Ovarian hemostasis and ovarian reserve: the perspective of a pediatric gynecologist

Introduction. All current methods of hemostasis used in ovarian surgery inevitably lead to damage to healthy follicles. Significant loss of ovarian reserve in childhood can lead to the development of premature ovarian insufficiency in the future. Therefore, the choice of a method of hemostasis that is most gentle on ovarian tissue becomes particularly important in pediatric gynecology. Materials and methods. Paper search and analysis was completed using the PubMed, Embase, Cochrane Library and Google Scholar databases. This literature review includes systematic reviews, cohort studies, case series, and randomized controlled trials (RCTs) from 1989 to 2024. Results. All modern methods of hemostasis lead to a decrease in the ovarian reserve. The rate and potential of ovarian tissue repair depends on the method as well as the technique of hemostasis. According to the presented data, there is no unambiguous opinion between coagulation and ligature hemostasis methods when working with ovarian tissue. Coagulation hemostasis is technically easier and less time-consuming than suturing, especially for an inexperienced surgeon. Complications associated with technical errors during hemostasis can lead to a significant deterioration of the ovarian reserve in the long-term perspective. Thus, the appropriate method of hemostasis in each clinical situation is determined according to technical capabilities, skills, and preferences of the surgeon and the operation plan. Conclusion. Careful preservation of ovarian reserve in pediatric practice is of paramount importance for the future reproductive health of female patients. When choosing a method of hemostasis, it is important to take into account the technical capabilities and skills of the surgeon. Further study is needed to assess the impact of modern hemostasis methods on ovarian reserve.