Ovarian remnant syndrome: comparison of laparotomy, laparoscopy and robotic surgery

Objective. To compare laparotomy, laparoscopy and robotic surgery in the management of ovarian remnant syndrome. Design. Retrospective comparative study. Setting. Mayo Clinic Arizona and Mayo Clinic Rochester, USA. Population. Women who underwent surgical treatment for ovarian remnant syndrome. Methods. The clinical records of 223 patients with histologically documented residual cortical ovarian tissue excised at Mayo Clinic by laparotomy, laparoscopy or a robotic approach, from January 1985 through February 2009, were reviewed. Data collected included the patient's age, body mass index, previous medical and surgical history, symptoms, prior management of ovarian remnant syndrome, preoperative imaging study, intraoperative details, postoperative course, complications and follow-up data. Main outcome measures. Intraoperative and postoperative outcomes. Results. One hundred and eighty-seven patients (83.9%) were operated by laparotomy, 19 (8.5%) by laparoscopy and 17 (7.6%) by a robotic approach. Estimated blood loss and length of stay were significantly lower in the robotic and laparoscopic groups compared with laparotomy (p < 0.01). After a mean follow-up of 21.1 +/- 32.4 months, the rate of pain improvement was 93.1, 94.4 and 71.4% for the laparotomy, laparoscopy and robotic surgery group, respectively. Conclusions. Robotic and laparoscopic surgery for the treatment of ovarian remnant syndrome offer advantages over laparotomy in terms of reduced blood loss, lower postoperative complications and shorter length of stay.