#308 : Comparative Outcomes of Robot-Assisted and Conventional Laparoscopic Ovarian Cystectomy for Endometrioma: Evaluating Ovarian Reserve, Recurrence, and Pregnancy Success

Abstract

Background and Aims: Laparoscopic ovarian cystectomy has been the mainstay of surgical methods for endometriosis. Recently, robot-assisted ovarian cystectomy using Da VinciⓇ Xi™surgical system has been successfully introduced into clinical practice and provides specific technical advantages. We aimed to compare robot-assisted ovarian cystectomy (RAOC) and laparoscopic ovarian cystectomy (LOC) in terms of ovarian reserve, recurrence, and pregnancy outcomes. Method: This was a retrospective study in a single tertiary hospital. Patients who underwent RAOC from January 2018 to December 2022 were identified. Propensity score matching was performed on a 1:1 ratio based on age, initial anti-Müllerian hormone (AMH), and BMI with those who underwent LOC during the same period. Results: Patients in the RAOC group (n=43) and LOC (n=43) had similar age (33.2±6.2 vs. 32.8±6.6 years), BMI (21.2±2.9 vs. 21.2±3.0 kg/m2) and AMH (3.25±2.73 vs 3.40±2.36 ng/mL). The cyst was unilateral in 25 cases all for both groups (58.1%) and bilateral in 18 cases (41.9%). The number of ovarian cysts and diameter of the largest cyst were comparable (1.7±0.9 vs. 1.5±0.7; 5.9±2.4 vs. 6.3±1.7 cm, respectively). RAOC had a longer operation time (106±31 vs. 59±20 mins, [Formula: see text]<0.001), but the duration of hospital stays, and postoperative hemoglobin change were similar (2.0±0.0 vs. 2.1±0.2 days; -1.8±0.8 vs. -1.6±0.9 g/dl, respectively). Compared to LOC group, RAOC group had less AMH decrement after six months (-30.6±33.7 vs. -50.8±25.5%, [Formula: see text] =0.007). However, both groups had comparable AMH decrements after 12 and 24 months. Recurrence rates after 24 months follow-up was similar (15.8 vs. 31.3%). There were no statistical differences in clinical pregnancy rate (75.0 vs 14.3%, [Formula: see text]=0.088). Conclusion: Robot-assisted ovarian cystectomy is a feasible treatment option for endometrioma, and it may lead to less short-term decline in ovarian reserve. This approach could be especially beneficial for those who plan to conceive soon after the operation, although the long-term benefits are still unclear.