Bipolar Electrocoagulation Versus Intracorporeal Hemostatic Suturing for Laparoscopic Ovarian Cystectomy: Prospective Cohort Study on Effects

Objective: Intracorporeal suturing is an effective hemostatic technique after laparoscopic ovarian cystectomy, but evidence of suturing superiority over electrocoagulation is lacking. This study compared the effects of bipolar electrocoagulation versus hemostatic suturing on ovarian reserve, as assessed by antral follicle count (AFC), anti-Mullerian hormone (AMH), and follicle-stimulating hormone (FSH) after laparoscopic benign ovarian cystectomy. Materials and Methods: This prospective cohort study, conducted in a tertiary-care university hospital, enrolled 50 patients with benign ovarian cysts. The patients were divided into 2 groups: (1) intracorporeal suturing and (2) bipolar electrocoagulation. Serial ultrasounds and blood samples for AMH and FSH were assessed preoperatively; then at 3- and 6-month follow-ups. Results: There was a statistically significant reduction in AMH (p < 0.001) at the 6-month follow up from baseline (preoperative) in patients managed with bipolar electrocoagulation (-0.49 +/- 0.28 ng/mL), compared to those who had hemostatic sutures (-0.25 +/- 0.36 ng/mL). The difference in FSH was also significantly higher in the bipolar-electrocoagulation group than in the hemostatic-sutures group (0.68 +/- 0.49 mIU/mL versus 0.39 +/- 0.81 mIU/mL; p < 0.001). However, there was a statistically significant increase in AFC in the hemostatic-sutures group, compared to the bipolar-electrocoagulation group (2.64 +/- 1.52 versus 1.8 +/- 2.27; p = 0.03). Conclusions: Intracorporeal hemostatic suturing is better than electrocauterization for patients undergoing laparoscopic benign ovarian cystectomy, with fewer deleterious effects on ovarian reserve markers.