Laparoscopic surgery of monolateral endometrioma using a new dual wavelengths laser system (DWLS) for hemostasis: our experience

Maristella De Padova;Felice Sorrentino;Francesca Greco;Maurizio Nicola D'alterio

;Stefano Angioni;Nappi Luigi

2021-01-01

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Abstract

Background The aim of the study was to evaluate the impact on ovarian reserve by dosing the anti-Mullerian hormone (AMH) using the stripping technique followed by the hemostasis with dual wavelengths laser system (DWLS) Methods We enrolled 48 patients scheduled for surgery for symptomatic unilateral endometrioma, greater than 35 mm. Patients were recruited between December 2018 and January 2020 in University of Foggia and Cagliari. Patients with previous gynaecological surgery, hormone therapy 3-6 months before surgery or BMI>30kg/m2 where excluded. Laparoscopic excision of endometriomas were performed with the combined technique of stripping followed by hemostasis of residual ovarian tissue using. The surgical procedure was uncomplicated in all patients. The endometrioma was excised following the conventional stripping technique. The hemostasis of residual ovarian tissue was performed using the DWLS, with a conic fiber of 1000 micron (Biolitec Ceralas HPD, wavelength of 980 nm and 1470 nm). This laser is characterized by combination of two wavelengths (980 nm and 1470 nm), giving contemporary capacity of cutting and vaporization. AMH serum levels was assayed before the surgery (baseline), 4-6 weeks (T1) and 6-9 months (T2) after the surgery and compared using paired samples t-test and Wilcoxon signed-rank test. Results In patient with higher AMH level at baseline (≥3 ng/ml) we found a lower AMH levels than baseline in both T1 and T2 times, even if AMH levels seemed to increase in T2 group rather than T1 group and this difference was statistically significant (p < 0.0001). The mean serum AMH after surgery corresponded to 93.6% of baseline levels. In patients with a low AMH levels at baseline (<2 ng/ml), the AMH levels lowed in T1 to T2 to 87.0% of the mean baseline value. Conclusions Evenifsurgerycoulddamageovarianreserve,ourstudyshowedhowanappropriatesurgicaltechnique combinedstrippingand ablation) with the use of laser hemostasis does not determine a significant reduction of ovarian reserve, in particular it seemed to allow partial recovery toward baseline of serum AMH.