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.