Minilaparoscopic ovarian biopsy performed under conscious sedation in women with premature ovarian failure

OBJECTIVE: To evaluate the feasibility of a bilateral multiple ovarian biop sy through minilaparoscopy under local anesthesia and conscious sedation an d to assess the efficacy of this technique as compared to the traditional l aparoscopic approach, STUDY DESIGN: Twenty-five infertile women with premature ovarian failure un derwent bilateral ovarian biopsy plus chromoperturbation. Twelve patients w ere treated with minilaparoscopy (minilap group) and preoperatively receive d mepivacaine for subcutaneous local anesthesia and midazolam plus fentanyl for conscious sedation. Following minilaparoscopy, 40 mt of 0.5% intraperi toneal subdiaphragmatic lidocaine and 5 mt of ropivacaine, 7.5 mg/mL, for i nfiltration of the trocar insertion sites were administered. Thirteen women (control group) were treated with the traditional laparoscopic approach un der general anesthesia. If necessary, ketoprofene or intramuscular ketorola c teas administered following surgery. Postoperative pain score was evaluat ed by a 1-10 visual analogic scale immediately after surgery and in the fol lowing 24 hours; in addition, the quantity of ovarian biopsy material for t he pathologist and the discharge and operative times were evaluated. RESULTS: The minilap group had lower postoperative pain scores postoperativ ely. Operative time was similar in both groups. The rate of discharge two h ours after surgery was significantly higher in the minilap group. In all ca ses the amount of ovarian tissue was sufficient diagnosis. Twenty-one patie nts were affected by premature menopause and four by resistant ovary syndro me. The need for postoperative analgesics was significantly higher in the c ontrol group. CONCLUSION: Minilap allows the performance of bi-lateral, multiple ovarian biopsy under local anesthesia and conscious sedation ill association with c hromoperturbation and the obtaining a sufficient amount of ovarian tissue f or histopathologic diagnosis. Intraperitoneal lidocaine administration and ropivacaine infiltration of the trocar sites were beneficial for patients u ndergoing operative minilap ill a day-surgery setting. The effect of these drugs was obviously temporary; however, low postoperative pain scores and l ow additional analgesic requirement permitted early discharge, within two h ours after surgery.