Changes in anti-Müllerian hormone values for ovarian reserve after minimally invasive benign ovarian cystectomy: Comparison of the Da Vinci robotic systems (Xi and SP) and the laparoscopic system

Changes in anti-Müllerian hormone values for ovarian reserve after minimally invasive benign ovarian cystectomy: Comparison of the Da Vinci robotic systems (Xi and SP) and the laparoscopic system | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Changes in anti-Müllerian hormone values for ovarian reserve after minimally invasive benign ovarian cystectomy: Comparison of the Da Vinci robotic systems (Xi and SP) and the laparoscopic system Yunjeong Park, Ayoung Song, Junghyun Jee, Nayoung Bae, Sumin Oh, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3247241/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 20 Apr, 2024 Read the published version in Scientific Reports → Version 1 posted You are reading this latest preprint version Abstract Objective To investigate the impact on the ovarian reserve after minimally invasive ovarian cystectomy using two platforms, the Da Vinci robotic system (Xi and SP) and the laparoscopic system. Materials and methods Patients underwent laparoscopic or Da Vinci robotic (Xi or SP) ovarian cystectomy for benign ovarian cysts between January 1, 2018, and December 31, 2022 at Guro Hospital, Korea University Medical center. We measured the change of AMH values(%) = [(postAMH − preAMH)] × 100 / preAMH. Main Results No significant differences in preoperative age, cyst size, estimated blood loss during surgery, hemoglobin drop, length of hospital stay, adhesion detachment rate and cyst rupture rate were observed. However, the operative time was significantly shorter in the laparoscopic group than that in the robotic group (67.78±30.58 min vs. 105.17±38.87 min, p<0.001) The mean preAMH and postAMH were significantly higher with the Da Vinci robotic group than with the laparoscopic group (preAMH: 5.89±4.81 ng/mL vs. 4.01±3.59 ng/mL, p=0.02, postAMH: 4.36±3.31 ng/mL vs. 3.08±2.60 ng/mL, p=0.02). However, the mean ΔAMH was not significantly different between two groups. ΔAMH also did not demonstrate significant differences among the three groups; laparoscopic, Xi and SP robotic. Even in the patient groups with preAMH < 2 and diagnosed with endometriosis, the ΔAMH did not show significant differences between the laparoscopic and robotic groups. Conclusion Although the Da Vinci robotic system requires a longer time for performing a benign ovarian cystectomy compared to laparoscopic surgery, it is an effective and minimally invasive method for preserving ovarian function. anti-Müllerian hormone ovarian reserve robotic surgical procedures laparoscopy benign ovarian cyst Introduction Preservation of ovarian function during surgery takes precedence as the foremost consideration for fertility preservation in the context of minimally invasive surgical procedures. Benign ovarian cysts may require surgical treatment because of torsion, pain, infertility, and decreased ovarian reserve, in which laparoscopic ovarian cystectomy has been the gold standard.[ 1 ] However, as laparoscopic surgery has been demonstrated to reduce ovarian function, determining the most suitable technique is important.[ 2 ] The development of minimally invasive surgical methods, such as laparoscopic and robotic systems, has led to increased patient satisfaction not only in terms of pain relief but also in cosmetic aspects, including the attainment of smaller scars. In 2000, the Da Vinci robotic system was approved by the Food and Drug Administration (FDA) and began to be used in the field of surgery. The Da Vinci SP system was developed and approved by the FDA in 2018, and can operate an articulating camera and up to three robotic instruments through an umbilical incision approximately 25 mm in size.[ 3 ] Several indicators have been used to evaluate ovarian reserve. Antral follicle count and ovarian volume are not recommended because of the variability in the menstrual cycle and lack of sensitivity.[ 4 ] Follicle stimulation hormone (FSH) has the disadvantages of significant variation and low reproducibility depending on the menstrual cycle. Estradiol is less influenced by the menstrual cycle compared to FSH, although its predictive power is limited. Inhibin B is also unsuitable as it fluctuates according to gonadotropin-realizing hormone agonist and FSH levels. Serum anti-Müllerian hormone (AMH) is a glycoprotein belonging to the transforming growth factor-β superfamily. AMH is synthesized from the granulosa cells of the pre-antral and antral follicles. It mainly inhibits the early stages of follicular development and affects tissue growth, differentiation, and regression of fetal Müllerian ducts. Moreover, it is less affected by gonadotropin or the menstrual cycle. Therefore, AMH is currently the most widely used marker for evaluating ovarian reserve.[ 4 – 6 ] This study aimed to investigate the impact of minimally invasive ovarian cystectomy using the Da Vinci robotic system (Xi and SP) and a laparoscopic system on ovarian reserve. Materials and methods Study population This study included patients who underwent laparoscopic or Da Vinci robotic (Xi or SP) ovarian cystectomy for benign ovarian cysts between January 1, 2018, and December 31, 2022, at a single institution. This retrospective study was conducted through an electronic medical record review. This study was approved by the Institutional Review Board and Ethics Committee of the Guro Hospital, Korea University Medical Center (IRB no. 2023GR0186). The inclusion criteria were as follows: (1) patients with confirmed AMH values within 1 month preoperatively and within 1 month to 1 year postoperatively; (2) with histopathologically confirmed benign ovarian cysts; (3) women aged 15–46 years; and (4) with regular menstrual cycles (21–35 days) at the time of surgery. The exclusion criteria were as follows: (1) pregnancy; (2) BMI ≥ 35 kg/m 2 ; (3) use of medications such as oral contraceptive pills or other hormonal agents within 6 months of surgery; (4) underwent oophorectomy; (5) prior surgery for borderline or malignant tumors of the ovary; (6) history of uncontrolled infections, diabetes, hypertension, ischemic heart disease, myocardial infarction within 6 months, or serious health conditions such as liver or kidney disease; (7) undergoing cancer treatment or diagnosed with cancer within the past 5 years; (8) use of anticancer drugs, immunosuppressive drugs, or steroid drugs; (9) presence of autoimmune diseases; and (10) history of organ transplantation. Outcome measures The primary outcomes were serum AMH levels including, preoperative AMH (preAMH) value, postoperative AMH (postAMH) value, and AMH change value (ΔAMH). The preAMH level was determined within 4 weeks before surgery, and the postAMH level was determined from 1 month to 1 year after surgery. The ΔAMH is expressed as a percentage value; ΔAMH = (postAMH − preAMH) × 100 / preAMH The secondary outcomes were operative outcomes, including histologic findings, operative time (min), estimated blood loss (mL), hemoglobin level change (g/dL), adhesiolysis, cyst rupture during surgery, transfusion, conversion to laparotomy, and length of hospital stay. The operative time was calculated as the time from skin incision to skin closure, including the docking time when the robotic surgery was performed. The change in hemoglobin level was calculated as the difference between the preoperative level and the level on postoperative day 1. Adhesiolysis was selected only when specific adhesion detachment was reported in the surgical records. Statistical analysis All statistical analyses were performed using SPSS version 26.0 (SPSS, Armonk, NY, USA). The mean ± standard deviation or median interquartile range (IQR) was used to describe the distribution of the data after the Kolmogorov–Smirnov normality test. Differences among the three groups were evaluated using the Kruskal–Wallis test or analysis of variance for continuous variables, and multiple comparisons were performed by post hoc test using the least significant difference method. Significance was set at p < 0.05. Results Study population characteristics In total, 132 patients were enrolled in this study. Among them, 74 underwent laparoscopic surgery and 58 underwent robotic surgery (21 with Xi robotic surgery, and 37 with SP robotic surgery). Comparison of operative outcomes between the laparoscopic system and robotic systems No significant differences in age, BMI, parity, histopathologic type, position, and maximum size (cm) of the ovarian cysts were observed between the groups. The estimated blood loss during surgery, hemoglobin drop, length of hospital stay, adhesion detachment rate, and cyst rupture rate also indicated no significant differences. The operative time was significantly shorter in the laparoscopic group than in the robotic group (68.51 ± 30.99 min vs. 105.17 ± 38.87 min, p < 0.001). ( Table 1. Table 2 ) The mean preAMH levels were significantly higher with the Da Vinci robotic group than with the laparoscopic group (5.89 ± 4.81 ng/mL vs. 4.01 ± 3.59 ng/mL, p = 0.02). The mean postAMH was also higher with the Da Vinci robotic group than with the laparoscopic group (4.36 ± 3.31 ng/mL vs. 3.08 ± 2.60 ng/mL, p = 0.02). However, the mean ΔAMH was not significantly different between the two groups (− 13.21%±57.10% in the laparoscopic system vs. −18.36%±39.64% in the robotic system, p = 0.56). ( Table 3 ) Comparison of operative outcomes between the laparoscopic system and Xi and SP robotic systems The patients who underwent SP robotic surgery were younger than those who underwent laparoscopic surgery (26.84 ± 6.10 years old vs 29.96 ± 6.74 years old, p = 0.034). No significant differences in BMI and parity of patients were observed among the groups. The histopathological type, position, and maximal size (cm) of the ovarian cysts demonstrated no significant differences among the three groups. Estimated blood loss (mL), hemoglobin drop (g/dL), adhesiolysis, cyst rupture, and length of hospital stay also indicated no significant differences among the groups. The operative time for Xi and SP robotic surgeries were longer than that for the laparoscopic surgery (101.62 ± 48.93 min, 107.19 ± 32.41 min vs. 67.78 min, p < 0.001). ( Table 4, Table 5 ) Significantly higher preAMH levels were noted in the SP robotic surgery group than in the laparoscopic surgery group (6.35 ± 5.26 vs. 4.01 ± 3.59, p = 0.023). The postAMH value was also higher in the SP robotic surgery group than that in the laparoscopic surgery group (4.66 ± 3.54 vs. 3.08 ± 2.60, p = 0.029). However, the ΔAMH did not demonstrate significant differences among the three groups (− 13.21 ± 57.10% in laparoscopic system vs. −14.63 ± 47.80% in Xi system vs. −20.47 ± 34.73% in the SP system, p = 0.772). ( Table 6 ) Comparison of ΔAMH between the laparoscopic system and robotic systems in the patients with preoperative AMH values of < 2.0 Even in the patient group with a preAMH level of < 2.0, the preAMH and postAMH values were not significantly different between the two groups. The ΔAMH was − 7.55 (IQR − 48.79, 19.87) in the laparoscopic group (N = 21) and − 29.73 (IQR − 59.89, 9.46) in the robotic group (N = 11), indicating no significant difference between the two groups (p = 0.72). ( Table 7 ) Comparison of operative outcomes between laparoscopic system and robotic system in patients diagnosed with endometriosis In patients diagnosed with endometriosis from postoperative histopathology, preAMH, postAMH, and ΔAMH were compared by dividing the group that underwent laparoscopic surgery (N = 31) and the group that underwent robotic surgery (N = 28). The preAMH, postAMH and ΔAMH values were not significantly different between the two groups. ( Table 8 ) There was no significant difference between the pre AMH, post AMH, and ΔAMH in the laparoscopic (N = 31) and SP robot groups (N = 20). (Table 9 ) Discussion This study investigated the effects of minimally invasive surgical techniques such as, laparoscopic and robotic systems on the ovarian reserve in benign ovarian cyst surgery. The changes in AMH values were calculated as a relative value (percentage) to assess the ovarian reserve. When the changes in the AMH values were compared for each surgical platform, no significant differences were observed between the laparoscopic and robotic systems. Even in the patient group with preAMH < 2.0, the relative preoperative and postoperative changes in AMH values were not significantly different between the two groups. Even in the group diagnosed with endometriosis, preAMH, postAMH, and ΔAMH did not show significant differences between the laparoscopic and robotic groups. A systematic review and meta-analysis of minimally invasive surgery for endometriosis in 2020 revealed that robotic surgery had a longer surgical time but no inferior compared to laparoscopic surgery for length of hospitalization, intra/post-operative complication, blood loss, and conversion rate.[ 7 ] Robotic surgery can be expected to be a more sophisticated operation due to the three-dimensional view and the natural movement of robotic instruments.[ 8 ] Another study in 2020 revealed that robotic surgery in bilateral ovarian endometrioma showed a better recovery rate of serum AMH and was beneficial for ovarian function protection.[ 9 ] In the subgroup analysis, based on an AMH value of 2, it was classified as a group < 2. We set this cut-off value by referring to the results of previous studies that the median AMH was 1.9 ng/mL among Japanese nulliparous women with a rapid decrease in fertility and serum AMH levels > 2 ng/mL, which demonstrated the highest probability of live birth.[ 10 – 12 ] A committee opinion published in 2015 by the American College of Obstetricians and Gynecologists recommends evaluating ovarian function in women undergoing ovarian surgery.[ 13 ] The most widely used indicator for assessing ovarian function is AMH. AMH is an indicator of the size of the primordial oocyte pool, and it starts to increase in young adolescent women and reaches its peak at 25 years of age. Afterwards, it decreases at a rate of 0.2 ng/mL/year until age 35, and then at a rate of 0.1 ng/mL/year between ages 35 and 40. From the age of 40 onwards the median and average decrease in AMH is 0.1 ng/mL/year.[ 10 ] Over time, this decline leads to a decrease in AMH levels of approximately 5.6% per year, eventually reaching undetectable levels at menopause.[ 6 , 10 , 14 , 15 ] However, the mechanism by which AMH levels decrease after ovarian surgery remains unclear. Normal ovarian tissue can fall off during the process of stripping the cyst capsule during ovarian cyst surgery and damage the functional cortex during the electrocauterization process for hemostasis. It decrease in the number of pre-antral and small antral follicles, and it may cause the reduction the serum AMH levels made from these follicles.[ 16 , 17 ] Also the ovarian endometrioma itself may cause damage to the its surrounding ovarian tissue, with decreasing serum AMH level.[ 18 ] Reduced ovarian reserve postoperatively is reported to recover at approximately 3–6 months.[ 19 , 20 ] Recovery of ovarian reserve could be attributed to the reperfusion of ovarian tissue, activation and rearrangement of ovarian follicles.[ 2 , 21 ] The Da Vinci SP robotic system has been widely used in gynecologic surgery since its introduction, with its FDA approval in 2018. To date, no study has analyzed the surgical outcomes of ovarian cysts according to the SP surgical platform. To the best of our knowledge, this is the first study to compare surgical outcomes, particularly ovarian function, between conventional platforms and the SP robotic system. The Xi and SP robotic surgeries required longer operative time than that of the laparoscopic surgery (101.62 ± 48.93 min, 107.19 from 32.41 min vs. 67.78 min, p < 0.001), and was calculated from skin incision to closure time. This could be calculated by considering the docking and undocking times; however, owing to the limitations of the retrospective study, determining exactly how many docking and undocking times the robot performed during each surgery was not possible. Moreover, the Da Vinci SP robotic system was introduced to our institution in 2020, and further research is needed to evaluate its proficiency and effectiveness, given its recent implementation in early stage surgeries. This study had some limitations. First, the study is retrospective in nature. The evaluation of the AMH value was not performed in a batch period, depending on the operator; therefore, the measurement of the postAMH value was widely done within one year. Owing to the nature of the tertiary institution, many patients were sent back to the 1st or 2nd institution postoperatively; therefore, only few patients had their AMH measured multiple times. Second, the sample size was small as the robotic group was further divided according to the two systems, SP and Xi. Compared to the existing laparoscopic system, the robotic system does not demonstrate a significant difference in the preservation of the ovarian reserve; therefore, it will be widely selected as an option for minimally invasive surgery. Conclusion Although the Da Vinci robotic system requires a longer time for performing a benign ovarian cystectomy compared to laparoscopic surgery, it is an effective and minimally invasive method for preserving ovarian function. Declarations Acknowledgments Funds/Grants statement: Not applicable. Conflicts of interest/Competing interests : The authors declare no conflict of interest. Ethics approval : This study was approved by the Institutional Review Board and Ethics Committee of the Guro Hospital, Korea University Medical Center (IRB no. 2023GR0186). Consent to participate : Not applicable. Consent for publication: The Author confirms that the work described has not been published before (except in the form of an abstract or as part of a published lecture, review, or thesis); that it is not under consideration for publication elsewhere; that its publication has been approved by all co-authors, if any; Availability of data and material (data transparency) : The data underlying this article will be shared on reasonable request to the corresponding author. Code availability : Not applicable. References Alborzi S, Foroughinia L, Kumar PV, Asadi N, Alborzi S. A comparison of histopathologic findings of ovarian tissue inadvertently excised with endometrioma and other kinds of benign ovarian cyst in patients undergoing laparoscopy versus laparotomy. 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Anti-Mullerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART). Hum Reprod Update. 2010;16(2):113-30. doi: 10.1093/humupd/dmp036. Restaino S, Mereu L, Finelli A, Spina MR, Marini G, Catena U, et al. Robotic surgery vs laparoscopic surgery in patients with diagnosis of endometriosis: a systematic review and meta-analysis. J Robot Surg. 2020;14(5):687-94. doi: 10.1007/s11701-020-01061-y. Ercoli A, Bassi E, Ferrari S, Surico D, Fagotti A, Fanfani F, et al. Robotic-Assisted Conservative Excision of Retrocervical-Rectal Deep Infiltrating Endometriosis: A Case Series. J Minim Invasive Gynecol. 2017;24(5):863-8. doi: 10.1016/j.jmig.2017.03.011. Lee HJ, Lee JS, Lee YS. Comparison of serum antimüllerian hormone levels after robotic-assisted vs. laparoscopic approach for ovarian cystectomy in endometrioma. Eur J Obstet Gynecol Reprod Biol. 2020;249:9-13. doi: 10.1016/j.ejogrb.2020.04.010. Seifer DB, Baker VL, Leader B. 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Li H, Yan B, Wang Y, Shu Z, Li P, Liu Y, et al. The Optimal Time of Ovarian Reserve Recovery After Laparoscopic Unilateral Ovarian Non-Endometriotic Cystectomy. Front Endocrinol (Lausanne). 2021;12:671225. doi: 10.3389/fendo.2021.671225. Goodman LR, Goldberg JM, Flyckt RL, Gupta M, Harwalker J, Falcone T. Effect of surgery on ovarian reserve in women with endometriomas, endometriosis and controls. Am J Obstet Gynecol. 2016;215(5):589.e1-.e6. doi: 10.1016/j.ajog.2016.05.029. Sugita A, Iwase A, Goto M, Nakahara T, Nakamura T, Kondo M, et al. One-year follow-up of serum antimüllerian hormone levels in patients with cystectomy: are different sequential changes due to different mechanisms causing damage to the ovarian reserve? Fertil Steril. 2013;100(2):516-22.e3. doi: 10.1016/j.fertnstert.2013.03.032. Tables Table 1 . Comparison of operative outcomes between laparoscopic system and robotic system: Baseline characteristics of the patients Laparoscope (N=74) Robot (N=58) p Age (years) 29.96±6.74 * 28.16±6.12 0.115 BMI (kg/m 2 ) 23.07±4.78 22.72±3.61 0.638 Parity Nullipara 65 (87.84%) 53 (91.38%) 0.270 Para 1 or more 9 (12.16%) 5 (8.62%) Histologic finding Endometrioma 31 (41.89%) 28 # (48.28%) 0.468 Mature cystic teratoma 30 (40.54%) 23 (39.66%) 0.919 Cystadenoma 9 (12.16%) 6 (10.34%) 0.746 Other cyst 4 (5.41%) 1 (0.17%) 0.246 Cyst size, in maximum (cm) 6.45±2.57 7.00±2.77 0.314 Cyst position Unilateral 56 (75.68%) 41 (70.69%) 0.523 Bilateral 18 (24.32%) 17 (29.31%) CA 125 (U/mL) 54.47±75.19 37.43±37.56 0.186 # Case in which a mature teratoma was identified concomitantly with an endometrioma. Table 2 . Comparison of operative outcomes between laparoscopic system and robotic system: Operative outcomes. Laparoscope (N=74) Robot (N=58) p Operative time (min) 67.78 ±30.58 105.17 ±38.87 <0.001 Estimated blood loss (mL) 62.84±93.29 93.97±103.91 0.073 Hb drop (g/dL) 1.69±1.00 1.87±0.91 0.278 Adhesiolysis 48.65% (36/74) 36.84% (21/57) 0.177 Cyst rupture 91.67% (66/72) 85.96% (49/57) 0.318 Complications 2 ‡ (transfusion) 0 Conversion 0 0 Length of hospital day 4.18±0.73 4.29±0.84 0.391 ‡Transfusion. Table 3 . Comparison of operative outcomes between laparoscopic system and robotic system: Serum anti-Müllerian hormone (AMH) levels (ng/mL). Laparoscope (N=74) Robot (N=58) p Preoperative 4.01 ±3.59 * 5.89 ±4.81 0.015 Postoperative 3.08 ±2.60 * 4.36±3.31 0.015 ΔAMH (%) −13.21±57.10 −18.36±39.64 0.560 AMH (%) = (postoperative AMH − preoperative AMH) × 100 / preoperative AMH. Table 4 . Comparison of operative outcomes between the laparoscopic system and Xi and SP robotic systems: Baseline characteristics of the patients. Laparoscope (N=74) Xi Robot (N=21) SP Robot (N=37) p Age (years) 29.96±6.74 * 30.48±5.56 26.84±6.10 * 0.034 BMI (kg/m 2 ) 23.07±4.78 23.23±4.07 22.44±3.35 0.720 Parity Nullipara 65 (87.84%) 19 (90.48%) 34 (91.89%) 0.529 Para 1 or more 9 (12.16%) 2 (9.52%) 3 (8.11%) Histopathologic finding Endometrioma 31 (41.89%) 8 (38.10%) 20 # (54.05%) 0.389 Mature cystic teratoma 30 (40.54%) 11 (52.38%) 12 (32.43%) 0.333 Cystadenoma 9 (12.16%) 2 (9.52%) 4 (10.81%) 0.939 Other cyst 4 (5.41%) 0 (0%) 1 (2.7%) 0.484 Cyst size, in maximum (cm) 6.45±2.57 7.35±3.54 6.80±2.25 0.376 Cyst position Unilateral 56 (75.68%) 16 (76.19%) 25 (67.57%) 0.635 Bilateral 18 (24.32%) 5 (23.81%) 12 (32.43%) CA 125 (U/mL) 54.47±75.19 37.94±46.36 37.13±32.46 0.419 #Case in which a mature teratoma was identified concomitantly with an endometrioma. Table 5 . Comparison of operative outcomes between the laparoscopic system and Xi and SP robotic systems: Operative outcomes. Laparoscope (N=74) Xi robot (N=21) SP robot (N=37) p Operative time (min) 67.78 ±30.58 † 101.62 ±48.93 † 107.19 ±32.41 † <0.001 † Estimated blood loss (mL) 62.84±93.29 111.90±125.40 83.78+79.80 0.116 Hb drop (g/dL) 1.69±1.00 2.18±1.27 1.70±0.59 0.108 Adhesiolysis 48.65% (36/74) 33.33% (7/21) 38.89% (14/36) 0.375 Cyst rupture 91.67% (66/72) 80.95% (17/21) 88.89% (32/36) 0.386 Complications 2 ‡ (transfusion) 0 0 Conversion 0 0 0 Length of hospital day 4.18±0.73 4.43±1.21 4.22±0.53 0.422 ‡Transfusion. Table 6 . Comparison of operative outcomes between the laparoscopic system and Xi and SP robotic systems: Serum anti-Müllerian hormone (AMH) levels (ng/mL). Laparoscope (N=74) Xi robot (N=21) SP robot (N=37) p Preoperative 4.01 ±3.59 * 5.09 ±3.91 6.35 ±5.26 * 0.023 Postoperative 3.08 ±2.60 * 3.81 ±2.88 4.66 ±3.54 * 0.029 ΔAMH (%) −13.21±57.10 −14.63±47.80 −20.47±34.73 0.772 Table 7 . Comparison of ΔAMH between the laparoscopic system and robotic system in the patients with preoperative AMH values < 2.0.: Serum anti-Müllerian hormone (AMH) levels (ng/mL). Laparoscope (N=21) Robot (N=11) p Preoperative 0.95 (0.46,1.48) 1.34 (0.74,1.87) 0.337 Postoperative 0.90 (0.33,1.35) 0.81 (0.52,1.04) 0.540 ΔAMH (%) −7.55 (−48.79,19.84) −29.73 (−59.89,9.46) 0.715 Table 8 . Comparison of operative outcomes between laparoscopic system and robotic system in patients diagnosed with endometriosis: Serum anti-Müllerian hormone (AMH) levels (ng/mL). Laparoscope (N=31) Robot (N=28) p Preoperative 3.90±3.16 4.47±3.44 0.506 Postoperative 2.49±2.35 * 2.79±2.35 0.609 ΔAMH (%) −23.59±72.69 −31.43±36.39 0.609 Table 9. Comparison of operative outcomes between laparoscopic system and robotic system in patients diagnosed with endometriosis: Serum anti-Müllerian hormone (AMH) levels (ng/mL) Laparoscope (N=31) SP Robot (N=20) p Preoperative 3.90±3.16 4.60±3.60 0.467 Postoperative 2.49±2.35 2.92±2.03 0.506 ΔAMH (%) −23.59±72.69 −28.40±36.83 0.786 Cite Share Download PDF Status: Published Journal Publication published 20 Apr, 2024 Read the published version in Scientific Reports → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3247241","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":227432916,"identity":"012a59aa-e4d2-4f2a-8eb0-c8fb63a76578","order_by":0,"name":"Yunjeong Park","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAs0lEQVRIiWNgGAWjYLCChAM2ciRrSTMm1ZoDhxMbiFas237G7MODM2np29nPGD6uYLCT0yWk2exMjvGMhBs2uTt7cowNzzAkG5sdIKTlQFoyQ8KHtNwNB9LSJBsYDiRuI6jl/DOQlsPpBuefpf8kTsuN5MMMCTcOJxjcSD7GSKSWx0AtZ9IMNwAZkg0GxPjlfGIz449jNvIG5xMbPzZU2MkR1IIGDEhTPgpGwSgYBaMABwAABjxI8IvKC7AAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0003-3999-5300","institution":"Korea University College of Medicine","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Yunjeong","middleName":"","lastName":"Park","suffix":""},{"id":227432917,"identity":"36d4410e-50c9-4ce0-b185-664a15b2f5b3","order_by":1,"name":"Ayoung Song","email":"","orcid":"","institution":"Korea University College of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ayoung","middleName":"","lastName":"Song","suffix":""},{"id":227432918,"identity":"36debafc-ac41-4184-bff5-b839f17d16bc","order_by":2,"name":"Junghyun Jee","email":"","orcid":"","institution":"Korea University College of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Junghyun","middleName":"","lastName":"Jee","suffix":""},{"id":227432919,"identity":"15630de3-89a0-483a-a258-3a6dc9121cbd","order_by":3,"name":"Nayoung Bae","email":"","orcid":"","institution":"Korea University College of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nayoung","middleName":"","lastName":"Bae","suffix":""},{"id":227432920,"identity":"9204e1eb-6fae-4838-88fb-3f9dbb1fcf5b","order_by":4,"name":"Sumin Oh","email":"","orcid":"","institution":"Korea University College of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Sumin","middleName":"","lastName":"Oh","suffix":""},{"id":227432921,"identity":"221e94ab-d40c-45e4-9bb8-e9df04c7ed58","order_by":5,"name":"Jung-Ho Shin","email":"","orcid":"","institution":"Korea University College of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jung-Ho","middleName":"","lastName":"Shin","suffix":""},{"id":227432922,"identity":"b3d3bef2-95d6-4a91-9929-b720a9aec89b","order_by":6,"name":"Yong Jin Kim","email":"","orcid":"","institution":"Korea University College of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yong","middleName":"Jin","lastName":"Kim","suffix":""}],"badges":[],"createdAt":"2023-08-09 03:25:50","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3247241/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3247241/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-024-59935-2","type":"published","date":"2024-04-20T22:59:03+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":55691057,"identity":"669cebaf-b4db-4720-afc1-de7db2c0e57b","added_by":"auto","created_at":"2024-05-01 22:59:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1098211,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3247241/v1/d74799be-cc62-4ebc-8248-b975fd919a70.pdf"}],"financialInterests":"","formattedTitle":"Changes in anti-Müllerian hormone values for ovarian reserve after minimally invasive benign ovarian cystectomy: Comparison of the Da Vinci robotic systems (Xi and SP) and the laparoscopic system","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePreservation of ovarian function during surgery takes precedence as the foremost consideration for fertility preservation in the context of minimally invasive surgical procedures. Benign ovarian cysts may require surgical treatment because of torsion, pain, infertility, and decreased ovarian reserve, in which laparoscopic ovarian cystectomy has been the gold standard.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] However, as laparoscopic surgery has been demonstrated to reduce ovarian function, determining the most suitable technique is important.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe development of minimally invasive surgical methods, such as laparoscopic and robotic systems, has led to increased patient satisfaction not only in terms of pain relief but also in cosmetic aspects, including the attainment of smaller scars. In 2000, the Da Vinci robotic system was approved by the Food and Drug Administration (FDA) and began to be used in the field of surgery. The Da Vinci SP system was developed and approved by the FDA in 2018, and can operate an articulating camera and up to three robotic instruments through an umbilical incision approximately 25 mm in size.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eSeveral indicators have been used to evaluate ovarian reserve. Antral follicle count and ovarian volume are not recommended because of the variability in the menstrual cycle and lack of sensitivity.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] Follicle stimulation hormone (FSH) has the disadvantages of significant variation and low reproducibility depending on the menstrual cycle. Estradiol is less influenced by the menstrual cycle compared to FSH, although its predictive power is limited. Inhibin B is also unsuitable as it fluctuates according to gonadotropin-realizing hormone agonist and FSH levels.\u003c/p\u003e \u003cp\u003eSerum anti-M\u0026uuml;llerian hormone (AMH) is a glycoprotein belonging to the transforming growth factor-β superfamily. AMH is synthesized from the granulosa cells of the pre-antral and antral follicles. It mainly inhibits the early stages of follicular development and affects tissue growth, differentiation, and regression of fetal M\u0026uuml;llerian ducts. Moreover, it is less affected by gonadotropin or the menstrual cycle. Therefore, AMH is currently the most widely used marker for evaluating ovarian reserve.[\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThis study aimed to investigate the impact of minimally invasive ovarian cystectomy using the Da Vinci robotic system (Xi and SP) and a laparoscopic system on ovarian reserve.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eThis study included patients who underwent laparoscopic or Da Vinci robotic (Xi or SP) ovarian cystectomy for benign ovarian cysts between January 1, 2018, and December 31, 2022, at a single institution. This retrospective study was conducted through an electronic medical record review. This study was approved by the Institutional Review Board and Ethics Committee of the Guro Hospital, Korea University Medical Center (IRB no. 2023GR0186).\u003c/p\u003e \u003cp\u003eThe inclusion criteria were as follows: (1) patients with confirmed AMH values within 1 month preoperatively and within 1 month to 1 year postoperatively; (2) with histopathologically confirmed benign ovarian cysts; (3) women aged 15\u0026ndash;46 years; and (4) with regular menstrual cycles (21\u0026ndash;35 days) at the time of surgery.\u003c/p\u003e \u003cp\u003eThe exclusion criteria were as follows: (1) pregnancy; (2) BMI\u0026thinsp;\u0026ge;\u0026thinsp;35 kg/m\u003csup\u003e2\u003c/sup\u003e; (3) use of medications such as oral contraceptive pills or other hormonal agents within 6 months of surgery; (4) underwent oophorectomy; (5) prior surgery for borderline or malignant tumors of the ovary; (6) history of uncontrolled infections, diabetes, hypertension, ischemic heart disease, myocardial infarction within 6 months, or serious health conditions such as liver or kidney disease; (7) undergoing cancer treatment or diagnosed with cancer within the past 5 years; (8) use of anticancer drugs, immunosuppressive drugs, or steroid drugs; (9) presence of autoimmune diseases; and (10) history of organ transplantation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eOutcome measures\u003c/h2\u003e \u003cp\u003eThe primary outcomes were serum AMH levels including, preoperative AMH (preAMH) value, postoperative AMH (postAMH) value, and AMH change value (ΔAMH). The preAMH level was determined within 4 weeks before surgery, and the postAMH level was determined from 1 month to 1 year after surgery. The ΔAMH is expressed as a percentage value; ΔAMH = (postAMH\u0026thinsp;\u0026minus;\u0026thinsp;preAMH) \u0026times; 100 / preAMH\u003c/p\u003e \u003cp\u003eThe secondary outcomes were operative outcomes, including histologic findings, operative time (min), estimated blood loss (mL), hemoglobin level change (g/dL), adhesiolysis, cyst rupture during surgery, transfusion, conversion to laparotomy, and length of hospital stay. The operative time was calculated as the time from skin incision to skin closure, including the docking time when the robotic surgery was performed. The change in hemoglobin level was calculated as the difference between the preoperative level and the level on postoperative day 1. Adhesiolysis was selected only when specific adhesion detachment was reported in the surgical records.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were performed using SPSS version 26.0 (SPSS, Armonk, NY, USA). The mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or median interquartile range (IQR) was used to describe the distribution of the data after the Kolmogorov\u0026ndash;Smirnov normality test. Differences among the three groups were evaluated using the Kruskal\u0026ndash;Wallis test or analysis of variance for continuous variables, and multiple comparisons were performed by post hoc test using the least significant difference method. Significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy population characteristics\u003c/h2\u003e\n \u003cp\u003eIn total, 132 patients were enrolled in this study. Among them, 74 underwent laparoscopic surgery and 58 underwent robotic surgery (21 with Xi robotic surgery, and 37 with SP robotic surgery).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eComparison of operative outcomes between the laparoscopic system and robotic systems\u003c/h2\u003e\n \u003cp\u003eNo significant differences in age, BMI, parity, histopathologic type, position, and maximum size (cm) of the ovarian cysts were observed between the groups. The estimated blood loss during surgery, hemoglobin drop, length of hospital stay, adhesion detachment rate, and cyst rupture rate also indicated no significant differences. The operative time was significantly shorter in the laparoscopic group than in the robotic group (68.51\u0026thinsp;\u0026plusmn;\u0026thinsp;30.99 min vs. 105.17\u0026thinsp;\u0026plusmn;\u0026thinsp;38.87 min, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). (\u003cstrong\u003eTable\u0026nbsp;1. Table\u0026nbsp;2\u003c/strong\u003e)\u003c/p\u003e\n \u003cp\u003eThe mean preAMH levels were significantly higher with the Da Vinci robotic group than with the laparoscopic group (5.89\u0026thinsp;\u0026plusmn;\u0026thinsp;4.81 ng/mL vs. 4.01\u0026thinsp;\u0026plusmn;\u0026thinsp;3.59 ng/mL, p\u0026thinsp;=\u0026thinsp;0.02). The mean postAMH was also higher with the Da Vinci robotic group than with the laparoscopic group (4.36\u0026thinsp;\u0026plusmn;\u0026thinsp;3.31 ng/mL vs. 3.08\u0026thinsp;\u0026plusmn;\u0026thinsp;2.60 ng/mL, p\u0026thinsp;=\u0026thinsp;0.02). However, the mean \u0026Delta;AMH was not significantly different between the two groups (\u0026minus;\u0026thinsp;13.21%\u0026plusmn;57.10% in the laparoscopic system vs. \u0026minus;18.36%\u0026plusmn;39.64% in the robotic system, p\u0026thinsp;=\u0026thinsp;0.56). (\u003cstrong\u003eTable\u0026nbsp;3\u003c/strong\u003e)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003eComparison of operative outcomes between the laparoscopic system and Xi and SP robotic systems\u003c/h2\u003e\n \u003cp\u003eThe patients who underwent SP robotic surgery were younger than those who underwent laparoscopic surgery (26.84\u0026thinsp;\u0026plusmn;\u0026thinsp;6.10 years old vs 29.96\u0026thinsp;\u0026plusmn;\u0026thinsp;6.74 years old, p\u0026thinsp;=\u0026thinsp;0.034). No significant differences in BMI and parity of patients were observed among the groups. The histopathological type, position, and maximal size (cm) of the ovarian cysts demonstrated no significant differences among the three groups. Estimated blood loss (mL), hemoglobin drop (g/dL), adhesiolysis, cyst rupture, and length of hospital stay also indicated no significant differences among the groups. The operative time for Xi and SP robotic surgeries were longer than that for the laparoscopic surgery (101.62\u0026thinsp;\u0026plusmn;\u0026thinsp;48.93 min, 107.19\u0026thinsp;\u0026plusmn;\u0026thinsp;32.41 min vs. 67.78 min, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). (\u003cstrong\u003eTable\u0026nbsp;4, Table\u0026nbsp;5\u003c/strong\u003e)\u003c/p\u003e\n \u003cp\u003eSignificantly higher preAMH levels were noted in the SP robotic surgery group than in the laparoscopic surgery group (6.35\u0026thinsp;\u0026plusmn;\u0026thinsp;5.26 vs. 4.01\u0026thinsp;\u0026plusmn;\u0026thinsp;3.59, p\u0026thinsp;=\u0026thinsp;0.023). The postAMH value was also higher in the SP robotic surgery group than that in the laparoscopic surgery group (4.66\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54 vs. 3.08\u0026thinsp;\u0026plusmn;\u0026thinsp;2.60, p\u0026thinsp;=\u0026thinsp;0.029). However, the \u0026Delta;AMH did not demonstrate significant differences among the three groups (\u0026minus;\u0026thinsp;13.21\u0026thinsp;\u0026plusmn;\u0026thinsp;57.10% in laparoscopic system vs. \u0026minus;14.63\u0026thinsp;\u0026plusmn;\u0026thinsp;47.80% in Xi system vs. \u0026minus;20.47\u0026thinsp;\u0026plusmn;\u0026thinsp;34.73% in the SP system, p\u0026thinsp;=\u0026thinsp;0.772). (\u003cstrong\u003eTable\u0026nbsp;6\u003c/strong\u003e)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eComparison of \u0026Delta;AMH between the laparoscopic system and robotic systems in the patients with preoperative AMH values of \u0026lt;\u0026thinsp;2.0\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eEven in the patient group with a preAMH level of \u0026lt;\u0026thinsp;2.0, the preAMH and postAMH values were not significantly different between the two groups. The \u0026Delta;AMH was \u0026minus;\u0026thinsp;7.55 (IQR \u0026minus;\u0026thinsp;48.79, 19.87) in the laparoscopic group (N\u0026thinsp;=\u0026thinsp;21) and \u0026minus;\u0026thinsp;29.73 (IQR \u0026minus;\u0026thinsp;59.89, 9.46) in the robotic group (N\u0026thinsp;=\u0026thinsp;11), indicating no significant difference between the two groups (p\u0026thinsp;=\u0026thinsp;0.72). (\u003cstrong\u003eTable\u0026nbsp;7\u003c/strong\u003e)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003eComparison of operative outcomes between laparoscopic system and robotic system in patients diagnosed with endometriosis\u003c/h2\u003e\n \u003cp\u003eIn patients diagnosed with endometriosis from postoperative histopathology, preAMH, postAMH, and \u0026Delta;AMH were compared by dividing the group that underwent laparoscopic surgery (N\u0026thinsp;=\u0026thinsp;31) and the group that underwent robotic surgery (N\u0026thinsp;=\u0026thinsp;28). The preAMH, postAMH and \u0026Delta;AMH values were not significantly different between the two groups. (\u003cstrong\u003eTable\u0026nbsp;8\u003c/strong\u003e) There was no significant difference between the pre AMH, post AMH, and \u0026Delta;AMH in the laparoscopic (N\u0026thinsp;=\u0026thinsp;31) and SP robot groups (N\u0026thinsp;=\u0026thinsp;20). (Table \u003cspan class=\"InternalRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study investigated the effects of minimally invasive surgical techniques such as, laparoscopic and robotic systems on the ovarian reserve in benign ovarian cyst surgery. The changes in AMH values were calculated as a relative value (percentage) to assess the ovarian reserve. When the changes in the AMH values were compared for each surgical platform, no significant differences were observed between the laparoscopic and robotic systems. Even in the patient group with preAMH\u0026thinsp;\u0026lt;\u0026thinsp;2.0, the relative preoperative and postoperative changes in AMH values were not significantly different between the two groups. Even in the group diagnosed with endometriosis, preAMH, postAMH, and ΔAMH did not show significant differences between the laparoscopic and robotic groups.\u003c/p\u003e \u003cp\u003eA systematic review and meta-analysis of minimally invasive surgery for endometriosis in 2020 revealed that robotic surgery had a longer surgical time but no inferior compared to laparoscopic surgery for length of hospitalization, intra/post-operative complication, blood loss, and conversion rate.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Robotic surgery can be expected to be a more sophisticated operation due to the three-dimensional view and the natural movement of robotic instruments.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Another study in 2020 revealed that robotic surgery in bilateral ovarian endometrioma showed a better recovery rate of serum AMH and was beneficial for ovarian function protection.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn the subgroup analysis, based on an AMH value of 2, it was classified as a group\u0026thinsp;\u0026lt;\u0026thinsp;2. We set this cut-off value by referring to the results of previous studies that the median AMH was 1.9 ng/mL among Japanese nulliparous women with a rapid decrease in fertility and serum AMH levels\u0026thinsp;\u0026gt;\u0026thinsp;2 ng/mL, which demonstrated the highest probability of live birth.[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eA committee opinion published in 2015 by the American College of Obstetricians and Gynecologists recommends evaluating ovarian function in women undergoing ovarian surgery.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] The most widely used indicator for assessing ovarian function is AMH. AMH is an indicator of the size of the primordial oocyte pool, and it starts to increase in young adolescent women and reaches its peak at 25 years of age. Afterwards, it decreases at a rate of 0.2 ng/mL/year until age 35, and then at a rate of 0.1 ng/mL/year between ages 35 and 40. From the age of 40 onwards the median and average decrease in AMH is 0.1 ng/mL/year.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] Over time, this decline leads to a decrease in AMH levels of approximately 5.6% per year, eventually reaching undetectable levels at menopause.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eHowever, the mechanism by which AMH levels decrease after ovarian surgery remains unclear. Normal ovarian tissue can fall off during the process of stripping the cyst capsule during ovarian cyst surgery and damage the functional cortex during the electrocauterization process for hemostasis. It decrease in the number of pre-antral and small antral follicles, and it may cause the reduction the serum AMH levels made from these follicles.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] Also the ovarian endometrioma itself may cause damage to the its surrounding ovarian tissue, with decreasing serum AMH level.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] Reduced ovarian reserve postoperatively is reported to recover at approximately 3\u0026ndash;6 months.[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] Recovery of ovarian reserve could be attributed to the reperfusion of ovarian tissue, activation and rearrangement of ovarian follicles.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe Da Vinci SP robotic system has been widely used in gynecologic surgery since its introduction, with its FDA approval in 2018. To date, no study has analyzed the surgical outcomes of ovarian cysts according to the SP surgical platform. To the best of our knowledge, this is the first study to compare surgical outcomes, particularly ovarian function, between conventional platforms and the SP robotic system.\u003c/p\u003e \u003cp\u003eThe Xi and SP robotic surgeries required longer operative time than that of the laparoscopic surgery (101.62\u0026thinsp;\u0026plusmn;\u0026thinsp;48.93 min, 107.19 from 32.41 min vs. 67.78 min, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and was calculated from skin incision to closure time. This could be calculated by considering the docking and undocking times; however, owing to the limitations of the retrospective study, determining exactly how many docking and undocking times the robot performed during each surgery was not possible. Moreover, the Da Vinci SP robotic system was introduced to our institution in 2020, and further research is needed to evaluate its proficiency and effectiveness, given its recent implementation in early stage surgeries.\u003c/p\u003e \u003cp\u003eThis study had some limitations. First, the study is retrospective in nature. The evaluation of the AMH value was not performed in a batch period, depending on the operator; therefore, the measurement of the postAMH value was widely done within one year. Owing to the nature of the tertiary institution, many patients were sent back to the 1st or 2nd institution postoperatively; therefore, only few patients had their AMH measured multiple times. Second, the sample size was small as the robotic group was further divided according to the two systems, SP and Xi.\u003c/p\u003e \u003cp\u003eCompared to the existing laparoscopic system, the robotic system does not demonstrate a significant difference in the preservation of the ovarian reserve; therefore, it will be widely selected as an option for minimally invasive surgery.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAlthough the Da Vinci robotic system requires a longer time for performing a benign ovarian cystectomy compared to laparoscopic surgery, it is an effective and minimally invasive method for preserving ovarian function.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunds/Grants statement:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest/Competing interests\u003c/strong\u003e: The authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e: This study was approved by the Institutional Review Board and Ethics Committee of the\u0026nbsp;Guro Hospital, Korea University Medical Center (IRB no. 2023GR0186).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e: Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eThe Author confirms\u003c/p\u003e\n\u003cp\u003ethat the work described has not been published before (except in the form of an abstract or as part of a published lecture, review, or thesis);\u003c/p\u003e\n\u003cp\u003ethat it is not under consideration for publication elsewhere;\u003c/p\u003e\n\u003cp\u003ethat its publication has been approved by all co-authors, if any;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material (data transparency)\u003c/strong\u003e: The data underlying this article will be shared on reasonable request to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode availability\u003c/strong\u003e: Not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAlborzi S, Foroughinia L, Kumar PV, Asadi N, Alborzi S. A comparison of histopathologic findings of ovarian tissue inadvertently excised with endometrioma and other kinds of benign ovarian cyst in patients undergoing laparoscopy versus laparotomy. Fertil Steril. 2009;92(6):2004-7. doi: 10.1016/j.fertnstert.2008.09.014.\u003c/li\u003e\n\u003cli\u003eChang HJ, Han SH, Lee JR, Jee BC, Lee BI, Suh CS, et al. Impact of laparoscopic cystectomy on ovarian reserve: serial changes of serum anti-M\u0026uuml;llerian hormone levels. Fertil Steril. 2010;94(1):343-9. doi: 10.1016/j.fertnstert.2009.02.022.\u003c/li\u003e\n\u003cli\u003eKwak YH, Lee H, Seon K, Lee YJ, Lee YJ, Kim SW. Da Vinci SP Single-Port Robotic Surgery in Gynecologic Tumors: Single Surgeon\u0026apos;s Initial Experience with 100 Cases. Yonsei Med J. 2022;63(2):179-86. doi: 10.3349/ymj.2022.63.2.179.\u003c/li\u003e\n\u003cli\u003eTesting and interpreting measures of ovarian reserve: a committee opinion. Fertil Steril. 2020;114(6):1151-7. doi: 10.1016/j.fertnstert.2020.09.134.\u003c/li\u003e\n\u003cli\u003eBroekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB. A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update. 2006;12(6):685-718. doi: 10.1093/humupd/dml034.\u003c/li\u003e\n\u003cli\u003eLa Marca A, Sighinolfi G, Radi D, Argento C, Baraldi E, Artenisio AC, et al. Anti-Mullerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART). Hum Reprod Update. 2010;16(2):113-30. doi: 10.1093/humupd/dmp036.\u003c/li\u003e\n\u003cli\u003eRestaino S, Mereu L, Finelli A, Spina MR, Marini G, Catena U, et al. Robotic surgery vs laparoscopic surgery in patients with diagnosis of endometriosis: a systematic review and meta-analysis. J Robot Surg. 2020;14(5):687-94. doi: 10.1007/s11701-020-01061-y.\u003c/li\u003e\n\u003cli\u003eErcoli A, Bassi E, Ferrari S, Surico D, Fagotti A, Fanfani F, et al. Robotic-Assisted Conservative Excision of Retrocervical-Rectal Deep Infiltrating Endometriosis: A Case Series. J Minim Invasive Gynecol. 2017;24(5):863-8. doi: 10.1016/j.jmig.2017.03.011.\u003c/li\u003e\n\u003cli\u003eLee HJ, Lee JS, Lee YS. Comparison of serum antim\u0026uuml;llerian hormone levels after robotic-assisted vs. laparoscopic approach for ovarian cystectomy in endometrioma. Eur J Obstet Gynecol Reprod Biol. 2020;249:9-13. doi: 10.1016/j.ejogrb.2020.04.010.\u003c/li\u003e\n\u003cli\u003eSeifer DB, Baker VL, Leader B. Age-specific serum anti-M\u0026uuml;llerian hormone values for 17,120 women presenting to fertility centers within the United States. Fertil Steril. 2011;95(2):747-50. doi: 10.1016/j.fertnstert.2010.10.011.\u003c/li\u003e\n\u003cli\u003eSegawa T, Omi K, Watanabe Y, Sone Y, Handa M, Kuroda M, et al. Age-specific values of Access anti-M\u0026uuml;llerian hormone immunoassay carried out on Japanese patients with infertility: a retrospective large-scale study. BMC Womens Health. 2019;19(1):57. doi: 10.1186/s12905-019-0752-z.\u003c/li\u003e\n\u003cli\u003eLukaszuk K, Liss J, Kunicki M, Jakiel G, Wasniewski T, Woclawek-Potocka I, et al. Anti-M\u0026uuml;llerian hormone (AMH) is a strong predictor of live birth in women undergoing assisted reproductive technology. Reprod Biol. 2014;14(3):176-81. doi: 10.1016/j.repbio.2014.03.004.\u003c/li\u003e\n\u003cli\u003eCommittee Opinion No. 618: Ovarian Reserve Testing. Obstetrics \u0026amp; Gynecology. 2015;125(1):268-73. doi: 10.1097/01.AOG.0000459864.68372.ec.\u003c/li\u003e\n\u003cli\u003eBentzen JG, Forman JL, Johannsen TH, Pinborg A, Larsen EC, Andersen AN. Ovarian antral follicle subclasses and anti-mullerian hormone during normal reproductive aging. J Clin Endocrinol Metab. 2013;98(4):1602-11. doi: 10.1210/jc.2012-1829.\u003c/li\u003e\n\u003cli\u003eNelson SM. Biomarkers of ovarian response: current and future applications. Fertil Steril. 2013;99(4):963-9. doi: 10.1016/j.fertnstert.2012.11.051.\u003c/li\u003e\n\u003cli\u003eHemmings R, Bissonnette F, Bouzayen R. Results of laparoscopic treatments of ovarian endometriomas: laparoscopic ovarian fenestration and coagulation. Fertil Steril. 1998;70(3):527-9. doi: 10.1016/s0015-0282(98)00219-2.\u003c/li\u003e\n\u003cli\u003eErcan CM, Sakinci M, Duru NK, Alanbay I, Karasahin KE, Baser I. Antimullerian hormone levels after laparoscopic endometrioma stripping surgery. Gynecol Endocrinol. 2010;26(6):468-72. doi: 10.3109/09513591003632134.\u003c/li\u003e\n\u003cli\u003eManeschi F, Maras\u0026aacute; L, Incandela S, Mazzarese M, Zupi E. Ovarian cortex surrounding benign neoplasms: a histologic study. Am J Obstet Gynecol. 1993;169(2 Pt 1):388-93. doi: 10.1016/0002-9378(93)90093-x.\u003c/li\u003e\n\u003cli\u003eLi H, Yan B, Wang Y, Shu Z, Li P, Liu Y, et al. The Optimal Time of Ovarian Reserve Recovery After Laparoscopic Unilateral Ovarian Non-Endometriotic Cystectomy. Front Endocrinol (Lausanne). 2021;12:671225. doi: 10.3389/fendo.2021.671225.\u003c/li\u003e\n\u003cli\u003eGoodman LR, Goldberg JM, Flyckt RL, Gupta M, Harwalker J, Falcone T. Effect of surgery on ovarian reserve in women with endometriomas, endometriosis and controls. Am J Obstet Gynecol. 2016;215(5):589.e1-.e6. doi: 10.1016/j.ajog.2016.05.029.\u003c/li\u003e\n\u003cli\u003eSugita A, Iwase A, Goto M, Nakahara T, Nakamura T, Kondo M, et al. One-year follow-up of serum antim\u0026uuml;llerian hormone levels in patients with cystectomy: are different sequential changes due to different mechanisms causing damage to the ovarian reserve? Fertil Steril. 2013;100(2):516-22.e3. doi: 10.1016/j.fertnstert.2013.03.032.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e. Comparison of operative outcomes between laparoscopic system and robotic system: Baseline characteristics of the patients\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaparoscope\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=74)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRobot\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=58)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e29.96\u0026plusmn;6.74\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e28.16\u0026plusmn;6.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e23.07\u0026plusmn;4.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e22.72\u0026plusmn;3.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.638\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eParity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNullipara\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e65 (87.84%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e53 (91.38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.270\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePara 1 or more\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e9 (12.16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e5 (8.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistologic finding\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEndometrioma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e31 (41.89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e28\u003csup\u003e#\u003c/sup\u003e (48.28%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.468\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMature cystic teratoma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e30 (40.54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e23 (39.66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.919\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCystadenoma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e9 (12.16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e6 (10.34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.746\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOther cyst\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e4 (5.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e1 (0.17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.246\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCyst size, in maximum (cm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e6.45\u0026plusmn;2.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e7.00\u0026plusmn;2.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.314\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCyst position\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnilateral\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e56 (75.68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e41 (70.69%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.523\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBilateral\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e18 (24.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e17 (29.31%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCA 125 (U/mL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e54.47\u0026plusmn;75.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e37.43\u0026plusmn;37.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.186\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e#\u003c/sup\u003eCase in which a mature teratoma was identified concomitantly with an endometrioma.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e. Comparison of operative outcomes between laparoscopic system and robotic system: Operative outcomes.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaparoscope\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=74)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRobot\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=58)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOperative time (min)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e67.78\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn;30.58\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e105.17\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn;38.87\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated blood loss (mL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e62.84\u0026plusmn;93.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e93.97\u0026plusmn;103.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHb drop (g/dL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e1.69\u0026plusmn;1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e1.87\u0026plusmn;0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.278\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdhesiolysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e48.65%\u003c/p\u003e\n \u003cp\u003e(36/74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e36.84%\u003c/p\u003e\n \u003cp\u003e(21/57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.177\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCyst rupture\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e91.67%\u003c/p\u003e\n \u003cp\u003e(66/72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e85.96%\u003c/p\u003e\n \u003cp\u003e(49/57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.318\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e\u0026Dagger;\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003e(transfusion)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eConversion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of hospital day\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e4.18\u0026plusmn;0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e4.29\u0026plusmn;0.84\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.391\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026Dagger;Transfusion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e. Comparison of operative outcomes between laparoscopic system and robotic system: Serum anti-M\u0026uuml;llerian hormone (AMH) levels (ng/mL).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaparoscope\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=74)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRobot\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=58)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.01\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn;3.59\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.89\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn;4.81\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.015\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.08\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn;2.60\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.36\u0026plusmn;3.31\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.015\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026Delta;AMH (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026minus;13.21\u0026plusmn;57.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026minus;18.36\u0026plusmn;39.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.560\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAMH (%) = (postoperative AMH \u0026minus; preoperative AMH) \u0026times; 100 / preoperative AMH.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e. Comparison of operative outcomes between the laparoscopic system and Xi and SP robotic systems: Baseline characteristics of the patients.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaparoscope\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=74)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eXi Robot\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSP Robot\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=37)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e29.96\u0026plusmn;6.74\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e30.48\u0026plusmn;5.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e26.84\u0026plusmn;6.10\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e23.07\u0026plusmn;4.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e23.23\u0026plusmn;4.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e22.44\u0026plusmn;3.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.720\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eParity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNullipara\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e65 (87.84%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e19 (90.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e34 (91.89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.529\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePara 1 or more\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e9 (12.16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e2 (9.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e3 (8.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistopathologic finding\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEndometrioma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e31 (41.89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e8 (38.10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e20\u003csup\u003e#\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003e(54.05%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.389\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMature cystic teratoma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e30 (40.54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e11 (52.38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e12 (32.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.333\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCystadenoma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e9 (12.16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e2 (9.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e4 (10.81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.939\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOther cyst\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e4 (5.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.484\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCyst size, in maximum (cm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e6.45\u0026plusmn;2.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e7.35\u0026plusmn;3.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e6.80\u0026plusmn;2.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.376\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCyst position\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnilateral\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e56 (75.68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e16 (76.19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e25 (67.57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.635\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBilateral\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e18 (24.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e5 (23.81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e12 (32.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCA 125 (U/mL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e54.47\u0026plusmn;75.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e37.94\u0026plusmn;46.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e37.13\u0026plusmn;32.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.419\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e#Case in which a mature teratoma was identified concomitantly with an endometrioma.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u003c/strong\u003e. Comparison of operative outcomes between the laparoscopic system and Xi and SP robotic systems: Operative outcomes.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaparoscope\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=74)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eXi robot\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSP robot\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=37)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOperative time (min)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e67.78\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn;30.58\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e101.62\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn;48.93\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e107.19\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn;32.41\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated blood loss (mL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e62.84\u0026plusmn;93.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e111.90\u0026plusmn;125.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e83.78+79.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHb drop (g/dL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1.69\u0026plusmn;1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e2.18\u0026plusmn;1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1.70\u0026plusmn;0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.108\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdhesiolysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e48.65%\u003c/p\u003e\n \u003cp\u003e(36/74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e33.33%\u003c/p\u003e\n \u003cp\u003e(7/21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e38.89%\u003c/p\u003e\n \u003cp\u003e(14/36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.375\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCyst rupture\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e91.67%\u003c/p\u003e\n \u003cp\u003e(66/72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e80.95%\u003c/p\u003e\n \u003cp\u003e(17/21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e88.89%\u003c/p\u003e\n \u003cp\u003e(32/36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.386\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e\u0026Dagger;\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003e(transfusion)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eConversion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of hospital day\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e4.18\u0026plusmn;0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e4.43\u0026plusmn;1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e4.22\u0026plusmn;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.422\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026Dagger;Transfusion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6\u003c/strong\u003e. Comparison of operative outcomes between the laparoscopic system and Xi and SP robotic systems: Serum anti-M\u0026uuml;llerian hormone (AMH) levels (ng/mL).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaparoscope\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=74)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eXi robot\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSP robot\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=37)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.01\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn;3.59\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.09\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn;3.91\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.35\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn;5.26\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.08\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn;2.60\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.81\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn;2.88\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.66\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn;3.54\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.029\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026Delta;AMH (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026minus;13.21\u0026plusmn;57.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026minus;14.63\u0026plusmn;47.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026minus;20.47\u0026plusmn;34.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.772\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7\u003c/strong\u003e. Comparison of \u0026Delta;AMH between the laparoscopic system and robotic system in the patients with preoperative AMH values \u0026lt; 2.0.: Serum anti-M\u0026uuml;llerian hormone (AMH) levels (ng/mL).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaparoscope\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRobot\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=11)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.95 (0.46,1.48)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.34\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(0.74,1.87)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.337\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.90 (0.33,1.35)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.81 (0.52,1.04)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.540\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026Delta;AMH (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026minus;7.55 (\u0026minus;48.79,19.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026minus;29.73 (\u0026minus;59.89,9.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.715\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 8\u003c/strong\u003e. Comparison of operative outcomes between laparoscopic system and robotic system in patients diagnosed with endometriosis: Serum anti-M\u0026uuml;llerian hormone (AMH) levels (ng/mL).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaparoscope\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=31)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRobot\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=28)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e3.90\u0026plusmn;3.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e4.47\u0026plusmn;3.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.506\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e2.49\u0026plusmn;2.35\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e2.79\u0026plusmn;2.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.609\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026Delta;AMH (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026minus;23.59\u0026plusmn;72.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026minus;31.43\u0026plusmn;36.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.609\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 9.\u003c/strong\u003e Comparison of operative outcomes between laparoscopic system and robotic system in patients diagnosed with endometriosis: Serum anti-M\u0026uuml;llerian hormone (AMH) levels (ng/mL)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaparoscope\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=31)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSP Robot\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=20)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e3.90\u0026plusmn;3.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e4.60\u0026plusmn;3.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.467\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e2.49\u0026plusmn;2.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e2.92\u0026plusmn;2.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.506\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026Delta;AMH (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026minus;23.59\u0026plusmn;72.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026minus;28.40\u0026plusmn;36.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.786\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"anti-Müllerian hormone, ovarian reserve, robotic surgical procedures, laparoscopy, benign ovarian cyst","lastPublishedDoi":"10.21203/rs.3.rs-3247241/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3247241/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo investigate the impact on the ovarian reserve after minimally invasive ovarian cystectomy using two platforms, the Da Vinci robotic system (Xi and SP) and the laparoscopic system.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients underwent laparoscopic or Da Vinci robotic (Xi or SP) ovarian cystectomy for benign ovarian cysts between January 1, 2018, and December 31, 2022 at Guro Hospital, Korea University Medical center. We measured the change of AMH values(%) = [(postAMH − preAMH)] × 100 / preAMH.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMain Results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo significant differences in preoperative age, cyst size, estimated blood loss during surgery, hemoglobin drop, length of hospital stay, adhesion detachment rate and cyst rupture rate were observed. However, the operative time was significantly shorter in the laparoscopic group than that in the robotic group (67.78±30.58 min vs. 105.17±38.87 min, p\u0026lt;0.001)\u003c/p\u003e\n\u003cp\u003eThe mean preAMH and postAMH were significantly higher with the Da Vinci robotic group than with the laparoscopic group (preAMH: 5.89±4.81 ng/mL vs. 4.01±3.59 ng/mL, p=0.02, postAMH: 4.36±3.31 ng/mL vs. 3.08±2.60 ng/mL, p=0.02). However, the mean ΔAMH was not significantly different between two groups. ΔAMH also did not demonstrate significant differences among the three groups; laparoscopic, Xi and SP robotic. Even in the patient groups with preAMH \u0026lt; 2 and diagnosed with endometriosis, the ΔAMH did not show significant differences between the laparoscopic and robotic groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlthough the Da Vinci robotic system requires a longer time for performing a benign ovarian cystectomy compared to laparoscopic surgery, it is an effective and minimally invasive method for preserving ovarian function.\u003c/p\u003e","manuscriptTitle":"Changes in anti-Müllerian hormone values for ovarian reserve after minimally invasive benign ovarian cystectomy: Comparison of the Da Vinci robotic systems (Xi and SP) and the laparoscopic system","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-08-23 10:47:49","doi":"10.21203/rs.3.rs-3247241/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0a00a6ee-e4c3-4ec3-ae3b-f25c6f037eb0","owner":[],"postedDate":"August 23rd, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-05-01T22:59:03+00:00","versionOfRecord":{"articleIdentity":"rs-3247241","link":"https://doi.org/10.1038/s41598-024-59935-2","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2024-04-20 22:59:03","publishedOnDateReadable":"April 20th, 2024"},"versionCreatedAt":"2023-08-23 10:47:49","video":"","vorDoi":"10.1038/s41598-024-59935-2","vorDoiUrl":"https://doi.org/10.1038/s41598-024-59935-2","workflowStages":[]},"version":"v1","identity":"rs-3247241","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3247241","identity":"rs-3247241","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}