Transvaginal ultrasound ovarian diathermy: sheep as an experimental model
Tóm tắt
Some techniques of transvaginal ovarian drilling have been previously described. Nevertheless a monopolar transvaginal ovarian cauterization, that use the expertise and safety of transvaginal puncture for oocyte captation seems to be an easier and feasible approach. The aim of this study was to develop a minimally invasive ovarian cauterization technique under transvaginal ultrasound control, and to evaluate the safety of the transvaginal ovarian monopolar cauterization, female sheep at reproductive age were used as an experimental model. An experimental study was performed in a university research center. Seventeen female sheep (15 Corriedale e 2 Suffolk) in reproductive age were submitted to transvaginal ovarian cauterization with a monopolar Valleylab Force 2 electrocautery. Macroscopic and microscopic lesions were assessed. Ovarian size were 1.31 cm2 ± 0,43 (Corriedale) and 3.41 cm2 ± 0,64 (Suffolk). From 30 ovaries from Corriedale sheep punctured, only 3 were cauterized, presenting macroscopic and typical microscopic lesion. In the Suffolk sheep group, only one ovary was cauterized. No lesion could be found in the needle path. This is the first experimental animal model described for ovarian cauterization needle guided by transvaginal ultrasound. The sheep does not seem to be the ideal animal model to study this technique. Another animal model, whose ovaries are better identified by transvaginal ultrasound should be sought for this technique, theoretically less invasive, before it could be offered safely to women with polycystic ovary syndrome.
Tài liệu tham khảo
Dunaif A: Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev 1997, 18: 774–800. 10.1210/er.18.6.774
Strowitzki T, Capp E, von Eye Corleta H: The degree of cycle irregularity correlates with the grade of endocrine and metabolic disorders in PCOS patients. Eur J Obstet Gynecol Reprod Biol 2010, 149: 178–181. 10.1016/j.ejogrb.2009.12.024
Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome Fertil Steril 2008, 89: 505–522.
Ehrmann DA: Polycystic ovary syndrome. N Engl J Med 2005, 352: 1223–1236. 10.1056/NEJMra041536
Amer SA, Li TC, Cooke ID: Laparoscopic ovarian diathermy in women with polycystic ovarian syndrome: a retrospective study on the influence of the amount of energy used on the outcome. Hum Reprod 2002, 17: 1046–1051. 10.1093/humrep/17.4.1046
Donesky BW, Adashi EY: Surgically induced ovulation in the polycystic ovary syndrome: wedge resection revisited in the age of laparoscopy. Fertil Steril 1995, 63: 439–463.
Api M: Could transvaginal, ultrasound-guided ovarian interstitial laser treatment replace laparoscopic ovarian drilling in women with polycystic ovary syndrome resistant to clomiphene citrate? Fertil Steril 2009, 92: 2039–2040. 10.1016/j.fertnstert.2009.06.024
Zhu WJ, Li XM, Chen XM, Lin Z, Zhang L: Transvaginal, ultrasound-guided, ovarian, interstitial laser treatment in anovulatory women with clomifene-citrate-resistant polycystic ovary syndrome. BJOG 2006, 113: 810–816. 10.1111/j.1471-0528.2006.00975.x
Ludwig AK, Glawatz M, Griesinger G, Diedrich K, Ludwig M: Perioperative and post-operative complications of transvaginal ultrasound-guided oocyte retrieval: prospective study of > 1000 oocyte retrievals. Hum Reprod 2006, 21: 3235–3240. 10.1093/humrep/del278
Syritsa A: Transvaginal ultrasound-guided electrocautery of the ovaries in infertile patients with polycystic ovarian disease. Int J Gynaecol Obstet 1998, 63: 293–294. 10.1016/S0020-7292(98)00115-5
Badawy A, Khiary M, Ragab A, Hassan M, Sherief L: Ultrasound-guided transvaginal ovarian needle drilling (UTND) for treatment of polycystic ovary syndrome: a randomized controlled trial. Fertil Steril 2009, 91: 1164–1167. 10.1016/j.fertnstert.2008.01.044
Gordts S, Puttemans P, Valkenburg M, Campo R, Brosens I: Transvaginal hydrolaparoscopy in the treatment of polycystic ovary syndrome. Fertil Steril 2009, 91: 2520–2526. 10.1016/j.fertnstert.2008.04.020
Kaya H, Sezik M, Ozkaya O: Evaluation of a new surgical approach for the treatment of clomiphene citrate-resistant infertility in polycystic ovary syndrome: laparoscopic ovarian multi-needle intervention. J Minim Invasive Gynecol 2005, 12: 355–358. 10.1016/j.jmig.2005.05.017
Gallagher K, Dhinsa B, Miles J: Electrosurgery. Surgery 2011, 29: 70–72. 10.1016/j.mpsur.2010.11.009
Toosi BM, Seekallu SV, Pierson RA, Rawlings NC: Evaluation of the ultrasound image attributes of developing ovarian follicles in the four follicular waves of the interovulatory interval in ewes. Theriogenology 2009, 72: 902–909. 10.1016/j.theriogenology.2009.06.006
Gonzalez-Bulnes A, Pallares P, Vazquez MI: Ultrasonographic imaging in small ruminant reproduction. Reprod Domest Anim 2010,45(Suppl 2):9–20.
Tozawa H, Brännström M, Petrucco O, Walker S, Chambers H, Pascoe V, Norman RJ: Distribution of leukocyte subtypes in the sheep ovary after laser drilling. Hum Reprod 1995, 10: 544–550.
Ewoldt JM, Anderson DE, Hardy J, Weisbrode SE: Evaluation of a sheep laparoscopic uterine trauma model and repeat laparoscopy for evaluation of adhesion formation and prevention with sodium carboxymethylcellulose. Vet Surg 2004, 33: 668–672. 10.1111/j.1532-950x.2004.04090.x