The Impact on Ovarian Reserve of Different Hemostasis Methods in Laparoscopic Cystectomy: A Systematic Review and Meta-analysis

Abstract

Objective The objective of this review was to analyze the impact on ovarian reserve of the different hemostatic methods used during laparoscopic cystectomy.

Data Sources The studies were identified by searching electronic databases (MEDLINE, Embase, Cochrane, LILACS) and scanning reference lists of articles.

Methods of Study Selection We selected clinical trials that assessed the influence of hemostatic techniques on ovarian reserve in patients with ovarian cysts with benign sonographic appearance submitted to laparoscopic cystectomy by stripping technique. The included trials compared different laparoscopic hemostatic techniques: suture, bipolar electrocoagulation, ultrasonic energy and hemostatic sealants. The outcomes evaluated were level of serum anti-Mullerian hormone (AMH) and antral follicle count (AFC). The possibility of publication bias was evaluated by funnel plots.

Tabulation, Integration and Results Twelve trials involving 1,047 patients were evaluated. Laparoscopic suture was superior to bipolar coagulation when evaluating serum AMH and AFC, in the 1st, 3rd, 6th and 12th month after surgery. In the comparison between bipolar and hemostatic sealants, the results favored the use of hemostatic agents. The use of ultrasonic energy was not superior to the use of bipolar energy.

Conclusion We recommend suture for hemostasis during laparoscopic cystectomy.

Resumo

Objetivo O objetivo desta revisão foi comparar o impacto dos diferentes métodos hemostáticos na reserva ovariana durante a ooforoplastia laparoscópica.

Fontes de Dados Os estudos foram identificados através da pesquisa de bases de dados eletrônicas (MEDLINE, Embase, Cochrane, LILACS) e listas de referência de artigos.

Seleção dos estudos Selecionamos ensaios clínicos que avaliaram a influência das técnicas hemostáticas na reserva ovariana em pacientes com cistos ovarianos com aspecto ultrassonográfico benigno submetidos à ooforoplastia laparoscópica pela técnica de tração e contra-tração. Os estudos incluídos compararam as técnicas hemostáticas: sutura, energia bipolar, energia ultrassônica e selantes hemostáticos.

Coleta de dados Os desfechos avaliados foram o hormônio antimülleriano e a contagem de folículos antrais. A possibilidade de viés de publicação foi avaliada por gráficos de funil.

Síntese dos dados Doze estudos envolvendo 1.047 pacientes foram avaliados. A sutura foi superior à coagulação bipolar, e, na comparação entre selantes e energia bipolar, os resultados favoreceram o uso do primeiro grupo. O uso de energia ultrassônica não foi superior ao uso da energia bipolar.

Conclusão Em conclusão, recomendamos a sutura para hemostasia durante a ooforoplastia laparoscópica.

Keywords

laparoscopy - ovarian reserve - ovarian cyst - systematic review - meta-analysis

Palavras-chave

laparoscopia - reserva ovariana - cisto ovariano - revisão sistemática - meta-análise

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