Impact of Different Hemostasis Methods During Laparoendoscopic Single-site Ovarian Cystectomy on Ovarian Reserve

Objective: Preserving ovarian reserve function during single-port laparoscopic ovarian cystectomy is crucial for women of reproductive age. This study aimed to evaluate the hemostatic efficacy and impact on ovarian reserve of three different hemostatic methods in LESS (laparoendoscopic single-site) ovarian cystectomy. Methods: Patients with unilateral ovarian cysts were divided into three groups based on hemostatic methods: the oxidized cellulose polymer group, the suture group, and the bipolar coagulation group. All participants underwent standardized LESS ovarian cystectomy. Intraoperative hemostatic effects within 10 minutes, intraoperative blood loss, and postoperative hemoglobin reduction were observed. Blood samples were collected before surgery, 1 month and 6 months after surgery to measure anti-MÜ llerian hormone (AMH) levels via radioimmunoassay. Vaginal ultrasound was performed preoperatively and 6 months postoperatively to obtain ovarian stromal peak systolic velocity (PSV) and antral follicle count (AFC). Results : All three hemostatic methods demonstrated equivalent hemostatic efficacy (P>0.05). However, significant differences emerged in ovarian reserve outcomes, at 6-month evaluation, oxidised cellulose polymer demonstrated superior preservation: AMH decline was 5.9% (Δ–0.22 ng/mL) with a 15.4% advantage over bipolar coagulation (mean difference Δ–0.80 ng/mL; P<0.001). Although there was no statistically significant difference in the decline of anti-Müllerian hormone (AMH) levels between the oxidized cellulose polymer group and the suture group (P = 0.749), the suture group still exhibited a greater reduction compared to the oxidized cellulose polymer group (Δ–0.27 ng/mL). However, in the endometriosis subgroup, the suture group demonstrated a significantly greater decline in AMH levels compared to the oxidized cellulose polymer group (P=0.006). Oxidized cellulose polymer again demonstrated superior preservation over suturing in AFC (mean decline ratio 0.11, 95% CI 0.10-0.14) and PSV (mean decline ratio 0.051, 95% CI 0.043 - 0.062), particularly in endometriosis patients where these differences were statistically significant (P<0.05). Conclusion: In LESS ovarian cystectomy, while bipolar coagulation, suturing, and oxidized cellulose polymer show equivalent hemostatic efficacy, the oxidized cellulose polymer demonstrates superior preservation of ovarian reserve function (AMH, AFC, and PSV parameters) with significantly less surgical trauma and greater technical simplicity. These findings strongly support the preferential use of oxidized cellulose polymer, particularly for fertility-preserving procedures in reproductive-age women, with added benefits for endometriosis patients who show heightened vulnerability to ovarian reserve compromise. (Clinical Trial Registration: ChiCTR2500102270)