Minilaparoscopic ovarian drilling under local anesthesia in patients with polycystic ovary syndrome

Objective: To assess pain control in patients with polycystic ovary syndrom e (PCOS) who are undergoing ovarian drilling during minilaparoscopy under l ocal anesthesia and conscious sedation and to evaluate the efficacy of this protocol compared with the traditional approach in terms of operative and discharge times, subsequent ovulation, and pregnancy. Design: Prospective randomized study. Setting: University hospitals and private day-surgery unit. Patient(s): Sixty-two infertile women with PCOS. Intervention(s): Group A underwent minilaparoscopic ovarian drilling under local anesthesia and conscious sedation. Group B (control group) was treate d with traditional ovarian drilling by laparoscopy under general anesthesia . Main Outcome Measure(s): Intraoperative pain score in group A. Hormonal pro file before and after surgery, operative and discharge times, postoperative analgesic requirements, and reproductive follow-up in both groups. Result(s): Group A showed a good intraoperative pain score. The hormonal pr ofile after surgery did not differ between groups A and B. Operative times were also similar for both groups, The number of patients discharged within 2 hours after surgery was significantly higher in group A. The need for po stoperative analgesics was significantly higher in group B. No statisticall y significant differences were noted between the groups in terms of pregnan cy and ovulation rates. Conclusion(s): Intraoperative and postoperative local anesthesia plus consc ious sedation allows outpatient bilateral ovarian drilling by minilaparosco py to be performed without general anesthesia. The high pregnancy rates, th e simplicity of the method, and the faster discharge time offer a new optio n for patients with PCOS who are resistant to clomiphene citrate. Moreover, ovarian cauterization can be performed simultaneously with, diagnostic min ilaparoscopy and integrated into the infertility workup of these patients. (C)2000 by American Society for Reproductive Medicine.