Robotic versus laparoscopic enucleation of ovarian endometriotic cysts with pathological analysis of inadvertent follicular loss

Yunjeong Park, Eunah Shin, Jimin Bae, SiHyun Cho, Young Sik Choi, Joo Hyun Park
In: Journal of Robotic Surgery · 2026 · vol. 20(1) · doi:10.1007/s11701-026-03415-4 · PMID:42237004 · PMC13233877 · W7163348717
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

Robotic-assisted ovarian endometriotic cyst enucleation resulted in a smaller excised cortical area compared to laparoscopic surgery, with no difference in follicle-based metrics.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This retrospective study compared robotic-assisted versus conventional laparoscopic enucleation of ovarian endometriotic cysts, using digitized hematoxylin-and-eosin slides to quantify inadvertent removal of ovarian cortex and evaluate follicle loss. Eighty-one patients (40 laparoscopic, 41 robotic) undergoing cystectomy by a single surgeon had excised cortical area measured on whole-slide digital pathology and categorized as follicle-containing cortex, cortex without follicles, or fibrosis, with log-linear regression adjusted for cyst length and width. Robotics was associated with a smaller excised cortical area than laparoscopy (robot-to-laparoscopy ratio 0.55 in the adjusted model), while follicle counts and antral follicle presence among follicle-containing specimens were comparable; the paper’s main limitation is its retrospective design and single-surgeon setting. This paper is centrally about endometriosis — specifically, it assesses how robotic versus laparoscopic cystectomy affects inadvertent ovarian cortical and follicle tissue loss in ovarian endometriotic cysts.

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Abstract

Ovarian endometrioma cystectomy may compromise ovarian reserve through inadvertent excision of ovarian cortex. We compared inadvertent cortical removal between robotic-assisted and conventional laparoscopic cystectomy using digital pathology. We retrospectively analyzed 81 patients (40 laparoscopic, 41 robotic) who underwent single-surgeon cystectomy (January 2020-December 2025) with digitized hematoxylin and eosin-stained slides available. Ninety-eight ovary/side specimens were classified as follicle-containing cortex, cortex without follicles, or fibrosis, and excised cortical area (mm²) was quantified. The primary analysis used log-linear regression adjusted for cyst length and width with patient-clustered robust standard errors. Tissue-type distribution did not differ by approach (P = 0.611). Excised cortical area was smaller with robotics (median 34.6 mm², interquartile range 16.9-82.3) than laparoscopy (median 65.4 mm², interquartile range 39.5-81.6; P = 0.011). In the adjusted model, robotics was associated with a smaller excised cortical area (robot-to-laparoscopy ratio 0.55, 95% confidence interval 0.32-0.93; P = 0.029). Follicle counts and antral follicle presence among follicle-containing specimens were comparable. Robotic-assisted cystectomy was associated with less inadvertent excision of ovarian cortex after accounting for cyst dimensions, while follicle-based specimen metrics did not differ.

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endometrioma

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