From the Guidelines
The best surgical technique for ovarian cystectomy to preserve fertility is laparoscopic ovarian cystectomy with careful stripping of the cyst wall, as it minimizes damage to the ovarian reserve and preserves the maximum amount of healthy ovarian tissue containing follicles. This approach is supported by the American Society of Clinical Oncology's guidelines for fertility preservation in patients with cancer, which emphasize the importance of discussing fertility preservation options with patients before treatment starts 1. Although the provided evidence does not directly compare different surgical techniques for ovarian cystectomy, the principles of minimizing tissue damage and preserving ovarian function are consistent with the recommendations for conservative gynecologic surgery in the treatment of gynecologic malignancies 1.
When performing laparoscopic ovarian cystectomy, it is essential to employ techniques that minimize trauma to the ovarian follicles, such as using targeted bipolar coagulation for hemostasis and the "hydrodissection" technique to separate tissue planes 1. The ovary should be reconstructed with minimal suturing to maintain its anatomical integrity. For endometriomas, extra care must be taken due to their adherent nature and higher risk of diminishing ovarian reserve. Preoperative assessment with antimüllerian hormone (AMH) levels and antral follicle counts can help evaluate baseline ovarian reserve, while postoperative hormonal suppression with combined oral contraceutives may be recommended for certain cyst types to prevent recurrence.
Key considerations for laparoscopic ovarian cystectomy include:
- Minimizing tissue damage to preserve ovarian function
- Using targeted bipolar coagulation for hemostasis
- Employing the "hydrodissection" technique to separate tissue planes
- Reconstructing the ovary with minimal suturing
- Taking extra care with endometriomas due to their adherent nature and higher risk of diminishing ovarian reserve
- Evaluating baseline ovarian reserve with AMH levels and antral follicle counts before surgery
- Considering postoperative hormonal suppression to prevent recurrence of certain cyst types.
From the Research
Surgical Techniques for Ovarian Cystectomy
The best surgical technique for ovarian cystectomy to preserve fertility is a topic of ongoing research. Some studies suggest that:
- Laparoscopic ovarian cystectomy is the standard surgical approach for treating benign ovarian cysts 2
- A combined laparoscopic and extra-abdominal microsurgical technique may simplify the surgical procedure and reduce postoperative adhesion formation 3
- Single-port laparoscopic ovarian cystectomy may be a minimally invasive alternative for patients who want to preserve their fertility, although it may result in higher blood loss and longer operative time 4
Key Considerations for Fertility-Preserving Surgery
When performing ovarian cystectomy, the following considerations are important for preserving fertility:
- Minimizing damage to the ovarian cortex and strategically assessing and responding to genital tract patency 5
- Using a precise and correct technique to preserve ovarian function, such as gentle traction and countertraction to peel the cyst capsule from the ovarian cortex 6
- Avoiding spillage of endometriotic contents and using careful hemostasis with a bipolar instrument 6
Techniques for Optimizing Ovarian Reserve
Some techniques that may help optimize ovarian reserve during laparoscopic cystectomy include: