Ovarian recovery after laparoscopic enucleation of ovarian cysts : insights from echographic short-term postsurgical follow-up

STUDY OBJECTIVE: To evaluate damage to ovarian reserve following laparoscopic cystectomy of benign ovarian cysts. DESIGN: Prospective study (Canadian Task Force classification II-3). SETTING: Tertiary gynecologic endoscopic unit at a university-affiliated hospital. PATIENTS. Thirty-one patients who underwent excision of monolateral (n 25) or bilateral (n 6) benign ovarian cysts. INTERVENTIONS: Serial transvaginal ultrasound examinations during the first and third postsurgical menstrual cycles. The following ovarian echographic variables were evaluated: antral follicle count, ovarian volume, stromal blood flow, and side of ovulation. Two types of statistical analysis were performed: a paired analysis comparing operated and intact ovaries of the same patient and a prospective analysis comparing ecographic characteristics of the operated gonad at first and second evaluation. MEASUREMENTS AND MAIN RESULTS: Antral follicle count and stromal blood flow were not significantly affected by surgery. While ovarian volume was similar in the operated and in the contralateral intact gonad at the first ultrasound evaluation, the volume of the operated ovary was significantly reduced at the second assessment. The median (interquartile range) of the percentage of this reduction was 33% (18%– 81%). This progressive reduction was confirmed by prospectively analyzing the operated ovaries. An increased probability of ovulation in the intact gonad was observed at both assessments. CONCLUSION: Laparoscopic excision of ovarian cysts is associated with damage to ovarian reserve, at least immediately after surgery. This effect does not appear to be consequent to an injury to ovarian vascularization.