Abstract:
Study Objective. To compare the effects of microlaparoscopy and decreased CO2 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 were applied to each ovary. Two to 3 weeks after the initial surgery second-look 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 glutathione (GSH) levels were studied in homogenized peritoneal tissues obtained during surgery in each group. Results. Clinical profiles were similar between groups. Mean exposure, amount, and pressure of CO2 were significantly less in the microlaparoscopy group (p <0.05). The laparoscopy group had significantly more adhesions than the microlaparoscopy group (24% vs 48%, p <0.05). The GSH-Px, SOD, CAT, and GSH levels were significantly lower in the laparoscopy group (0.425 μmol, 1.2 ng, 37.55 μmol, and 0.9 nmol vs 0.755 μmol, 2.1 ng, 625 μmol, and 2.6 nmol, respectively). Conclusion. Reduced exposure to and amount of CO2 during microlaparoscopy may result in decreased adhesion formation compared with conventional laparoscopy. This effect may possibly be due to lack of or minimal adverse effects on peritoneal microcirculation and cell-protective systems, which are proposed mechanisms for adhesion formation and closely related to peritoneal injury. In addition, microlaparoscopy may be a cost- effective alternative to conventional laparoscopy.