Impact on ovarian reserve after laparoscopic ovarian cystectomy with reduced port number: a randomized controlled trial

Objectives: Single-port access (SPA) laparoscopic ovarian cystectomy has been reported as a comparable procedure to conventional laparoscopy in terms of operative outcomes. However, whether ovarian function after SPA laparoscopic surgery is similar to conventional laparoscopy is questioned due to the limitations in moving instruments. The aim of this study was to evaluate whether the reduced port number affects the ovarian reserve after laparoscopic ovarian cystectomy. Study design: This was a randomized controlled trial of 87 women with benign ovarian cyst, who attended a university hospital and were scheduled for laparoscopic ovarian cystectomy. Women were randomized to SPA, two-port access (TPA), or four-port access (FPA) laparoscopic groups. The primary outcome was the serum anti-Mullerian hormone (AMH) levels: preoperative, 1 week, 1 month and 3 months after the operation. Secondary outcomes were operative outcomes. Results: The mean serum AMH levels of preoperative, 1 week, 1 month and 3 months after laparoscopy were 4.4 +/- 2.9, 2.7 +/- 2.2, 2.3 +/- 1.9, and 2.5 +/- 1.5 ng/mL (in the SPA group), 3.6 +/- 2.5, 2.3 +/- 2.2, 2.6 +/- 3.2, and 2.7 +/- 2.6 ng/mL (in the TPA group), and 3.9 +/- 3.2, 2.4 +/- 2.1, 2.5 +/- 2.0, and 2.8 +/- 2.2 ng/mL (in the FPA group), respectively. There was no statistically significant difference in the serial change of AMH levels among the SPA, TPA and FPA groups. Conclusions: The laparoscopic ovarian cystectomy with reduced port number does not affect the serial change of ovarian reserve. The SPA or TPA laparoscopy may be the alternative method to conventional laparoscopy in terms of ovarian reserve. (C) 2014 Elsevier Ireland Ltd. All rights reserved.