The optimal time for laparoscopic excision of ovarian endometrioma: a
prospective randomized controlled trial
Abstract
Objective: The purpose of this study was to explore the optimal time of
laparoscopic cystectomy for unilateral ovarian endometrioma patients and
to evaluate the influence on the ovarian reserve. Design: Prospective
randomized controlled study. Setting: University hospital Population or
Sample:88 patients received their first identified diagnosis of ovarian
endometrioma by ultrasound (>4 cm) and were given oral
contraceptive pills (OCP, drospirenone and ethinylestradiol) for one
cycle before laparoscopy. Methods:Randomly divided into two groups:
laparoscopy at Late luteal phase (group LLP) (n=44): Termination of OCP
for 2 days; and laparoscopy at Early follicular phase (group EFP)
(n=44): Day 3 after menstruation. Main Outcome Measure(s): Serum
Anti-Müllerian hormone (AMH) and Leukocyte esterase (LE) levels of
endometrioma wall were measured. Assessment of ovarian reserve damage
based on alterations in the serum AMH levels after unilateral ovarian
endometrioma surgery. Result(s): Preoperative serum AMH levels of both
group decreased from preoperative to post-operative 1 week and
post-operative 6 months, while difference values of group EFP were
larger than those of group LLP at post-operative 1 week and
post-operative 6 months respectively(1.87±0.97 vs 1.31±0.93, P<0.01;
1.91±1.06 vs 1.54±0.93, P<0.01);the mean rates of post-operative serum
AMH decline were 37.92% and 46.34% in group EFP respectively, which
were significantly higher than those of group LLP (25.83% vs
31.43%,P<0.01). Ovarian endometrioma wall AMH of group LLP was
significantly lower than that of group EFP ([22.86±3.74] vs
[31.02±5.23], P<0.01);While ovarian endometrioma LE concentration
of group LLP was significantly higher than that group
EFP([482.83±115.88] vs [371.68±84.49], P<0.01). And significant
negative correlation between leukocyte esterase and AMH concentration in
the cyst wall of ovarian endometrioma (r=-0.564,P<0.01).
Conclusion(s): The optimal time for laparoscopic cystectomy for
patients with first identified unilateral ovarian endometrioma is late
luteal phase, which reduces ovarian tissue loss and preserves ovarian
reserve effectively and safely.