Comparing ovarian reserve after laparoscopic excision of endometriotic cysts and hemostasis achieved either by bipolar coagulation or suturing: a randomized clinical trial

Zahra Asgari, Safoura Rouholamin, Reihaneh Hosseini, Mahdi Sepidarkish, Leila Hafizi, Atiyeh Javaheri
Archives of gynecology and obstetrics · 2015 · vol. 293(5) , pp. 1015–1022 · doi:10.1007/s00404-015-3918-4 · PMID:26493551 · W2111173222
article OA: closed CC0 ⤵ 49 in-corpus citations
Full text JSON View on OpenAlex View on PubMed View at publisher
⚙ AI-generated summary by claude@2026-06+body, 2026-06-08 ⓘ

This study found that laparoscopic suturing for hemostasis after endometrioma excision resulted in less damage to ovarian reserve, as measured by AMH and FSH levels, compared to bipolar coagulation.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

Full text 8,115 characters · extracted from oa-doi-fallback · 5 sections · click to expand

Abstract

Purpose This study aimed to compare ovarian reserve between laparoscopic suturing and bipolar coagulation techniques in women with unilateral endometrioma.

Methods

In a prospective randomized clinical trial, 109 patients with unilateral endometrioma underwent laparoscopic cystectomy. Patients were then randomized to undergo hemostasis with either bipolar coagulation (n = 57) or suturing (n = 52) technique. We evaluated the impact of surgery and hemostasis techniques on ovarian reserve using serum levels of anti-Mullerian hormone (AMH) and follicle-stimulating hormone (FSH) that were measured preoperatively and at 3 months postoperatively.

Results

Baseline characteristics such as age and preoperative AMH and FSH levels were similar between the two study groups. At 3-month follow-up, in both groups, postoperative AMH levels were significantly lower and FSH levels were significantly higher than before surgery. The decline rate of AMH levels was significantly greater in the bipolar coagulation (53.42 ± 15.28) group than in the suturing group (15.94 ± 18.55). Furthermore, patients in the suturing group had higher AMH and lower FSH as compared with the other group (p < 0.001).

Conclusion

After laparoscopic stripping of endometrioma, intracorporeal suturing showed less damage on ovarian reserve as compared with bipolar electrocoagulation. Therefore, hemostatic suturing technique may be considered as a better choice after laparoscopic ovarian cystectomy. Similar content being viewed by others

References

De Ziegler D, Borghese B, Chapron C (2010) Endometriosis and infertility: pathophysiology and management. Lancet 376(9742):730–738 Jones K, Fan A, Sutton C (2002) The ovarian endometrioma: why is it so poorly managed? Indicators from an anonymous survey. Hum Reprod 17(4):845–849 Hart RJ, Hickey M, Maouris P, Buckett W (2008) Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev 16(2):CD004992 Vercellini P, Chapron C, De Giorgi O, Consonni D, Frontino G, Crosignani PG (2003) Coagulation or excision of ovarian endometriomas? Am J Obstet Gynecol 188(3):606–610 Jenkins S, Olive DL, Haney AF (1986) Endometriosis: pathogenetic implications of the anatomic distribution. Obstet Gynecol 67(3):335–338 Raffi F, Metwally M, Amer S (2012) The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis. J Clin Endocrinol Metab 97(9):3146–3154 Somigliana E, Berlanda N, Benaglia L, Viganò P, Vercellini P, Fedele L (2012) Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antimüllerian hormone level modifications. Fertil Steril 98(6):1531–1538 Benaglia L, Somigliana E, Vighi V, Ragni G, Vercellini P, Fedele L (2010) Rate of severe ovarian damage following surgery for endometriomas. Hum Reprod 25(3):678–682 Reich H, Abrao MS (2006) Post-surgical ovarian failure after laparoscopic excision of bilateral endometriomas: is this rare problem preventable? Am J Obstet Gynecol 195(2):339–340 Fanchin R, Schonäuer LM, Righini C, Guibourdenche J, Frydman R, Taieb J (2003) Serum anti-Müllerian hormone is more strongly related to ovarian follicular status than serum inhibin B, estradiol, FSH and LH on day 3. Hum Reprod 18(2):323–327 Iwase A, Hirokawa W, Goto M, Takikawa S, Nagatomo Y, Nakahara T, Manabe S, Kikkawa F (2010) Serum anti-Müllerian hormone level is a useful marker for evaluating the impact of laparoscopic cystectomy on ovarian reserve. Fertil Steril 94(7):2846–2849 Dewailly D, Andersen CY, Balen A, Broekmans F, Dilaver N, Fanchin R, Griesinger G, Kelsey TW, La Marca A, Lambalk C (2014) The physiology and clinical utility of anti-Müllerian hormone in women. Hum Reprod Update 20(3):370–385 Song T, Kim WY, Lee KW, Kim KH (2014) Effect on ovarian reserve of hemostasis by bipolar coagulation versus suture during laparoendoscopic single-site cystectomy for ovarian endometriomas. J Minim Invasive Gynecol 22(3):415–420 Takashima A, Takeshita N, Otaka K, Kinoshita T (2013) 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 39(7):1246–1252 Coric M, Barisic D, Pavicic D, Karadza M, Banovic M (2011) Electrocoagulation versus suture after laparoscopic stripping of ovarian endometriomas assessed by antral follicle count: preliminary results of randomized clinical trial. Arch Gynecol Obstet 283(2):373–378 Özgönen H, Erdemoglu E, Günyeli İ, Güney M, Mungan T (2013) Comparison of the effects of laparoscopic bipolar electrocoagulation and intracorporeal suture application to ovarian reserve in benign ovarian cysts. Arch Gynecol Obstet 287(4):729–732 Tsolakidis D, Pados G, Vavilis D, Athanatos D, Tsalikis T, Giannakou A, Tarlatzis BC (2010) The impact on ovarian reserve after laparoscopic ovarian cystectomy versus three-stage management in patients with endometriomas: a prospective randomized study. Fertil Steril 94(1):71–77 Littman E, Giudice L, Lathi R, Berker B, Milki A, Nezhat C (2005) Role of laparoscopic treatment of endometriosis in patients with failed in vitro fertilization cycles. Fertil Steril 84(6):1574–1578 Moscarini M, Milazzo GN, Assorgi C, Pacchiarotti A, Caserta D (2014) Ovarian stripping versus cystectomy: recurrence of endometriosis and pregnancy rate. Arch Gynecol Obstet 290(1):163–167 Ferrero S, Venturini PL, Gillott DJ, Remorgida V, Maggiore ULR (2012) Hemostasis by bipolar coagulation versus suture after surgical stripping of bilateral ovarian endometriomas: a randomized controlled trial. J Minim Invasive Gynecol 19(6):722–730 Toner JP, Seifer DB (2013) Why we may abandon basal follicle-stimulating hormone testing: a sea change in determining ovarian reserve using antimüllerian hormone. Fertil Steril 99(7):1825–1830 Fedele L, Bianchi S, Zanconato G, Bergamini V, Berlanda N (2004) Bipolar electrocoagulation versus suture of solitary ovary after laparoscopic excision of ovarian endometriomas. J Am Assoc Gynecol Laparosc 11(3):344–347 Zaitoun MM, Zaitoun MM, El Behery MM (2013) Comparing long term impact on ovarian reserve between laparoscopic ovarian cystectomy and open laprotomy for ovarian endometrioma. J Ovarian Res 6:76 Mohamed ML, Nouh AA, El-Behery MM, Mansour SA-A (2011) Effect on ovarian reserve of laparoscopic bipolar electrocoagulation versus laparotomic hemostatic sutures during unilateral ovarian cystectomy. Int J Gynecol Obstet 114(1):69–72 Sugita A, Iwase A, Goto M, Nakahara T, Nakamura T, Kondo M, Osuka S, Mori M, Saito A, Kikkawa F (2013) One-year follow-up of serum antimüllerian hormone levels in patients with cystectomy: are different sequential changes due to different mechanisms causing damage to the ovarian reserve? Fertil Steril 100(2):516–522.e3 Alborzi S, Keramati P, Younesi M, Samsami A, Dadras N (2014) The impact of laparoscopic cystectomy on ovarian reserve in patients with unilateral and bilateral endometriomas. Fertil Steril 101(2):427–434 Song T, Lee S-H, Kim WY (2014) Additional benefit of hemostatic sealant in preservation of ovarian reserve during laparoscopic ovarian cystectomy: a multi-center, randomized controlled trial. Hum Reprod 29(8):1659–1665 Acknowledgments Financial support was provided by the Tehran University of Medical Sciences, Tehran, Iran. Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of interest The authors declare that they have no conflict of interest. Ethical standards The study was registered in Iranian Registry of clinical Trial (www.IRCT.ir) by the number of IRCT201403088897N2. Rights and permissions About this article Cite this article Asgari, Z., Rouholamin, S., Hosseini, R. et al. 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 293, 1015–1022 (2016). https://doi.org/10.1007/s00404-015-3918-4 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00404-015-3918-4

Text is read by the "Ask this paper" AI Q&A widget below. Extraction quality varies by source — PMC NXML preserves structure cleanly, OA-HTML may include some navigation residue, and OA-PDF can have broken hyphenation. The publisher copy (via DOI) is the canonical version.

My notes (saved in your browser only)

⚙ Ask this paper AI returns verbatim quotes from the full text · source: oa-doi-fallback ⓘ

Answers must be backed by verbatim quotes from this paper's full text. Hallucinated quotes are dropped automatically; if no verbatim passage answers the question, we say so. How this works

Condition tags

mesh:D004715

MeSH descriptors

Cystectomy Cysts Endometriosis Laparoscopy Ovarian Neoplasms Ovarian Reserve Adult Anti-Mullerian Hormone Anti-Mullerian Hormone Blood Coagulation Cysts Endometriosis Female Follicle Stimulating Hormone Follicle Stimulating Hormone Follow-Up Studies Hemostasis Hemostatics Hemostatic Techniques Humans

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (27)

Cited by (49)

Source provenance

europepmc
last seen: 2026-06-04T01:30:01.192114+00:00
openalex
last seen: 2026-06-04T00:00:01.174412+00:00
pubmed
last seen: 2026-05-13T22:17:33.600579+00:00
License: CC0 · commercial use OK