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Laparoscopic cystectomy of endometrioma: Good surgical technique does not adversely affect ovarian reserve.

Bhat RG, Dhulked S, Ramachandran A, Bhaktha R, Vasudeva A, Kumar P, Rao AC - J Hum Reprod Sci (2014)

Bottom Line: Significance level was P < 0.05.Preoperative and post-operative values; FSH (7.24 ± 1.21, 7.23 ± 1.51 m IU/ml), LH levels (6.37 ± 1.8, 6.6 ± 2.3 m IU/ml), residual ovarian volume (8.5 cm(3) ± 5.3, 7.4 cm(3) ± 5.8), antral follicle count(3.3 ± 1.9, 4.1 ± 1.5) and stromal blood flow (6.8 cm/sec ± 4.57, 7.1 cm/sec ± 3.55) were statistically not significant.Laparoscopic cystectomy when performed for endometriotic cysts with accurate surgical technique leads to no significant ovarian tissue removal.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.

ABSTRACT

Background: The damage to ovarian reserve inflicted by surgery for endometriosis represents a major concern in the balance between reproductive benefits and risks.

Aim: To evaluate the ovarian reserve in sub fertile women after laparoscopic endometriotic cystectomy.

Settings and design: Prospective study, done in Department of Obstetrics and Gynecology, tertiary care hospital between August 2010-2012.

Materials and method: Laparoscopic cystectomy performed by stripping technique for endometriotic cysts. Endometriosis was staged according to revised American Society of Reproductive Medicine classification (rASRM). Ovarian reserve assessed by comparing FSH and LH levels, measurement of residual ovarian volume, antral follicle counts and stromal blood flow on second day of menses pre and postoperatively. Cyst wall was evaluated histologically to note the presence of normal ovarian tissue in resected tissue.

Statistical analysis: SPSS for Windows version 16.0 (SPSS Inc., Chicago, IL) was used for statistical calculations. Wilcoxon signed test and Pearson Chi - Square test were applied. Significance level was P < 0.05.

Results: Incidence of minimal, mild, moderate, and severe endometriosis was 4.1%, 21.9%, 28.7%, 45.3% respectively. Ovarian reserve was assessed both by ultrasound and biochemical parameters on day 2 of menses; pre and post-operatively. Preoperative and post-operative values; FSH (7.24 ± 1.21, 7.23 ± 1.51 m IU/ml), LH levels (6.37 ± 1.8, 6.6 ± 2.3 m IU/ml), residual ovarian volume (8.5 cm(3) ± 5.3, 7.4 cm(3) ± 5.8), antral follicle count(3.3 ± 1.9, 4.1 ± 1.5) and stromal blood flow (6.8 cm/sec ± 4.57, 7.1 cm/sec ± 3.55) were statistically not significant. Loss of follicle was seen in 27.2% cyst walls on histopathological examination while 72.73% had no loss.

Conclusion: Laparoscopic cystectomy when performed for endometriotic cysts with accurate surgical technique leads to no significant ovarian tissue removal.

No MeSH data available.


Related in: MedlinePlus

Measuring stromal blood flow
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Figure 2: Measuring stromal blood flow

Mentions: Prospective study, conducted in Department of Obstetrics and Gynecology, tertiary care hospital between August 2010 and August 2012 in patients with ovarian endometriomas requiring surgical removal. A total of 85 women who were subfertile, and underwent laparoscopic endometriotic cystectomy for the first time irrespective of their age, duration of infertility, body mass index (BMI) and were included in the study. Patients who have undergone any prior pelvic surgery were excluded from the study. None of our patients received prior medical management for endometriosis. Preoperatively on day 2 of menses, ovarian and endometrioma volumes, antral follicle counts (AFCs) and stromal blood flow (peak systolic flow) was noted using a real-time ultrasound, 5.0-7.5 MHz endovaginal probe. Color and pulsed Doppler sonography were used to assess the ovarian stromal blood flow. The blood flow velocity waveform from the ovarian artery was recorded at the ovarian hilus. The peak systolic velocity (PSV cm/s) values were electronically computed. All ultrasonographic examinations were performed by the same observer to eliminate the interobserver variations [Figures 1 and 2]. FSH, luteinizing hormone (LH) levels (measured using immuno chemiluscence method in the laboratory, Rosche Diagnostics) were also checked on the same day. Normal values as per our laboratory being FSH: 3.85-8.78 mIU/ml and LH: 2.12-10.89 mIU/ml.


Laparoscopic cystectomy of endometrioma: Good surgical technique does not adversely affect ovarian reserve.

Bhat RG, Dhulked S, Ramachandran A, Bhaktha R, Vasudeva A, Kumar P, Rao AC - J Hum Reprod Sci (2014)

Measuring stromal blood flow
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150139&req=5

Figure 2: Measuring stromal blood flow
Mentions: Prospective study, conducted in Department of Obstetrics and Gynecology, tertiary care hospital between August 2010 and August 2012 in patients with ovarian endometriomas requiring surgical removal. A total of 85 women who were subfertile, and underwent laparoscopic endometriotic cystectomy for the first time irrespective of their age, duration of infertility, body mass index (BMI) and were included in the study. Patients who have undergone any prior pelvic surgery were excluded from the study. None of our patients received prior medical management for endometriosis. Preoperatively on day 2 of menses, ovarian and endometrioma volumes, antral follicle counts (AFCs) and stromal blood flow (peak systolic flow) was noted using a real-time ultrasound, 5.0-7.5 MHz endovaginal probe. Color and pulsed Doppler sonography were used to assess the ovarian stromal blood flow. The blood flow velocity waveform from the ovarian artery was recorded at the ovarian hilus. The peak systolic velocity (PSV cm/s) values were electronically computed. All ultrasonographic examinations were performed by the same observer to eliminate the interobserver variations [Figures 1 and 2]. FSH, luteinizing hormone (LH) levels (measured using immuno chemiluscence method in the laboratory, Rosche Diagnostics) were also checked on the same day. Normal values as per our laboratory being FSH: 3.85-8.78 mIU/ml and LH: 2.12-10.89 mIU/ml.

Bottom Line: Significance level was P < 0.05.Preoperative and post-operative values; FSH (7.24 ± 1.21, 7.23 ± 1.51 m IU/ml), LH levels (6.37 ± 1.8, 6.6 ± 2.3 m IU/ml), residual ovarian volume (8.5 cm(3) ± 5.3, 7.4 cm(3) ± 5.8), antral follicle count(3.3 ± 1.9, 4.1 ± 1.5) and stromal blood flow (6.8 cm/sec ± 4.57, 7.1 cm/sec ± 3.55) were statistically not significant.Laparoscopic cystectomy when performed for endometriotic cysts with accurate surgical technique leads to no significant ovarian tissue removal.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.

ABSTRACT

Background: The damage to ovarian reserve inflicted by surgery for endometriosis represents a major concern in the balance between reproductive benefits and risks.

Aim: To evaluate the ovarian reserve in sub fertile women after laparoscopic endometriotic cystectomy.

Settings and design: Prospective study, done in Department of Obstetrics and Gynecology, tertiary care hospital between August 2010-2012.

Materials and method: Laparoscopic cystectomy performed by stripping technique for endometriotic cysts. Endometriosis was staged according to revised American Society of Reproductive Medicine classification (rASRM). Ovarian reserve assessed by comparing FSH and LH levels, measurement of residual ovarian volume, antral follicle counts and stromal blood flow on second day of menses pre and postoperatively. Cyst wall was evaluated histologically to note the presence of normal ovarian tissue in resected tissue.

Statistical analysis: SPSS for Windows version 16.0 (SPSS Inc., Chicago, IL) was used for statistical calculations. Wilcoxon signed test and Pearson Chi - Square test were applied. Significance level was P < 0.05.

Results: Incidence of minimal, mild, moderate, and severe endometriosis was 4.1%, 21.9%, 28.7%, 45.3% respectively. Ovarian reserve was assessed both by ultrasound and biochemical parameters on day 2 of menses; pre and post-operatively. Preoperative and post-operative values; FSH (7.24 ± 1.21, 7.23 ± 1.51 m IU/ml), LH levels (6.37 ± 1.8, 6.6 ± 2.3 m IU/ml), residual ovarian volume (8.5 cm(3) ± 5.3, 7.4 cm(3) ± 5.8), antral follicle count(3.3 ± 1.9, 4.1 ± 1.5) and stromal blood flow (6.8 cm/sec ± 4.57, 7.1 cm/sec ± 3.55) were statistically not significant. Loss of follicle was seen in 27.2% cyst walls on histopathological examination while 72.73% had no loss.

Conclusion: Laparoscopic cystectomy when performed for endometriotic cysts with accurate surgical technique leads to no significant ovarian tissue removal.

No MeSH data available.


Related in: MedlinePlus