Ovarian-conserving surgery for large ovarian mature teratomas and cystadenomas: impact of surgical hemostasis techniques on ovarian reserve
Ibragimova U.D., Kozachenko I.F., Goryachev A.A., Adamyan L.V.
Benign ovarian tumors are common in women of reproductive age and often require ovarian-conserving surgery. The primary goal of such procedures is to remove the cystic lesion while maximizing the preservation of healthy ovarian tissue and reproductive potential. A critical aspect of the intervention is the choice of hemostasis method, as it can significantly affect ovarian reserve. Bipolar coagulation is associated with thermal damage to the ovarian stroma and microvasculature, potentially leading to a reduction in ovarian reserve, while the suture method offers mechanical vessel compression.
Objective: To evaluate the impact of hemostasis techniques on changes in ovarian reserve following laparoscopic cystectomy in reproductive-age patients with benign ovarian tumors.
Materials and methods: The study included 50 women aged 18–45 years with large (>8 cm) benign cystic ovarian tumors (mature teratomas and cystadenomas) who underwent surgery at the Gynecological Department of the V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology from 2022 to 2024. Patients were divided into two groups (n=25 each): following cystectomy, either suture hemostasis or bipolar coagulation was performed. Serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) were assessed via transvaginal ultrasound before surgery and three months postoperatively; reproductive outcomes were also recorded.
Results: Baseline demographic and hormonal parameters were comparable between the groups. All surgeries were uneventful, with no statistically significant differences in operative duration or blood loss between the groups. Three months after cystectomy, both groups exhibited statistically significant reductions in AMH levels and AFC compared with baseline values; however, intergroup differences in the degree of reduction were not significant. Reproductive outcomes were also comparable between the groups.
Conclusion: Laparoscopic fertility-sparing cystectomy for benign ovarian tumors is associated with a reduction in ovarian reserve, the extent of which is influenced by the hemostasis technique employed. Both bipolar coagulation and suture-based hemostasis resulted in decreased AMH levels and AFC. Therefore, selecting a modern, effective hemostasis technique that minimizes damage to ovarian tissue is crucial for preserving reproductive potential.
Authors' contributions: Adamyan L.V., Kozachenko I.F. – conception and design of the study; Kozachenko I.F., Ibragimova U.D., Goryachev A.A. – data collection and processing; Ibragimova U.D., Kozachenko I.F., Goryachev A.A. – statistical analysis; Ibragimova U.D., Kozachenko I.F. – drafting of the manuscript; Adamyan L.V. – editing of the manuscript
Conflicts of interest: The authors have no conflicts of interest to declare.
Funding: There was no funding for this study.
Ethical Approval: The study was reviewed and approved by the Research Ethics Committee of the V.I. Kulakov NMRC for OG&P.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
For citation: Ibragimova U.D., Kozachenko I.F., Goryachev A.A., Adamyan L.V. Ovarian-conserving surgery for large ovarian mature teratomas and cystadenomas: impact of surgical hemostasis techniques on ovarian reserve.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (1): 70-77 (in Russian)
https://dx.doi.org/10.18565/aig.2025.290
Keywords
benign ovarian tumors
ovarian mature teratomas
ovarian cystadenomas
reproductive age
ovarian reserve
anti-Müllerian hormone
antral follicle count
laparoscopic cystectomy
surgical hemostasis methods
bipolar coagulation
suture hemostasis
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Received 15.10.2025
Accepted 03.12.2025
About the Authors
Ummusalimat D. Ibragimova, PhD student, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, amintaeva_umm@mail.ru, https://orcid.org/0009-0008-6984-7193Irena F. Kozachenko, Dr. Med. Sci., Leading Researcher, obstetrician-gynecologist, Gynecological Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, irenakozachenko@rambler.ru,
https://orcid.org/0000-0003-1822-9164
Alexander A. Goryachev, 6th year student, Pirogov Russian National Research Medical University, Ministry of Health of Russia, 117513, Russia, Moscow, Ostrovityanova str.,
1, build. 7, alexgoryachev2022@mail.ru, https://orcid.org/0009-0003-0221-3050
Leila V. Adamyan, Academician of the Russian Academy of Sciences, Dr. Med. Sci., Professor, Deputy Director for Research, Head of the Department of Operative Gynecology, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4; Chief Specialist in Gynecology of the Ministry of Health of Russia; Head of the Department of Reproductive Medicine and Surgery of the Faculty of Postgraduate Education, Russian University of Medicine, 127473, Russia, Moscow, Delegatskaya str., 20-1, adamyanleila@gmail.com,
https://orcid.org/0000-0002-3253-4512
Corresponding author: Ummusalimat D. Ibragimova, amintaeva_umm@mail.ru
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