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

Q: What surgical techniques are compared in this study?

The study compares ROS-RAL (robot-assisted laparoscopy using the Reapproximation of Ovarian Stroma method) versus conventional laparoscopy (CL) for resection of ovarian endometriomas.

Q: How is ovarian reserve assessed over time?

Ovarian reserve is assessed using anti-Müllerian hormone (AMH) levels measured preoperatively and at postoperative intervals of 1, 6, 12, 24, and 36 months, along with the incidence of diminished ovarian reserve (DOR).

Q: What were the main findings regarding AMH decline and DOR?

The ROS-RAL group had higher AMH levels at postoperative months 1, 12, and 36, and the AMH decline rate was significantly lower at all postoperative time points. At 36 months, DOR incidence was also lower in the ROS-RAL group than in the CL group.

Sep 29, 2026

Uploaded by Ezra

This retrospective study evaluates a novel suturing technique for ovarian endometriomas (OMA), the Reapproximation of Ovarian Stroma (ROS) method, using robot-assisted laparoscopy (RAL), compared with conventional laparoscopy (CL). A total of 154 patients undergoing OMA resection at Jeonbuk National University Hospital in Korea between 2017 and 2023 were analyzed. Anti-Müllerian hormone (AMH) was measured preoperatively and up to 36 months to track AMH decline and diminished ovarian reserve (DOR). ROS-RAL showed higher AMH levels, a slower AMH decline, and a lower DOR incidence, with no recurrences in the RAL group. Logistic regression identified ROS-RAL as a protective factor for ovarian reserve function.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Introduction

Ovarian endometriosis and ovarian endometriomas

Treatment rationale and fertility preservation

Methods

Study design and patient groups

Surgical techniques and follow-up schedule

Outcomes and statistical analysis

Results

AMH levels and AMH decline

DOR incidence and recurrence

Logistic regression protective factors

Conclusion

Implications and future research

Journal of Robotic Surgery (2026) 20:138 [https://doi.org/10.1007/s1](https://doi.org/10.1007/s1) 1701-025-03089-4 RESEARCH Robotic assisted versus conventional laparoscopic ovarian suture reapproximation in ovarian cystectomy of ovarian endometriomas in preserving ovarian reserve Chuan Lin1,2,3,4,5 · Guihua Chen5 · Mingda Wang5,6 · Chongkai Zhai7 · Seong-Tshool Hong5,10 · Hee-Suk Chae1,8,9 Received: 13 November 2025 / Accepted: 17 December 2025 © The Author(s) 2025 Abstract 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 ofAMH 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 inpatients 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. Keywords Ovarian endometriomas · Conventional laparoscopy · Robot-assisted laparoscopy · Reapproximation of ovarian stroma Introduction Ovarian endometriosis (endometrioma, OMA) is a disease in which endometrial-like tissues grow inside or on the surface of the ovaries, undergoing hemorrhagic changes with Chuan Lin and Guihua Chen contributed equally to this work. Extended author information available on the last page of the article each menstrual cycle [1] . Endometrial-like tissue invadesthe ovaries, forming cysts knowns as OMA. OMA is the most common manifestation of endometriosis, accounting for 17% to 44% of cases [2] . As the condition progresses, the cysts enlarge, causing extensive adhesions with 1 3 surrounding pelvic tissues and damaging the ovarian cortex, thereby impairing its function. Patients with OMA experience symptoms such as pelvic pain, dyspareunia, abnormal menstruation, infertility, and decreased ovarian function, severely affecting their quality of life and reproductive health [3]

FAQs

What surgical techniques are compared in this study?

The study compares ROS-RAL (robot-assisted laparoscopy using the Reapproximation of Ovarian Stroma method) versus conventional laparoscopy (CL) for resection of ovarian endometriomas.

How is ovarian reserve assessed over time?

Ovarian reserve is assessed using anti-Müllerian hormone (AMH) levels measured preoperatively and at postoperative intervals of 1, 6, 12, 24, and 36 months, along with the incidence of diminished ovarian reserve (DOR).

What were the main findings regarding AMH decline and DOR?

The ROS-RAL group had higher AMH levels at postoperative months 1, 12, and 36, and the AMH decline rate was significantly lower at all postoperative time points. At 36 months, DOR incidence was also lower in the ROS-RAL group than in the CL group.

Sep 29, 2026

Uploaded by Ezra