Laparoscopic Ovarian Cystectomy of Endometrioma vs Deroofing and Ovarian Reserve
Condition: Endometrioma
MeSH terms: Endometriosis
Study type: Interventional

Summary: 
      The purpose of this study is to evaluate the impact of laparoscopic ovarian cystectomy versus
      laparoscopic cyst deroofing on ovarian reserve measured by serum levels of anti mullerian
      hormone and antral follicle count in patients with endometriomas.
    

Detailed description: 
      One of the major concerns about excision of endometriomas is their negative effect on ovarian
      reserve because of follicle loss, removal of endometriomas has been associated with poorer
      performance in IVF procedures, and decreased ovarian volumes have also been reported after
      surgery.Ovarian reserve is defined as the functional potential of the ovary which reflects
      the number and quality of the follicles left in the ovary, and is well-correlated with the
      response to ovarian stimulation using exogenous gonadotrophin. Over the years, various tests
      and markers of ovarian reserve have been reported; the static tests include serum markers,
      such as basal FSH, inhibin-B and anti-Mullerian hormone (AMH), and ultrasonographic markers,
      such as ovarian volume and antral follicle count.This study will include 122 patients aged
      between 18 and 35 years who have been diagnosed with endometrioma (unilateral or bilateral)
      and they are candidates for laparoscopic surgery. They will be selected according to
      inclusion and exclusion criteria.they will be randomized into two study groups, one study
      group will undergo laparoscopic ovarian cystectomy, the other study group will undergo
      laparoscopic cyst deroofing.AMH,AFC and ovarian volume will be measured pre-operative and
      post-operative.
    

Intervention name(s): Laparoscopic ovarian cystectomy; laparoscopic cyst deroofing
Intervention type(s): Procedure; Procedure
Intervention description(s): will be performed using video control under general anesthesia, pneumoperitoneum is induced by carbon dioxide, with three 5-mm trocars in the lower abdomen and a 10-mm intraumbilical main trocar, and we will use 5-mm scissors and graspers, and Ringer's lactate solution for irrigation. Before initiating ovarian surgery, the ovaries are completely freed with obtuse and sharp dissection.after a cleavage plane between the cyst wall and ovarian cortex is identified, the ovaries are pulled slowly and gently in opposite directions by means of two a traumatic grasping forceps. After removing the pseudo capsule from the abdominal cavity, selective minimal (15 watt) bipolar coagulation of bleeding is performed, without excessive coagulation of the surgical defect to avoid damaging the ovary.; will be performed using video control under general anesthesia, pneumoperitoneum is induced by CO2, with three 5-mm trocars in the lower abdomen and a 10-mm intraumbilical main trocar, and we will use 5-mm scissors and graspers, and Ringer's lactate solution for irrigation. Before initiating ovarian surgery, the ovaries are completely freed with obtuse and sharp dissection. after mobilizing the ovary, the contents of the cyst is removed with the suction-irrigator probe and the cavity is irrigated. The inside of the cyst is evaluated and the portion of ovarian cortex involved with endometriosis is removed. Small blood vessels from the ovarian bed and bleeding from the ovarian hilum can be controlled with bipolar electro coagulation (15 watt). Low-power bipolar coagulation applied to the inside wall of the redundant ovarian capsule
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: Laparoscopy; AMH; AFC; Endometrioma; ovarian reserve; Ovarian cystectomy; ovarian cyst deroofing