European Journal of Obstetrics & Gynecology and Reproductive Biology
Full length articleComparison of serum antimüllerian hormone levels after robotic-assisted vs. laparoscopic approach for ovarian cystectomy in 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.
References (30)
- et al.
Decline of serum antimullerian hormone levels after laparoscopic ovarian cystectomy in endometrioma and other benign cysts: a prospective cohort study
Fertil Steril.
(2014) - et al.
Mullerian Inhibiting Substance is an ovarian growth factor of emerging clinical significance
Fertil Steril.
(2007) - et al.
Serum antimullerian hormone levels best reflect the reproductive decline with age in normal women with proven fertility: a longitudinal study
Fertil Steril.
(2005) - et al.
Antimullerian hormone serum levels: a putative marker for ovarian aging
Fertil Steril.
(2002) - et al.
Ovarian cortex surrounding benign neoplasms: a histologic study
Am J Obstet Gynecol.
(1993) - et al.
Anti-Mullerian hormone follow-up in young women treated by chemotherapy for lymphoma: preliminary results
Reprod Biomed Online
(2010) - et al.
Impact of laparoscopic cystectomy on ovarian reserve: serial changes of serum anti-Mullerian hormone levels
Fertil Steril.
(2010) - et al.
Laparoscopic stripping of endometriomas negatively affects ovarian follicular reserve even if performed by experienced surgeons
Reprod Biomed Online.
(2011) - et al.
Changes in serum antimullerian hormone levels in patients 6 and 12 months after endometrioma stripping surgery
Fertil Steril.
(2018) - et al.
Laparoscopic excision of ovarian cysts: is the stripping technique a tissue-sparing procedure?
Fertil Steril.
(2002)
Effect of laparoscopic excision of endometriomas on ovarian reserve: serial changes in the serum antimullerian hormone levels
Fertil Steril.
The impact of electrocoagulation on ovarian reserve after laparoscopic excision of ovarian cysts: a prospective clinical study of 191 patients
Fertil Steril.
Effect of Endometrioma cystectomy on cytokines of follicular fluid and IVF outcomes
J Ovarian Res.
Anti-Mullerian hormone inhibits initiation of primordial follicle growth in the mouse ovary
Endocrinology.
Anti-Mullerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART)
Hum Reprod Update
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