Bipolar electrocoagulation versus suturing in laparoscopic endometriotic cystectomy: a randomized clinical trial

ABSTRACT

Objectives. The aim of this study was to assess the impact of bipolar electrocoagulation compared to suturing on ovarian reserve during endometriotic cystectomy.

Materials and Methods. A single centre prospective randomized clinical trial was conducted in a university hospital during the period from September 2023 till May 2024. Forty-eight women with unilateral endometriotic ovarian cysts undergoing laparoscopic cystectomy were randomly assigned to one of two haemostasis techniques following the stripping of the cyst wall: bipolar electrocoagulation or intracorporeal suturing.

Results. In both groups, postoperative Anti-Müllerian hormone levels were lower than preoperative levels (p ≤ 0.001). The mean AMH decline ratio of was significantly greater in the bipolar electrocoagulation than in the suturing group 26.39 ± 12.67 and 15.68 ± 9.53 respectively. Neither the number of sutures nor the number of coagulation pulses was associated with AMH decline ratio (P-value 0.337 and 0.963). Although the AMH ratio declined more significantly in the bipolar electrocoagulation group, a higher number of women in this group were able to achieve pregnancy post-surgery compared to the suturing group (p = 0.0395; 95%CI 3.19% to 69.47%).

Conclusions. Laparoscopic cystectomy for endometrioma is complicated by reduced ovarian reserve, irrespective of the haemostasis technique used. After laparoscopic stripping of endometrioma, intracorporeal suturing is associated with less detrimental impact on ovarian reserve compared to bipolar electrocoagulation.

Key words
Bipolar electrocoagulation; endometrioma; laparoscopic cystectomy; laparoscopic suturing; ovarian reserve.