Reproductive Outcome After Laparoscopic Ovarian Endometrioma Stripping With Volumetric Hydrodissection

Hydrodissection (HD) is used in surgical blunt dissection covering its two types. The first one is volumetric with application of neutral fluids to obtain exclusive separation of tissue planes. The second one is hybrid with additional effect by addition of some pharmaceutics like vasoconstrictors to neutral fluid. In most reports dealing with ovarian endometrioma stripping, the hybrid HD is used.

To assess application of volumetric HD in endometrioma stripping in respect to intraoperative and postoperative data including reproductive outcome.

The prospective observational study was conducted in a group of 53 women qualified for laparoscopic enucleation of endometrial cysts. The patients were operated with two methods according to surgeon choice. First method was the enucleation proceeded by volumetric HD, and in the other one, classic stripping was performed. The patients operated with these methods constituted two groups accordingly. All the patients were asked to fulfill the questionnaires dealing with their reproductive data.

Volumetric HD was not found to reduce surgery time, to diminish the frequency of ovarian stitching, and to reduce postoperative pain. Decrease in the AMH was lower in Group I, but it did not reach statistical significance (p = 0.19). Evacuation of intact endometrial cyst and removal of reduced resected tissue through endobag were more frequent in Group 1 (69.2% vs. 22.2%, p = 0.0006; 46.2% vs. 7.4% p = 0.0039, respectively). Very important fact was absence of mature ovarian cortex in all samples coming from Group 1. We did not observe the differences between the groups in reproductive outcome. Spontaneous conceiving was 63.1% in Group 1 vs. 63.6% in Group 2, and in-time deliveries were 47.3% in Group 1 vs. 50.0% in Group 2.

There are some positive postoperative changes after application of volumetric HD in endometrioma stripping, but it did not cause better reproduction outcome.