Kang Jun-Hyeok, Chang Chi-Son, Noh Joseph J, Kim Tae-Joong
Department of Obstetrics and Gynecology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si 11759, Gyeonggi-do, Republic of Korea.
Department of Obstetrics and Gynecology, Chung-Ang University Gwang-Myung Hospital, Chung-Ang University College of Medicine, Gwangmyeong-si 14353, Gyeonggi-do, Republic of Korea.
J Clin Med. 2023 Jul 14;12(14):4673. doi: 10.3390/jcm12144673.
The purpose of this study was to compare single-port access (SPA) laparoscopy and SPA robot assisted laparoscopy (RAL) for endometriosis with respect to ovarian reserve preservation and surgical outcomes. Clinical factors affecting any reduction in ovarian function after surgery were also evaluated. Patients with endometriosis who underwent SPA laparoscopy (n = 87) or RAL (n = 78) were retrospectively reviewed. Patients' baseline characteristics, including the severity of endometriosis and surgical outcomes including surgical complexity, were collected. To assess the preservation of ovarian reserve after surgery, serum anti-Müllerian hormone (AMH) levels before surgery, at two weeks, and at three months after surgery were collected. Age, ovarian cyst size, location of cyst, complexity of surgery, and the severity of endometriosis were associated with the reduction in AMH levels after surgery. The severity of endometriosis was higher in the RAL group than in the SPA group. There were no significant differences in other clinical baseline characteristics, including preoperative AMH levels. For surgical outcomes, radical surgery was more frequently performed in the RAL group. In univariate and multivariate linear regression analyses, age, ovarian cyst size, location of cyst, complexity of surgery, and the severity of endometriosis were associated with the reduction in AMH levels after surgery. Incorporating surgical approaches and risk factors for postoperative ovarian function decrease, RAL was more beneficial than SPA laparoscopy for the preservation of ovarian reserve in patients with mild endometriosis (stage I/II) (postoperative 3 month AMH reduction rate (%), SPA laparoscopy vs. RAL, 33.51 ± 19.98 vs. 23.58 ± 14.98, = 0.04) and in patients who underwent non-complex surgery (postoperative 3 month AMH reduction rate (%), SPA laparoscopy vs. RAL, 37.89 ± 22.37 vs. 22.37 ± 17.49, = 0.022). SPA RAL may have advantages over SPA laparoscopy in ovarian function preservation, especially in patients with mild endometriosis and patients who have undergone a non-complex surgery.
本研究旨在比较单孔腹腔镜手术（SPA）和单孔机器人辅助腹腔镜手术（RAL）治疗子宫内膜异位症在保留卵巢储备功能及手术效果方面的差异。同时评估了影响术后卵巢功能下降的临床因素。对接受SPA腹腔镜手术（n = 87）或RAL手术（n = 78）的子宫内膜异位症患者进行了回顾性分析。收集了患者的基线特征，包括子宫内膜异位症的严重程度，以及手术效果，包括手术复杂性。为评估术后卵巢储备功能的保留情况，收集了术前、术后两周及术后三个月时的血清抗苗勒管激素（AMH）水平。年龄、卵巢囊肿大小、囊肿位置、手术复杂性及子宫内膜异位症的严重程度与术后AMH水平下降有关。RAL组子宫内膜异位症的严重程度高于SPA组。包括术前AMH水平在内的其他临床基线特征无显著差异。在手术效果方面，RAL组更常进行根治性手术。在单因素和多因素线性回归分析中，年龄、卵巢囊肿大小、囊肿位置、手术复杂性及子宫内膜异位症的严重程度与术后AMH水平下降有关。综合手术方式及术后卵巢功能下降的危险因素，对于轻度子宫内膜异位症（I/II期）患者（术后3个月AMH降低率（%），SPA腹腔镜手术组 vs. RAL组，33.51±19.98 vs. 23.58±14.98，P = 0.04）及接受非复杂手术的患者（术后3个月AMH降低率（%），SPA腹腔镜手术组 vs. RAL组，37.89±22.37 vs. 22.37±17.49，P = 0.022），RAL在保留卵巢储备功能方面比SPA腹腔镜手术更具优势。在保留卵巢功能方面，尤其是对于轻度子宫内膜异位症患者和接受非复杂手术的患者，SPA RAL可能比SPA腹腔镜手术更具优势。
