Surgical technique of endometrioma excision impacts on the ovarian reserve. Single-port access laparoscopy versus multiport access laparoscopy: a case control study

Abstract

Several recent studies report the detrimental effect of endometrioma excision on the ovarian reserve. Surgical technique and the excessive use of bipolar coagulation could be the key factors. Single-port access laparoscopy (SPAL) ovarian cystectomy has been reported as a comparable procedure to conventional laparoscopy in terms of operative outcomes. The aim of this study was to evaluate whether the single-port surgery affects the ovarian reserve whilst performing laparoscopic ovarian cystectomy for unilateral endometrioma. This was a prospective, case-control study of 99 women with unilateral endometrioma. Forty-nine women underwent single-port cystectomy and 50 women underwent multiport laparoscopic (MPL) conventional cystectomy. The primary outcome was the assessment of the ovarian reserve. We evaluated the serum anti-Mullerian hormone (AMH) levels before, 4-6 weeks and 3 months after surgery. At T2 we performed an ultrasound assessment of the antral follicular count (AFC). We have drawn attention to a statistically significant decrease of the mean AMH value and AFC in the SPAL group at the 4-6-week and 3-month follow-up compared to the conventional laparoscopy group. In conclusion, our results suggest that SPAL cystectomy should not be recommended to patients undergoing surgery for endometrioma excision who want to preserve their fertility.

Age-related trends in anti-Mullerian hormone serum level in women with unilateral and bilateral ovarian endometriomas prior to surgery

“…In contrast, Vignali et al reported that the postoperative decrease in AMH levels in women who had undergone laparoscopic excision of ovarian endometrial cysts was temporary; AMH levels returned to preoperative values 12 months after surgery [ 37 ]. Angioni et al investigated the feasibility of single-port access laparoscopy (SPAL) compared with multiport laparoscopy (MPL) for cystectomy of ovarian endometriomas [ 38 ]. Over a 3-month follow-up period, they observed a significant decrease in AMH serum concentrations and antral follicle count after SPAL compared with MPL and concluded that SPAL cystectomy should not be recommended for women with endometriomas who desire pregnancy [ 38 ].…”

Laparoendoscopic single-site surgery compared with conventional laparoscopic surgery for benign ovarian masses: a systematic review and meta-analysis

“…The characteristics of these 13 studies, including four RCTs9–12 and nine retrospective studies,13–21 are shown in tables 1 and 2. The geographic distribution of these study institution was varied, with seven reports from Korea, two from Italy and one from America, England, China and Turkey, respectively.…”

“…All studies9–21 reported operative time for 1542 patients, and the LESS group had longer operative time than the CL group (WMD: 3.43 min; 95% CI: −0.03 to 6.88; p=0.05). Significant heterogeneity was found between these studies (χ²=34.85, df=12, p＜0.001; I²=66%)(figure 6).…”

“…The size of adnexal masses was objectively assessed in 11 studies10–18 20 21 that investigated 1313 patients (figure 8B), and there was no significant difference between the LESS and CL groups (WMD: −0.21, 95% CI: −0.68 to 0.26; p=0.38). In terms of BMI reported in all 13 studies,9–21 there was no significant difference between the LESS and CL groups (WMD: −0.02, 95% CI: −0.32 to 0.29; p=0.90) (figure 8C). Nine studies included 956 reported the history of previous abdominal surgery and showed no significant difference between both groups (25.47% and 27.25%; OR: 0.99; 95% CI: 0.73 to 1.34, p=0.94) (figure 8D).…”

Robotics and Reproductive Surgery

“…However, the removal of ovarian endometriosis is one of the fields in which the outcome of conventional LESS surgery is reported to be inferior to multiport laparoscopy (in terms of residual ovarian reserve), likely because in LESS surgery electrocautery is likely to be used instead of suturing to achieve hemostasis. 178,179 In this perspective, one could claim that overcoming the extreme ergonomic challenges of LESS surgery by robotic assistance makes sense also for this application. Gargiulo et al have recently described a technique of RSS excision of endometrioma that includes a modification of the partial stripping and partial CO 2 laser ablation originally proposed by Donnez et al 83,180 In conclusion, RSS surgery has made some significant strides in recent years, in parallel with the development of the first generation of dedicated technology.…”