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

Source: PubMed, NCBI / U.S. National Library of Medicine

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.