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Grand Rounds

Does Vasopressin Injection Reduce Risk of Reduced Ovarian Reserve During Surgery for Bilateral Endometriomas?

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BACKGROUND AND PURPOSE:

  • Cystectomy is a recognized treatment for endometriomas, but previous literature suggests that especially with bilateral endometriomas, there may be decreased post-op ovarian reserve
  • Qiong-zhen et al. (JMIG, 2018) sought to determine if vasopressin injection during laparoscopic cystectomy for bilateral endometriomas can protect ovarian reserve

METHODS:

  • Prospective randomized controlled trial (RCT)
  • Participants
    • Women with bilateral endometriomas
    • Mean diameter of 4.0 to 6.0 cm (based on ultrasound)
    • Age 30 to 38 years
    • Normal menses: 28 to 30 days in the 6 months before surgery
    • No previous surgical treatment for endometriosis
    • No previous medical treatment for endometriosis in previous 9 months
    • No intention to become pregnant in the next 1 to 2 years
  • Patients randomized to 3 groups
    • Laparoscopic cystectomy by stripping with vasopressin injection technique (VIT group)
      • 20 to 30 mL diluted vasopressin (vasopressin concentration 0.06 U/mL) injected between the cyst wall and the normal ovarian cortex using 22-gauge suction needles
      • 1 puncture for each ovary
      • Total of 2.4 to 3.6 U vasopressin was injected in each cyst
    • Laparoscopic cystectomy by stripping with injection of saline solution (saline)
    • Laparoscopic cystectomy by stripping without injection (control)
  • Primary outcome
    • Removed ovarian tissue thickness
    • Coagulation events
  • Secondary outcomes
    • Basal FSH level before surgery and at 3-, 6-, and 12-month follow-up
  • Statistics
    • P value of <0.05 used for statistical significance

RESULTS:

  • 86 women were included
    • 29 VIT group | 29 control group | 28 saline group
    • Baseline characteristics (e.g. age, size of endometrioma) were the similar in all groups
  • No complications in any of the groups
    • Transient BP elevation in some patients (10-15 mmHg) in VIT group
  • Cyst stripping was easier in the VIT and saline groups because fluid improved separation of surgical planes between normal ovary and cyst
    • VIT group had less oozing and made finding bleeding points easier to identify
  • Compared to controls both VIT and saline group had (p<0.01)
    • Less ovarian tissue in the cyst wall
      • Control group: 0.55 mm
      • Saline group: 0.31 mm
      • VIT group: 0.30 mm
    • Less mean (SD) coagulation events p<0.01)
      • Control group: 17.8 (4.2)
      • Saline group: 10.8 (2.4)
      • VIT group: 4.4 (1.2)
    • Compared to the saline group, the VIT group had
      • Fewer coagulation events (p < 0.01)
      • Lower preoperative FSH levels (p < 0.01) detected than in the saline group
      • There was no significant difference in the thickness of ovarian tissues removed in the 2 groups (p > 0.05)
    • Basal FSH levels were significantly different (slightly) before and after surgery in the control and saline groups (p < 0.01) but not in the VIT group (p > .05)
    • 12-month follow up FSH levels were similar in the 3 groups (p > 0.05)
    • Premature Ovarian Failure
      • Control: 3 patients
      • Saline: 1 patient
      • VIT: 0 patients

CONCLUSION:

  • Vasopressin injection appears to limit to ovarian reserve in the setting of bilateral endometriomas
  • Further studies needed to confirm long-term benefits related to cyst recurrence and fertility

Learn More – Primary Sources:

Effect of Vasopressin Injection Technique in Laparoscopic Excision of Bilateral Ovarian Endometriomas on Ovarian Reserve: Prospective Randomized Study

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Related ObG Topics:

Ongoing Pelvic / Lower Abdominal Pain and a Negative Work-Up: What Next?
Evaluation and Treatment of Endometriosis
Results from the LAROSE Study: Robotic Surgery vs Laparoscopy for Endometriosis

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