Laparoscopic Bipolar Versus Unipolar Ovarian Drilling in Infertile Women with Resistant Polycystic Ovarian Syndrome: A Pilot Study

Sharma, Meenakshi; Kriplani, Alka; Agarwal, Nutan

doi:10.1089/gyn.2006.22.105

Cited by 14 publications

(5 citation statements)

References 10 publications

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“…The included trials did not adequately report long-term efficacy regarding live births and adverse events: only 4 reported live births [7,9,22,25], 5 reported multiple pregnancies [6,9,10,13,14,22] and postoperative adhesion [19,20,22,23,27], 2 reported AMH [13,14,21], 1 reported OHSS [28]. The outcomes of the included studies were mostly restricted to 6-month follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Only 4 RCTs reported the outcome of live births [7,9,22,25]. Low quality of evidence allowed for the inability to determine difference in live births between unilateral and bilateral LOD (Table 2; p = 1.00) [5,6,17,18,21−23]; 10 or 5 punctures per ovary (Supplemental Table 1; p = .35) [7,8]; bilateral LOD with bipolar versus monopolar diathermy (Supplemental Table 2; p = .18) [9,10,12−14, 19,20,24−28], bilateral LOD using CO 2 laser compared with monopolar diathermy (Supplemental Table 2; p = .37) [9,10,12−14,19,20,24−28].…”

Section: Live Birthsmentioning

confidence: 99%

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Variation of Laparoscopic Ovarian Drilling for Clomiphene Citrate-resistant Patients with Polycystic Ovary Syndrome and Infertility: A Meta-analysis

Zhang

Zhou

Luo

et al. 2020

Journal of Minimally Invasive Gynecology

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Register in February 2019. Methods of Study Selection: Randomized controlled trials (RCTs) evaluating LOD for patients with clomiphene citrateresistant polycystic ovary syndrome and infertility and reporting reproductive outcomes, surgical complications, serum indexes, menses resumption, and ultrasound results were included. Quality and risk of bias were evaluated by 2 authors, respectively. Tabulation, Integration, and Results: A total of 20 RCTs with 1615 patients were included. Evaluation of the quality of evidence for each study was based on each study's limitations of 5 outcome domains described by the Grading of Recommendations, Assessment, Development, and Evaluation and found to be moderate to very low. Live births were only reported by 4 studies. Unilateral LOD did not differ with bilateral LOD in reproductive outcomes, such as pregnancy (p = .11, I 2 = 75%), ovulation (p = .08, I 2 = 0%), miscarriage (p = .61), and menstruation resumption (p = .06). There was insufficient evidence regarding efficacy and safety of novel methods of LOD, such as transvaginal hydrolaparoscopy (1 RCT) and micro-LOD (3 RCTs). Evidence regarding the suitable number of ovarian punctures, duration of drilling, and antim€ ullerian hormone or antral follicle numbers following LOD were inconclusive. Conclusion: Unilateral LOD seems to be suitable replacement for conventional bilateral LOD for clomiphene citrate-resistant polycystic ovary syndrome, although more studies involving long-term reproductive efficacy, adverse events, and varying forms of LOD are warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Live Birthsmentioning

confidence: 99%

Variation of Laparoscopic Ovarian Drilling for Clomiphene Citrate-resistant Patients with Polycystic Ovary Syndrome and Infertility: A Meta-analysis

Zhang

Zhou

Luo

et al. 2020

Journal of Minimally Invasive Gynecology

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“…[ 24 ] Electrocautery, using an insulated unipolar needle electrode with a non-insulated distal end measuring 1-2 cm, is the most commonly used method, although few authors have reported similar ovulation and pregnancy rates with bipolar energy. [ 25 26 ] The number of punctures is empirically chosen depending on the ovarian size. In the original procedure, 3-8 diathermy punctures (each of 3 mm diameter and 2-4 mm depth) per ovary were applied, using power setting of 200-300 W for 2-4 s.[ 27 ] Most surgeons perform four punctures per ovary, each for 4 s at 40 W (rule of 4), delivering 640 J of energy per ovary (the lowest effective dose recommended).…”

Section: Methodsmentioning

confidence: 99%

Laparoscopic ovarian drilling: An alternative but not the ultimate in the management of polycystic ovary syndrome

Mitra¹,

Nayak²,

Agrawal³

2015

J Nat Sc Biol Med

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Since its introduction in 1984, laparoscopic ovarian drilling has evolved into a safe and effective surgical treatment for anovulatory, infertile women with polycystic ovary syndrome (PCOS), unresponsive to clomiphene citrate. It is as effective as gonadotropins in terms of pregnancy and live birth rates, but without the risks of ovarian hyperstimulation syndrome and multiple pregnancies. It improves ovarian responsiveness to successive ovulation induction agents. Its favorable reproductive and endocrinal effects are sustained long. Despite its advantages, its use in unselected cases of PCOS or for non-fertility indications is not prudent owing to the potential risks of iatrogenic adhesions and ovarian insufficiency.

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“…The clinical pregnancy rate was comparable in one study randomizing 44 patients between unilateral and bilateral treatment (RR 1.00; 0.52, 1.91; P ¼ 1.00); in both groups 10/22 patients became pregnant. The number of live births was 8/22 in the unilateral group and 9/22 in the bilateral group (RR 0.89; 95% CI: 0.42-1.88; P ¼ 0.74) (19,21) . studied the pregnancy rate following laparoscopic ovarian drilling after randomizing between bipolar or unipolar electrocautery in 20 patients.…”

Section: Laparoscopic Ovarian Drillingmentioning

confidence: 96%

“…In the bipolar group 7/10 (70%) patients Figure 2 Summary of meta-analysis presenting relative ratio with CI for primary outcomes per comparison of techniques. The number of live births was four in the unipolar group and was not reported for the bipolar group, thus comparison was not possible (19,20 ) . randomized the right and left ovaries to 6 or 12 puncture holes in 90 women undergoing bilateral ovarian drilling using a unipolar electrocautery technique.…”

Section: Laparoscopic Ovarian Drillingmentioning

confidence: 99%

A Systematic Review and Meta-Analysis for Surgical Techniques Intended to Alleviate Post-Operative Adhesions Following Abdominal and Pelvic Surgery

Allehaiby¹,

Aldosari²,

Alalwan³

2017

EJHM

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Background: postoperative peritoneal adhesions are common and frequent complication following abdominal and Pelvic Surgery. Adhesions can lead to bowel obstructions and infertility in women (when they develop around the reproductive organs), chronic pain which consequently results in reducing the quality of life for patients, level of energy, productivity, and increase the risk, complexity and chance of complications in subsequent surgeries .Main objective of this review is to study the implication of using the ‗good surgical techniques' in the prevention of postoperative adhesions. Methods: the present review included randomized controlled trials (RCTs) that investigated the different surgical technique impact on adhesion-related outcomes were identified through search in Pubmed, CENTRAL and Embase. Identified endpoints were: clinical outcomes and incidence of adhesions. The primary Identification of papers and data extraction were performed by independent researchers. Results: out of 1709 studies, there were only 21 papers eligible for a systematic review and included in the meta-analysis and qualitative assessment. None of the techniques that were compared significantly reduced the incidence of adhesive small bowel obstruction. In a small low-quality trial, the pregnancy rate increased after subserous fixation of suture knots. However, the incidence of adhesions was lower after laparoscopic compared with open surgery [relative risk (RR) 0.14; 95% confidence interval (CI): 0.03-0.61] and when the peritoneum was not closed (RR 0.36; 95% CI: 0.21-0.63). Conclusion: None of the specific techniques that were compared reduced the two main adhesion-related clinical outcomes, small bowel obstruction and infertility. The meta-analysis provides some evidence for the surgical principle that using less invasive techniques, introducing less foreign bodies or causing less ischemia reduces the extent and severity of adhesions.

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Laparoscopic Bipolar Versus Unipolar Ovarian Drilling in Infertile Women with Resistant Polycystic Ovarian Syndrome: A Pilot Study

Cited by 14 publications

References 10 publications

Variation of Laparoscopic Ovarian Drilling for Clomiphene Citrate-resistant Patients with Polycystic Ovary Syndrome and Infertility: A Meta-analysis

Variation of Laparoscopic Ovarian Drilling for Clomiphene Citrate-resistant Patients with Polycystic Ovary Syndrome and Infertility: A Meta-analysis

Laparoscopic ovarian drilling: An alternative but not the ultimate in the management of polycystic ovary syndrome

A Systematic Review and Meta-Analysis for Surgical Techniques Intended to Alleviate Post-Operative Adhesions Following Abdominal and Pelvic Surgery

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