Strengths and Limitations
There are some limitations of our study. First, ovarian reserve may also
be affected by the mechanical nature of performing cystectomy in an
endometrioma versus a dermoid cyst or cystadenoma or by whether
unilateral or bilateral cystectomy was performed 38.
Some RCTs included patients with both unilateral and bilateral ovarian
cysts undergoing surgery 2, 4, 16-18, 20, 21, 24, we
could not analyze the data separately. However, our results suggest that
the detrimental effect of electrocoagulation compared to the nonthermal
method remains consistent, regardless of whether cystectomy was
performed unilaterally or bilaterally. Furthermore, some patients
underwent repeated laparoscopic cystectomy, although the studies did not
provide specific data on these cases. It’s also worth noting that the
inflammatory factors associated with endometriosis can impact ovarian
reserve. Moreover, it’s important to acknowledge that blinding surgeons
in these studies is challenging, potentially introducing performance and
detection biases. However, it’s noteworthy that in the majority of the
included RCTs, surgical procedures were carried out by either a single
surgeon or a limited number of surgeons, effectively mitigating
performance bias. Ultimately, it’s essential to acknowledge the presence
of substantial heterogeneity, potentially stemming from variations in
nonthermal hemostatic methods, the sizes and histologic types of ovarian
cysts across the studies. We performed a comprehensive, broad, and
systematic search for the present report, with hand-searching of some
references of included studies and previous systematic reviews. Further
studies with double-blinded RCTs and long-term follow-up may be needed
to define better the impact of different hemostatic techniques on
ovarian reserve.