Robotic assisted versus conventional laparoscopic ovarian suture reapproximation in ovarian cystectomy of ovarian endometriomas in preserving ovarian reserve

This study aims to introduce and evaluate a novel suturing technique for treating ovarian endometriomas (OMA) using robot-assisted laparoscopy (RAL), termed the Reapproximation of Ovarian Stroma (ROS) method. The primary focus is to assess the efficacy of ROS-RAL in treating OMA and preserving ovarian reserve, as measured by anti-Müllerian hormone (AMH) levels, compared to conventional laparoscopy (CL). In this retrospective study, we evaluated 154 patients who underwent OMA resection via either CL or RAL at Jeonbuk National University Hospital in Korea between February 1, 2017, to December 31, 2023. Among the participants, 85 patients received CL using conventional ovarian surgery, while 69 patients received ROS-RAL surgery. AMH levels were measured preoperatively and at postoperative intervals of 1, 6, 12, 24, and 36 months to determine the rate of AMH decline. The incidence of diminished ovarian reserve (DOR) was assessed to evaluate the impact on ovarian function over time. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with decreased ovarian reserve following OMA surgery. The ROS-RAL group exhibited higher AMH levels at postoperative months 1, 12, and 36 compared to the CL group (p < 0.05). Furthermore, the rate of AMH decline at all postoperative time points was significantly lower in the ROS-RAL group (p < 0.05). At 36 months postoperatively, the incidence of DOR was also notably lower in the ROS-RAL group than in the CL group (27.54% vs. 44.71%, p = 0.028). Multivariate logistic regression analysis showed that ROS-RAL (OR: 0.207, 95% CI: 0.068–0.561, p = 0.003), higher preoperative AMH levels (OR: 0.43, 95% CI: 0.29–0.59, p < 0.001), unilateral cysts (OR: 3.36, 95% CI: 1.24–9.74, p = 0.020), and younger age (OR: −0.12, 95% CI: −0.16 to −0.08, p < 0.001) were found as protective factors for postoperative ovarian reserve function. Additionally, the postoperative recurrence rate in the CL group was 5.88%, while no recurrence cases were observed in the RAL group. This study demonstrates that the novel ROS-RAL surgery offers significant advantages in treating OMA and preserving ovarian function postoperatively in patients with OMA. Future research should incorporate larger sample sizes and evaluate the influence of surgical expertise and refinement in technique to substantiate and expand upon these results, ultimately contributing to optimized treatment strategies for OMA.