Ovaryan Endometrioma Olgularında Laparoskopik Kist Eksizyonu ile Laparoskopik Fenestrasyon, Drenaj Ve Argon Beam Coagulator ile Vaporizasyonun Ovaryan Rezerv Üzerine Etkileri

Year 2014, Volume: 67 Issue: 3, 123 - 128, 25.08.2015

Şerife Esra Çetinkaya , Ruşen Aytaç

Abstract

Aim: There is general agreement that medical treatment alone is inadequate and surgery is the gold standart in the treatment of ovarian endometriomas. Laparoscopy is the preferred surgical method. mHowever, it has been proposed that surgery, especially cystectomy may damage ovarian tissue and reserve. In this study, we aimed to determine whether laparoscopic excision and laparoscopic fenestration, drainage and vaporization using the argon beam coagulator have any effect on ovarian reserve tests.

Materials and methods: Patients who underwent laparoscopy between 20 –37 years of age with mendometriomas at the Ankara University Medical Faculty, Department of Obstetrics and Gynecology mmwere included in the study. Laparoscopic cystectomy (n = 7) or laparoscopic fenestration, drainageand vaporization with the argon beam coagulator (n = 4) was performed. Ovarian reserve was measured by day 3 FSH, estradiol levels and day 10 FSH levels after clomiphene citrate challenge test inall patients and preoperative and postoperative levels were compared.

Results: There were no significant differences in basal FSH, estradiol levels and day 10/day 10+3 FSH mlevels preoperatively and postoperatively in all patients. The ovarian reserve tests were also similar preoperatively and postoperatively in the laparoscopic cystectomy or vaporization groups. Ovarian reserve tests were found to be normal in all patients but one with a history of laparotomic excision of bilateral endometriomas.

Conclusion: In this preliminary study, no effect on basal FSH, estradiol and clomiphene citrate challenge test with both surgical techniques has been observed. A prospective, randomized study is needed to make a definitive conclusion regarding the effect of cystectomy and ablation on ovarian reserve and the use of argon beam coagulator in endometrioma surgery

Keywords

Endometrioma , kistektomi , ablation , argon beam coagulator , ovarian reserve

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Ovaryan Endometrioma Olgularında Laparoskopik Kist Eksizyonu ĝle Laparoskopik Fenestrasyon, Drenaj Ve Argon Beam Coagulator ĝle Vaporizasyonun Ovaryan Rezerv Üzerine Etkileri

Abstract

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References

• 1. Ozkan S, Murk XV, Aricİ A. Endometriosis and Infcrtİlİty. Epidemiology and evidencc bascd treatments. Annals of tine New York Academy of Scİences 2008;1127:92-100.
• 2. Busacca M, Vıgnalİ M: Ovarİan endometrİosİs: from pathogencsis to surgİcal treatment. Curr Opİn Obstet Gynecol 2003;15: 321-326.
• 3. Gupta S, Agarwal A, Agarwal R, et al. Impact of ovarİan endometrioma on assisted reproduction outcomes. Reprod Biomed Online 2006; 13: 349—360.
• 4. Uncu G, Kasapoglu I, Ozerkan K, et al. Prospective assessment of the İmpact of endometriomas and theİr removal on ovarİan reserve and determinants of Che rate of declİne İn ovadan reserve. Humansuna verilebilecek hasar kaygısı İlgiyi yeniden fenestrasyon ve ablasyon tekniklerine yöneltmiştir. Ablasyon over rezervine daha az zarar veriyor gibi görünmektedir ancak çalışmalar henüz yetersizdir (7,12). Ablasyon tekniğinde bipolar koagulasyon kullanımının over dokusu üzerine termal zarar vereceği kaygısı da başka enerji omas: state of the art? Fertil Steril 2012; 98: 556-563.
• 5.Jadoul P, Kitajima M, Donnez O, et al. Surgical treatment of ovarian endometri mas: state of the art? Fertil Steril 2012:98: 556563.
• 6. Donnez J, Lousse JC, Jadoul P, et al. Laparoscopic management of endometri- omas usİng a combİned technique of excisional (cystectomy) and ablative surgery. Fertil Steril 2010; 94: 28—32.
• 7. Limin Dan H, F. Laparoscopic Ovarİan Cystectomy versus Fenestratİon/Coagulation or Laser Vaporİzatİon for Che Treatment of Endometriomas: A Meta-Analysİs of Randomized Controlled Trials. Gynecol Obstet Invest 2013; 76: 75-82.
• 8.Alborzi S, Keramatİ P, Younesİ M, et al. The İmpact of laparoscopic cystectomy on ovadan reserve in patients with unilateral and bilateral endometriomas, Fertil Steril 2014; 101: 427-34.
• 9. Hart RJ1, Hickey M, Maouris P, Buckett W.Excisional surgery versus ablative sur gery for ovarian endometriomata.Cochrane 16:CDO04992. Database Syst Rev. 2008
• 10. Hachisuga T, Kawarabayashi T. Histo pathological analysis of laparoscopically treated ovarian endometriotic cysts with special reference to loss of follicles. Hum Reprod 2002; 17: 432435.
• 11. Raffi E, Metwally M,Amer S. The Impact of Excision of Ovarian Endometrioma on Ovarian Reserve: A Systematic Review and Meta-Analysis. J Clin Endocrinol Me tab 2012: 97: 3146-3154.
• 12. Var T, Batioglu S, Tonguc E, et al. The effect of laparoscopic ovarian cystectomy versus coagulation in bilateral endometri omas on ovarian reserve as determined by antral follicle count and ovarian volu me: a prospective randomized study. Fer Steril 2011;95: 2247-2250.
• 13. Carmona F, Martinez-Zamora A, Rabanal A, et al. Ovarian cystectomy versus laser vaporization in the treatment of ovarian endometriomas: a randomízed clinical trial with a five-vecar follow-up. Fertil Ste 2011;96:25 1-254.
• 14. Tsolakidis D, Pados G, Vavilis D, et al. The impact on ovarian reserve after lapa roscopic ovarian cystectomy versus thrce stage management in patients with en dometriomas: a prospective randomized study. Fertil Steril 2010,94:71-76.
• 15. Roman H, Auber M, Mokdad C, et Ovarian endometrioma ablation using plasma energy versus cystectomy: a step toward better preservation of the ovarian parenchyma in women wishing to conce ive. Fertil Steril 2011:96:1396 400.
• 16. Danicll JE, Dover RW. Laparoscopic use of the argon beam coagulator. In: endos copic Surgery for Gynccologists, second edition, Sutton C, Diamond MP. P: 1998;105-110.
• 17. Asensio JA1, Mazzini FN,Gonzalo R, et al. Argon beam coagulator: an effective adjunct to stapled pulmonary tractotomy to control hemohage in penetrating pulmonary injuries.J Am Coll Surg. 2012 ;214: e9-e12.
• 18. Kandeel A1, Meguid A, Hawasli A. Cont rolling difficult pelvic bleeding with argon beam coagulator during laparoscopic ultra low anterior resection. Surg Laparosc Endosc Percutan Tech. 2011; 21: e21-23.
• 19. Saurabh S1, Strobos EH, Patankar S, et al. The argon beam coagulator: a more ef fective and expeditious way to address presacral bleeding. Tech Coloproctol. 2014; 18: 73-76.
• 20. Fanning J, Hojat R, Johnson J, et al. Laparoscopic cytoreduction for primary advanced ovarian cancer. JSLS 2010; 14: 80-82.
• 21. Fischer L1, Seiler CM, Broclsch CE,et al. Hemostatic efficacy of TachoSil in liver resection compared with argon beam co agulator treatment: an open, randomized, prospective, multicenter, parallel-group trial. Surgery. 2011;149:48-55.
• 22. Okada TI, Sasaki F, Kurauchi N, ct al. Laparoscopic liver biopsy using cup shaped punch biopsy forceps and argon beam coagulator in children. Pediatr Surg Int. 2007; 23: 947-951.
• 23. Brand E, Pearlman N. Electrosurgical debulking of ovarian cancer: a new tech nique using the argon beam coagulator. Gynecol Oncol 1990; 39: 115-118.
• 24. Wines MP1, Lynch WD. A new mini mally invasive technique for treating radi ation cystitis: the argon-bcam coagulator. BJU Int. 2006; 98: 610-612.
• 25. Karam AK, Bristow RE, Bienstock J, et al. Argon beam coagulation facilitates management of placenta percreta with bladder invasion. Obstet Gyneco2003; 102:555-556.
• 26. Shrivastava VK1, Imagawa D, Wing DA. Argon beam coagulator for treatment ofhepatic rupture with hemolysis, elevatedliver enzymes, low platelets (HELLP) syndrome. Obstet Gynecol 2006; 107: 525-526.
• 27. Brosens I, Sutton C. Laparoscopic treat ment of ovarian endometriomas. In: En doscopic surgery for gynecologists, se cond edition, WB Saunders, 1998: 221 232.
• 28. Brosens IA, Puttemans PJ, Deprest J.The endoscopic localization of endometrial implants in the ovarian chocolate cyst. Fertil Steril 1994; 61: 1034-1038.
• 29. Nisolle M, Donnez J. Peritoneal endo metriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril 1997; 68: 585-596.
• 30. Donnez J, Nisolle M, Gillet N, Smets M, Bassil S, Casanas-Roux F. Large ovarian endometriomas. Hum Reprod 1996; 11:641-646.
• 31. Marconi G, Vilela M, Quintana R, et al. Laparoscopic cystectomy of endometri omas does not affect the ovarian respon seto gonadotropin stimulation. Ferilril Steril 2002; 78: 876-878.
• 32. Canis M, Pouly JL, Tamburro S, Ovarian response et during transfer cycles after VP-embryo cystectomy for endometi°pic ovaria cm cysts of>3 in diameter. Hum Reprod 2001: 16 2583-2586.
• 33. Ho HY, Lee RK, Hwu YM, al. Poor response of ovaries with endometrioma previously treated with cystectomy to controlled ovarian hyperstimulation. I Assist Reprod Genctics 2002; 19: 507 511.
• 34. Loh FH,Tan AT, Kumar J,et al.Ovarian response afterlaparoscopic ovariancVstectomy for endometriotic cysts in 132monitored cycles. Fertil Steril 1999: 72.316-321.
• 35. Biacchiardi CP, Piane LD, Camanni M,etal. Laparoscopic stripping of endometri omas negatively affects ovarian follicularreserve even if performedby experienced surgeons. Reprod Biomed Online 2011.23: 740746.
• 36. Iwase A, Hirokawa W, Goto M, et al Serum anti-Mullerian hormone level is a useful marker for evaluating the impact of laparoscopic Cstectomy on ovananre serve. Fertil Steril 2010; 94:2846-2849,
• 37. Celik HG, Dogan E, Okyay E, et al. Effect of laparoscopic excision of endo metriomas on ovarian reserve: serial changes in the serum antimullerian hor mone levels. Fertil Steril 2012; 97: 1472 1478.
• 38. Broer SL, Mol BW, Hendriks D, et al. The role of antimullerian hormone in prediction of outcome after IVF: compa rison with the antral follicle count. FertilSteril 2009,91:705-714.
• 39. Ferrero S,Scala C, Racca A, et al. Second surgery for recurrent unilateral endometriomas and impact on ovarian reserve: acase-control study. Fertil Steril.2015;103:1236-1243.