Laparoscopic ovarian reconstruction without suturing after cystectomy for endometrioma

The primary aim of this study is to evaluate the technique of ovarian reconstruction without suturing after laparoscopic cystectomy of endometrioma. The secondary aim is to find the pregnancy rate following this technique. The study is a prospective observational study (Canadian Task Force classification II-3). The interventions used in the study are laparoscopic ovarian cystectomy and reconstruction without suturing. Laparoscopic ovarian cystectomy was performed in 240 patients between May 2007 and April 2012 of which 182 consecutive patients who met the selection criteria were enrolled in the study. Intraoperatively, the cyst wall is completely enucleated. Ovarian tissue is kept apposed together with a bowel grasper for 5 min to reconstruct the ovary. No sutures are used for approximation of ovarian edges. The median (range) operating time for cystectomy and reconstruction was 22 min (15-75), and estimated blood loss was 50 ml (30-200). The ovarian reconstruction was good in 84.6 % of the cases, average in 10 % and poor in 5.4 % of the patients. Postoperative scan on day 1 showed pelvic collection (blood) in five cases (20-50 ml). 9.89 % had intraovarian haematoma of 2-3 cm which resolved spontaneously. All patients were followed at 1 month and pregnancy rate was calculated after a minimum follow up of 12months. Pregnancy rate was 50.7% (33 patients) in our study. Approximation of ovarian surface for ovarian reconstruction was associated with shorter operating times, good morphological ovarian reconstruction and comparable pregnancy outcome. This technique requires further well-designed randomized controlled trials.