Influence of modern methods of hemostasis on ovarian reserve during ovarian preservation operations

• Solomatina Antonina A.
• Khamzin I.Z.
• Tyumentseva M.Yu.

Abstract

The aim of this study was to determine the most attenuated method of hemostasis during ovarian preservation operations which is based on ovarian reserve (OR) study results.

Material and methods. 122 patients with endometrioid formations (EFO) and 112 with mature teratomas (MT) were examined. The 1^st group (bipolar coagulation) included 32 patients with EFO and 29 patients with MT. In the 2^nd group (ligature haemostasis), the corresponding formations were in 34 and 30 patients. The 3^rd group (argon plasma coagulation) consisted of 29 patients with EFO and 28 patients with MT. In the 4^th group (coagulation was not required) - there were 27 and 25 patients, respectively. All patients underwent laparoscopic cystectomy. Prior to surgery, and 6 and 12 months after the intervention, the volume of healthy ovarian tissue, Antral Follicle Count (AFC), their size, location and shape were evaluated. With Color Doppler Visualization V_max and resistance index (RI) were studied.

Results. Both in the pre- and postoperative periods in patients with EFO OR criteria (Vcm³ of ovarian tissue, AFC and their diameter, V_max, RI) were reduced from 1.3 to 1.5 times in comparison with patients with MT. The most pronounced OR changes have been detected in patients with EFO from the bipolar coagulation group.

Conclusion. EFO reduces OR. Maximum preservation of morphofunctional ovarian tissue is achieved by absence of indications for hemostasis in case of cystectomy. If it is necessary to stop bleeding, preference should be given to attenuated methods of hemostasis (argon plasma coagulation and ligature haemostasis). Enucleation with bipolar coagulation is accompanied by severe abnormalities in morphofunctional ovarian tissue state.

Keywords:ovarian reserve, bipolar coagulation, ligature hemostasis, argon plasma coagulation, ovarian endometrioid lesions, mature teratomas

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