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

OBJECTIVE: Serum antimullerian 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.