A Randomized Control Trial Comparing Direct Stripping and Bipolar Electrocoagulation for Laparoscopic Endometriotic Cystectomy-Surgical and Histopathological Aspects

DOI: 10.4236/ijcm.2011.22013   PDF   HTML     4,437 Downloads   7,454 Views   Citations


The present study compared two different techniques of endometriotic cystectomy at the hilus : continuation of strip-ping and bipolar elctrocoagulation and cuttin . This was a randomized controlled study was done on 64 patients, who had laparoscopically confirmed endometriomas > 3 cm in diameter. Endometriotic cystectomy was initiated by excision of a circular rim of tissue at the original adhesion site followed by stripping and randomization was done at the ovarian hilum into 2 groups. In Group I surgery was completed by continuation of stripping and in group II surgery was completed by bipolar coagulation and cutting with scissors. Operative time and operative difficulty were evaluated at both steps by the same surgeon. Histopathology confirmation of the loss of normal ovarian tissue was recorded in the excised cyst and at the hilus separately. Data was analysed using Stata software, fisher’s exact test was employed to assess operative difficulty and Kruskal-Wallis test was used to evaluate ovarian tissue quality. The mean operating time was reported to be significantly lesser in the coagulation and cutting group. The operative difficulty was comparable in two groups. The number of primordial follicles sacrificed showed no significant difference in both groups. Complication rate in terms of hemorrhage was higher in the direct stripping group.

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K. Roy, S. Singla, H. Chawla, J. Baruah, J. Sharma and S. Jain, "A Randomized Control Trial Comparing Direct Stripping and Bipolar Electrocoagulation for Laparoscopic Endometriotic Cystectomy-Surgical and Histopathological Aspects," International Journal of Clinical Medicine, Vol. 2 No. 2, 2011, pp. 69-74. doi: 10.4236/ijcm.2011.22013.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] [1] T. A. Mahmood, A. Templeton, “Prevalence and Genesis of Endometriosis,” Human Reproduction, Vol. 6, No.4, 1991, pp. 544-549.
[2] [2] P. Vercellini, C. Chapron, O. De Giorgi, D. Consonni, G. Frontino, P. G. Crosignani , “Coagulation or Excision of Ovarian Endometriomas?,” American Journal of Obstet-rics and Gynecolog , Vol. 188, No. 3, 2003, pp. 606-610. doi:10.1067/mob.2003.7
[3] [3] F. Golfier, M. Sabra, “Surgical management of endo- metriosis,” Journal de gynecologie, obstetrique et biologie de lareproduction ,Vol. 36, No. 2, 2007, pp. 162- 172.
[4] [4] P. Beretta, M. Franchi, F. Ghezzi, M. Busacca, E. Zupi and P. Bolis, “Randomized Clinical Trial of Two Laparoscopic Treatments of Endometriomas: Cystectomy Versus Drainage and Coagulation,” Fertility and Sterility , Vol. 70, No. 6, 1998, pp. 1176-1180. doi:10.1016/S0015-0282(98)00385-9
[5] [5] R. J. Hart, M. Hickey, P. Maouris, W. Buckett , “Exci-sional Surgery Versus Ablative Surgery for Ovarian En-dometriomata,” Cochrane Database Systematic Review, Vol. 16, No. 2, 2008.
[6] [6] M. Busacca and M. Vignali, “Endometrioma Excision and Ovarian Reserve: a Dangerous Relation,” Journal of Minimally Invasive Gynecology”, Vol. 16, No.2, 2009, pp. 142-148. doi:10.1016/j.jmig.2008.12.013
[7] [7] D. C. Martin, “Laparoscopic Treatment of Ovarian En-dometriomas,” Clinics in Obstetrics and Gynecology Vol. 34, No. 2, 1991, pp. 452-459. doi:10.1097/00003081-199106000-00029
[8] [8] L. Muzii, F. Bellati, A. Bianchi, I. Palaia, N. Manci, M. A. Zullo, R. Angioli and P. B. Panici, “Laparoscopic Strip-ping of Endometriomas: A Randomized Trial on Differ-ent surgical Techniques. Part II: Pathological Results,” Human Reproduction, Vol. 20, No. 7, 2005, pp. 1987- 1992. doi:10.1093/humrep/deh851
[9] [9] P. Vercellini, “Endometriosis: What Pain It Is,” Seminars in Reproductive Endocrinology Vol. 15, No. 3, 1997, pp. 251-256. doi:10.1055/s-2008-1068755
[10] [10] P. P. Yeung Jr, J. Shwayder and R. P. Pasic, “Laparo-scopic Management of Endometriosis: Comprehensive Review of Best Evidence,” Journal of Minimally Invasive Gynecology, Vol. 16, No. 3, 2009, pp. 269-281. doi:10.1016/j.jmig.2009.02.007
[11] [11] I. A. Brosens, P. van Ballaer, P. Puttemans and J. Deprest, “Reconstruction of the Ovary Containing Large Endo-metriomas by an Extraovarian Endosurgical Technique,” Fertility and Sterility, Vol. 66, No.4, 1996, pp. 517-521.
[12] [12] J. Donnez, M. Nisolle, N. Gillet, M. Smets, S. Bassil and F. Casanas-Roux, “Large Ovarian Endometriomas,” Hu-man Reproduction, Vol. 11, No. 3, 1996, pp. 641-646.
[13] [13] C. J. Sutton, S. P. Ewen, N. Whitelow and P. Haines, “Prospective, Randomized, Double-Blind Controlled Trial of Laser Laparoscopy in the Treatment of Pelvic Pain Associated with Minimal, Mild, and Moderate En-dometriosis,” Fertility and Sterility, Vol. 62, No.4, 1994, pp. 696-700.
[14] [14] M. Canis, G. Mage, A. Wattiez, C. Chapron, J. L. Pouly and S. Bassil, “Second Look Laparoscopy after Laparo-scopic Cystectomy of Large Ovarian Endometriomas,” Fertility and Sterility, Vol. 58, No.3, 1992, pp. 611-619.
[15] [15] H. Reich and F. McGlynn, “Treatment of Ovarian Endo-metriomas using Laparoscopic Surgical Techniques,” Journal of Reproductive Medicine, Vol. 31, No. 7, 1986, pp. 577-584.
[16] [16] R. Hemmings, F. Bissonnette and R. Bouzayen, “Results of Laparoscopic Treatments of Ovarian Endometriomas: Laparoscopic Ovarian Fenestration and Coagulation,” Fertility and Sterility, Vol. 70, No.3, 1998, pp. 527-529. doi:10.1016/S0015-0282(98)00219-2
[17] [17] G. Marconi, M, Vilela, R. Quintana and C. Sueldo, “Laparoscopic Ovarian Cystectomy of Endometriomas Does Not Affect the Ovarian Response to Gonadotropin Stimulation,” Fertility and Sterility, Vol. 78, No. 4, 2002, pp. 876-878. doi:10.1016/S0015-0282(02)03326-5
[18] [18] K. Semm, “Course of Endoscopic Abdominal Surgery,” Operative manual for endoscopic abdominal surgery, K. Semm and E. R. Freidrich, Eds., C.V. Mosby, 1987, p. 21.
[19] [19] L. Muzii, F. Bellati, I. Palaia, F. Plotti, N. Manci, M. A. Zullo, R. Angioli and P. B. Panici, “Laparoscopic Strip-ping of Endometriomas: A Randomized Trial on Differ-ent Surgical Techniques. Part I: Clinical Results,” Human Reproduction, Vol. 20, No. 7, 2005, pp. 1981-1986. doi:10.1093/humrep/dei007
[20] [20] E. H. Yanushpolsky, C. L. Best, K. V. Jackson, R. N. Clarke, R. L. Barbieri and M. D. Hornstein, “Effects of Endometriomata on Oocyte Quality, Embryo Quality, and Pregnancy Rates in in vitro Fertilization Cycles: A Pro-spective, Case-Controlled Study,” Journal of Assisted Reproduction and Genetics Vol. 15, No. 4, 1998, pp. 193-197. doi:10.1023/A:1023048318719
[21] [21] A. Shushan, H. Mohamed and A. L. Magos, “How Long Does Laparoscopic Surgery Really Take? Lessons Learned from 1000 Operative Laparoscopies,” Human Reproduction, Vol. 14, No. 1, 1999, pp. 39-43. doi:10.1093/humrep/14.1.39
[22] [22] B. G. Bateman, L. A. Kolp, S. Mills, “Endoscopic Versus Laparotomy Management Ofendometriomas,” Fertility and Sterility, Vol. 62, No. 4, 1994, pp. 690-695.
[23] [23] P. Del, E. Girat and A. Vazquez, “Laparoscopic Man-agement of Endometriosis with CO2 Laser,” Gynaecology Endoscopy, Vol. 4, 1995, pp.195-199.

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