Adhesion formation after microlaparoscopic and laparoscopic ovarian coagulation for polycystic ovary disease

Study Objective. To compare the effects of microlaparoscopy and decreased C O2 exposure on peritoneal microcirculation and potential adhesion formation after ovarian surgery with those of conventional operative laparoscopy. Design. Prospective, randomized study (Canadian Task Force classification I ). Setting. Teaching hospital. Patients. Eighteen women with polycystic ovary disease. Interventions. Microlaparoscopic or laparoscopic ovarian coagulation of the ovaries. Measurements and Main Results. Approximately 10 to 12 coagulation points we re applied to each ovary. Two to 3 weeks after the initial surgery second-l ook microlaparoscopy was performed to determine the extent of adhesions in both groups. The frequency of adhesion formation and changes in glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), catalase (CAT), and gluta thione (GSH) levels were studied in homogenized peritoneal tissues obtained during surgery in each group. Results. Clinical profiles were similar between groups. Mean exposure, amou nt, and pressure of CO2 were significantly less in the microlaparoscopy gro up (p <0.05). The laparoscopy group had significantly more adhesions than t he microlaproscopy group (24% vs 48%, p <0.05). The GSH-Px, SOD, CAT, and G SH levels were significantly lower in the laparoscopy group (0.425 mu mol, 1.2 ng, 37.55 mu mol, and 0.9 nmol vs 0.755 mu mol, 2.1 ng, 625 mu mol, and 2.6 nmol, respectively). Conclusion. Reduced exposure to and amount of CO2 during microlaparoscopy m ay result in decreased adhesion formation compared with conventional laparo scopy. This effect may possibly be due to lack of or minimal adverse effect s on peritoneal microcirculation and cell-protective systems, which are pro posed mechanisms for adhesion formation and closely related to peritoneal i njury. In addition, microlaparoscopy may be a cost-effective alternative to conventional laparoscopy.