Introduction
Benign ovarian cysts are very common in women of reproductive age and often require surgical excision, particularly when they cause symptoms or infertility1. However, there has been a growing concern over the possible damaging effect of this procedure on ovarian reserve2, 3. The continuous development of technology and minimally invasive techniques during the recent years has established laparoscopic ovarian cystectomy as the first-line treatment for benign ovarian tumors, such as symptomatic endometriomas, dermoid cysts or serous cystadenomas4. Due to favourable surgical outcomes, fewer complications, less pain, and improved cosmetic results laparoscopic cystectomy has almost replaced open surgery5. Nevertheless, several studies have indicated that laparoscopic ovarian cystectomy is associated with a decreased ovarian reserve and for this reason there has been much debate about the most suitable laparoscopic approach that causes the less damage in ovarian reserve after surgery6-9.
A recent advancement in the field of minimally invasive gynecology is transumbilical single-port laparoscopy (SPL). This minimally invasive approach to surgery requires only one entry point, typically in the umbilical region. In particular, the use of SPL in adnexal disease as well as in endometriomas excision has been proposed10. There have been clinical reports that show that a limited operative space in SPL causes unstable camera motion and interference between instruments which may increase the difficulty and risk of surgery11-12. Yoon et al., Huang et al. and Wang et al. found that the ovarian reserve did not statistically differ between single-port laparoscopic cystectomy (SPL) and conventional multiport laparoscopic cystectomy (MPL)13-15. However, Angioni et al concluded that the mean anti-Müllerian hormone (AMH) concentration –an ovarian reserve indicator- significantly decreased in the SPL group at four to six-week and three-month follow-up periods compared with that in the MPL group16.
Among other traditional biologic indicators AMH is considered to be the most accurate biomarker of ovarian reserve. AMH reflects the decreasing ovarian reserve earlier than other hormones such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol E2 and other ovarian indicators such as inhibin B and antral follicle count (AFC)6, 17-18 . The aim of our review is to evaluate the impact of surgical technique on the ovarian reserve by comparing the preoperative and postoperative AMH levels of patients who underwent SPL or MPL.