Illustration of ovaries with fibrin sealant protection

Fibrin Sealant: A Gentle Approach to Ovarian Endometrioma Excision?

Lena Kashyap in Health & Wellness October 2026 • 4 min read.

"Discover how fibrin sealant (Tisseel) offers a safe, suture-free alternative in laparoscopic surgery, promoting quicker recovery and minimal tissue damage."

Ovarian endometriomas, cysts formed by endometrial tissue, affect many women, causing pain and potential fertility issues. Laparoscopic cystectomy (LC), the surgical removal of these cysts, is a common treatment, but it can come with risks. Traditional methods sometimes lead to damage to the ovaries, impacting future fertility.

Typical laparoscopic cystectomy involves stripping the cyst wall and using electrocautery to stop bleeding. However, electrocautery can harm the healthy ovarian tissue. Surgeons often suture the ovary to control bleeding, but this too can cause issues like adhesions (internal scar tissue) and further tissue damage. The challenge lies in finding a balance between effectively removing the endometrioma and preserving the delicate ovarian tissue.

Now, a new approach is emerging: the use of fibrin sealant, specifically Tisseel. This two-component sealant mimics the body's natural clotting process to control bleeding and aid tissue repair. A recent study published in the Taiwanese Journal of Obstetrics & Gynecology explores the potential benefits of Tisseel in laparoscopic cystectomy, suggesting it could minimize the need for electrocautery and sutures, leading to less ovarian damage and improved patient outcomes.

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Stats & Impact

Ovarian Health and Disease

Ovarian disorders affecting women's health include cancer, cysts, polycystic ovary syndrome, and ovarian torsion. The National Cancer Institute identifies ovarian epithelial cancer as the most common type of ovarian cancer, while cancer can also begin at the end of the fallopian tube near the ovary or in the peritoneum and spread to the ovary. The ovaries, located on either side of the uterus, produce eggs and the hormones estrogen and progesterone.

Tisseel: A Minimally Invasive Solution for Ovarian Health?

Illustration of ovaries with fibrin sealant protection

The study, conducted between January 2011 and December 2015, compared two groups of women undergoing laparoscopic cystectomy for ovarian endometriomas. One group (53 women) had Tisseel applied to the surgical site to control bleeding and repair the ovarian defect after cyst removal. The other group (221 women) underwent the traditional procedure using bipolar electrocautery and sutures.

Researchers collected data on various factors, including:

Operative time
Estimated blood loss (EBL)
Complications
Postoperative hospital stay
Size of the endometrioma

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Latest Research

Fibrin Sealants in Ovarian Surgery

A retrospective comparative study of transvaginal natural orifice ovarian cystectomy reported on the use of human fibrin glue, specifically Tisseel, for benign and non-endometriotic ovarian tumors. The study notes that a prior study demonstrated the safety and feasibility of using Tisseel during laparoscopic excision of ovarian endometrioma. A gynecologic surgery review also describes topical hemostatic and tissue-sealing agents as superior to conventional hemostatic methods in the cited evidence.

Counterpoints

Preliminary Evidence and Limits

The available source describes the evidence for Tisseel in laparoscopic excision of ovarian endometriomas as a preliminary series. That series reported that using Tisseel without bipolar coagulation or suturing of ovarian tissue was clinically safe and feasible. Because the source characterizes the findings as preliminary, they do not by themselves establish effectiveness across broader patient groups or surgical settings.

The results indicated that Tisseel was effective in achieving complete hemostasis (stopping bleeding) in all patients. While the group treated with Tisseel had larger endometriomas on average, there was no significant difference in operative time, blood loss, or length of hospital stay compared to the traditional method. Importantly, the study reported no major complications in either group, suggesting Tisseel is a safe and feasible alternative to electrocautery and sutures.

The Future of Endometrioma Surgery: A Gentler Approach

The study offers encouraging initial evidence for the use of Tisseel in laparoscopic cystectomy for ovarian endometriomas. By potentially reducing the need for electrocautery and sutures, Tisseel may help minimize ovarian damage, preserve fertility, and improve overall patient outcomes. Further research, including larger, randomized controlled trials, is needed to confirm these findings and explore the long-term benefits of this promising technique. For women facing ovarian endometrioma surgery, Tisseel represents a potential step towards a gentler, more tissue-sparing approach.

What an observational comparison can establish

Observational study (level 4 of 8)

This was an observational study of patients undergoing laparoscopic cystectomy for endometrioma, with outcomes compared against a group that did not receive Tisseel. It can describe how the groups’ reported outcomes differed, but it cannot establish that Tisseel caused those outcomes.^[1]

Where this Tisseel evidence is weakest

The comparison was retrospective, which limits how confidently differences can be attributed to Tisseel itself.^[1]

The Tisseel cystectomy study at a glance

Study design	Observational study^[1]
Population	Patients who underwent laparoscopic cystectomy of endometrioma^[1]
Sample size	274 patients (53 with Tisseel and 221 without Tisseel)^[1]
Duration	January 2011 to December 2015^[1]
Comparison	LC of endometrioma without Tisseel (group B)^[1]
Main outcome	Control of minor bleeding and repair of the ovarian defect^[1]
Effect size	Complete hemostasis was achieved in all patients^[1]
p-value	p = 0.033^[1]
Times cited	9^[1]

How later papers placed this ovarian-surgery result

A later paper on transvaginal cystectomy for benign, non-endometriotic tumors cited this work as prior evidence of Tisseel’s safety and feasibility in laparoscopic endometrioma excision.^[2]

Sources

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.tjog.2017.04.014, Alternate LINK

Title: The Use Of Fibrin Sealant (Tisseel) In Laparoscopic Excision Of Ovarian Endometrioma

Subject: Obstetrics and Gynecology

Journal: Taiwanese Journal of Obstetrics and Gynecology

Publisher: Elsevier BV

Authors: Yu-Cheng Liu, Yi-Chieh Li, Hsin-Hong Kuo, Chin-Jung Wang, Kai-Yun Wu

Published: 2017-06-01

Everything You Need To Know

What is Fibrin Sealant (Tisseel), and how is it used?

Fibrin sealant, specifically Tisseel, is a substance used in laparoscopic cystectomy to stop bleeding and help repair the ovarian defect after cyst removal. It mimics the body's natural clotting process, offering a suture-free and potentially electrocautery-free alternative. This approach aims to minimize tissue damage during the surgical removal of ovarian endometriomas, ultimately preserving fertility and improving patient outcomes.

What are ovarian endometriomas, and how are they treated?

Ovarian endometriomas are cysts formed by endometrial tissue that grow outside the uterus, often on the ovaries. Their presence can cause pain and can lead to potential fertility issues. Laparoscopic cystectomy (LC) is a surgical procedure to remove these cysts. The traditional approach often involves electrocautery and sutures. The use of Fibrin Sealant (Tisseel) offers a less invasive approach to address these endometriomas.

Why is using Fibrin Sealant (Tisseel) considered important in this context?

Tisseel is significant because it potentially reduces the need for electrocautery and sutures, which are traditional methods in laparoscopic cystectomy. Eletrocautery can cause harm to the healthy ovarian tissue, while sutures can lead to adhesions and further tissue damage. By using Tisseel, surgeons aim to minimize these risks, leading to less damage and improved patient outcomes, especially concerning fertility.

What was the study comparing, and what were the key findings?

Laparoscopic cystectomy (LC) is a surgical procedure to remove ovarian endometriomas. In the study, one group of women had Tisseel applied to the surgical site, while the other group underwent the traditional method involving bipolar electrocautery and sutures. The study evaluated various factors, including operative time, estimated blood loss, complications, postoperative hospital stay, and the size of the endometrioma. The results indicated that Tisseel was effective in achieving complete hemostasis (stopping bleeding) and was safe.

What are the potential implications of using Fibrin Sealant (Tisseel) for women's health?

Using Tisseel in laparoscopic cystectomy has implications for women's health by potentially reducing ovarian damage, preserving fertility, and improving overall patient outcomes. This approach represents a step toward a gentler, more tissue-sparing method. Further research is needed to confirm the long-term benefits and establish Tisseel as a standard practice, providing a better quality of life and future reproductive possibilities for women undergoing surgery for ovarian endometriomas.