Autologous platelet-rich fibrin glue in surgery of endometrioid ovarian cysts: a strategy for preserving ovarian reserve

Introduction. Endometriomas are one of the most common gynecological diseases. Surgical removal of endometriomas is considered the standard treatment for large endometriomas and/or those associated with pain. However, despite the clinical effectiveness of endometrioma removal, this approach is associated with a number of reproductive risks.

Objective: to compare the effect of two intraoperative hemostasis methods – autologous platelet-rich fibrin glue versus standard bipolar coagulation – on ovarian function preservation after laparoscopic cystectomy of ovarian endometriomas.

Materials and Methods: A prospective comparative cohort study was conducted involving 72 reproductive-aged women with ovarian endometriomas. Patients were allocated into two groups of 36 each. All patients underwent laparoscopic cystectomy. In Group 1, hemostasis was achieved using autologous platelet-rich fibrin glue; in Group 2, bipolar coagulation was applied. Ovarian reserve was assessed before and 6 months after surgery by measuring serum AMH, FSH, and CA-125 levels; ovarian volume, antral follicle count (AFC), and ovarian artery resistance index (RI) were evaluated by transvaginal ultrasound.

Results: Baseline demographic, hormonal, and ultrasound characteristics were comparable between groups. At 6 months postoperatively, the fibrin glue group showed significantly higher AMH levels compared to the coagulation group: 3.85 (1.89–7.17) vs. 2.1 (1.1–4.3) ng/mL, p=0.03. FSH levels significantly increased in Group 2 (p=0.03) but remained stable in Group 1. AFC in the operated ovary increased in the fibrin glue group (p=0.03) and did not change in the coagulation group. RI significantly decreased in both groups (p<0.01). Postoperative CA-125 levels were significantly lower in Group 1 (p=0.02).

Conclusion: The use of autologous platelet-rich fibrin glue for hemostasis during laparoscopic cystectomy of ovarian endometriomas provides significantly better preservation of ovarian function compared to bipolar coagulation. This technique may be recommended as a priority approach in patients desiring fertility preservation.

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