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Comparison of serum antimüllerian hormone levels after robotic-assisted vs. laparoscopic approach for ovarian cystectomy in endometrioma

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Abstract

Objective

Serum antimüllerian hormone (sAMH) is regarded as a useful marker in predicting for ovarian functional reserve. To evaluate whether postoperative change in ovarian reserve differs between robotic-assisted and laparoscopic single-site ovarian cystectomy in patients with ovarian endometrioma by comparing sAMH levels.

Study design

The perioperative outcomes in 94 patients with ovarian endometrioma who underwent robotic assisted (n = 40) or laparoscopic (n = 54) cystectomy were compared retrospectively. The sAMH levels were measured by enzyme immunoassay preoperatively and at 3 months and 6 months after surgery. The difference and ratio of sAMH levels between preoperative and 3 months, 6 months after cystectomy were compared between robotic-assisted and laparoscopic approach for predicting which method is better for preservation of ovarian function.

Result(s)

The sAMH levels were obviously decreased after the surgery (ratio of sAMH levels between preoperative and 3 months, 0.49 ± 0.46 versus 0.52 ± 0.28 ng/mL, mean ± standard deviation) in both groups. There was no difference of the recovery sAMH level at 6 months (ratio of 6 months sAMH to preoperative sAMH level) after cystectomy in unilateral ovarian cystectomy. However, in patients with bilateral endometrioma, the recovery of sAMH level was higher in robotic assisted approach than those of laparoscopic surgery (0.40 ± 0.24 versus 0.21 ± 0.23, p = 0.009). In multivariate linear regression analysis, the coefficient of robot surgery was 0.442 (p = 0.028).

Conclusion(s)

In our study, robotic-assisted cystectomy had higher preservation of ovarian function than the laparoscopic approach for bilateral ovarian endometrioma, but not for unilateral endometrioma. The robotic-assisted approach could be considered for preserving ovarian function in patients with bilateral ovarian endometrioma.

Introduction

Endometriosis is defined as the presence of endometrial-like tissue outside of the uterus. It is common gynecological disease affecting more than 10 % women of reproductive age [1].

Endometrioma is a main pathognomonic feature and the most commonly diagnosed form of endometriosis in reproductive-aged women. While ovarian cystectomy is considered the treatment of choice because of its decreased recurrence rates, there are concerns that the surgery may damage surrounding healthy ovarian tissue and cause a reduction in ovarian reserve.

Ovarian reserve is defined as the quantity and quality of the remaining ovarian follicle pool that is capable of growing in the presence of gonadotropins. Although there is no single ideal marker for predicting functional ovarian reserve in women of reproductive age, antimüllerian hormone (AMH) has been shown to be a good marker [2]. AMH is a dimeric glycoprotein hormone that belongs to the transforming growth factor-ß family. It is secreted by granulosa cells in preantral and antral follicles, but not in primordial follicles [3]. Thus the AMH level indirectly represents the total number of follicles, as estimated by the number of early-growing-stage follicles. Because AMH levels are independent of the menstrual cycle [4], are not affected by the use of gonadotropin-releasing hormone (GnRH) agonists or oral contraceptives [5], and are very sensitive to advancing age [[6], [7], [8]], serum AMH has been widely used in clinical practice for assessing ovarian reserve [9]. It has been demonstrated that serum AMH levels are decreased after the excision of an ovarian endometrioma [[10], [11], [12]] and then can recover after the rearrangement of new growing AMH-secreting follicles [13].

The purpose of the present study is to evaluate whether postoperative changes in ovarian reserve differ between robotic-assisted ovarian cystectomy and the laparoscopic approach in patients with ovarian endometrioma by comparing serum AMH (sAMH) level recovery. To the best of our knowledge, our study is the first series to compare robotic cystectomy with the laparoscopic approach in patients with endometrioma.

Section snippets

Subjects

We retrospectively analyzed a total of 94 women who underwent ovarian cystectomy for endometrioma by robotic-assisted single port (n = 40) or laparoscopic single port (n = 54) surgery between May 2013 and November 2018 at the Department of Obstetrics and Gynecology, Kyungpook National University, Daegu, Korea. The retrospective data collection and analysis were approved by the institutional review board of Kyungpook National University Hospital. The need for informed consent was waived because

Results

The clinical characteristics, preoperative sAMH levels, 3 months and 6 months postoperative sAMH levels, and the ratios among preoperative, 3 months postoperative, and 6 months postoperative sAMH levels are summarized in Table 1. The sAMH levels were decreased at 3 months after ovarian cystectomy in all patients from both the robotic-assisted and laparoscopic groups. Operative time was longer in the robotic-assisted group compared with the laparoscopic group (p = 0.015). There were no

Discussion

Ovarian endometrioma cystectomy in patients of reproductive age leads to a significant reduction in circulating sAMH. The effect is more profound following bilateral ovarian cystectomy compared with unilateral cystectomy. Among patients with bilateral endometrioma in our study, robotic-assisted ovarian cystectomy was better than the laparoscopic approach for postoperative recovery of sAMH level. The recovery of sAMH level at 6 months postoperative was not different between the robotic-assisted

Conclusion

Based on the results of our study, we conclude that robotic-assisted cystectomy in bilateral ovarian endometrioma is better than the laparoscopic approach for the preservation of ovarian function. The robotic-assisted approach could be considered for ovarian cystectomy to preserve fertility in patients with bilateral ovarian endometrioma.

Funding

The authors have no commercial, proprietary, or financial interest in the products and companies described in this article.

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