoperative AFC in the electrocoagulation group for
endometrioma cases. Conclusions Nonthermal hemostatic methods
are associated with better preservation of ovarian reserve compared to
bipolar electrocoagulation in laparoscopic cystectomy for ovarian
endometriomas. However, no significant impact on ovarian reserve was
observed with bipolar electrocoagulation in patients with benign ovarian
cysts.