«Aggressiveness» of cystectomy in endometrioid ovarian cysts

The objective: To assess the «aggressiveness» of laparoscopic cystectomy performed by the developed method based on dynamic measurement of the levels of anti-Müllerian hormone (AMH) and intraovarian blood flow. Patients and methods: The study included 131 patients of reproductive age with primary infertility and unilateral endometriomas (OE). Two groups were singled out depending on the state of ovarian reserve (OR): basic group - 71 (54.2%) women with low OR (levels of AMH <2.0 ng/ml, follicle-stimulating hormone (FSH) >10 IU/l) and control group - 60 (45.8%) patients with normal levels OR (levels of AMH <2.0 ng/ml, FSH <8 IU/l). In each group, 2D- and 3D-transvaginal echography with Doppler imaging was performed. All patients underwent cystectomy through laparoscopic access according to the developed method. In both groups, 1 and 3 months after cystectomy the functional state of the ovaries was assessed. Results: The results we have obtained indicate that a correct technique of cystectomy with the use of argon plasma coagulation and also under favourable basic surgical conditions, including a «marginal » location of tumour in an ovary irrespective of the initial state of OR, surgical intervention does not have any significant effect on AMH levels. Irrespective of the cyst location, the values of pulsatility index (PI) and resistance index (RI) were by 1.5 times lower, and vascularisation index (VI) and flow index (FI) - by 1.7 times higher in the group with normal OR as compared to the group with low OR in all points of study. A decrease of intraovarian blood flow was noted 1 month after surgery as compared with pre-operational levels, and 3 months afterwards blood flow was restored. Conclusion: The «aggressiveness» of cystectomy and its effect on OR are determined by the technique of operative intervention and specificities of the cyst location. © 2018 Dynasty Publishing House. All rights reserved.