Comparative impact of 3D and 2D laparoscopy on ovarian reserve following endometrioma excision: A retrospective study

Aim: To compare the effects of three-dimensional (3D) and two-dimensional (2D) laparoscopic visualization systems on operative efficiency and ovarian reserve following unilateral endometrioma excision. Methods: This retrospective study included 89 women aged 18–40 years who underwent laparoscopic unilateral endometrioma excision between 2021 and 2024. Patients were divided into two groups according to the visualization system used: 3D ( n = 46) and 2D ( n = 43). Operative time, change in hemoglobin (Hb), cyst diameter, and serum anti-Müllerian hormone (AMH) levels measured preoperatively and 6 months postoperatively were compared using non-parametric tests (Mann–Whitney U and chi-square). A p -value <0.05 was considered statistically significant. Results: The median operative time was significantly shorter in the 3D group (66 min (IQR = 50–87)) compared with the 2D group (165 min (IQR = 153–188); p < 0.001). No statistically significant differences were observed between the groups in hemoglobin change ( p = 0.538), cyst diameter ( p = 0.787), or pre- and postoperative AMH levels ( p = 0.662 and 0.955, respectively). Although the postoperative decline in AMH was greater in the 3D group, this difference did not reach statistical significance ( p = 0.125). Conclusions: Three-dimensional laparoscopy significantly enhances surgical efficiency during endometrioma excision without compromising ovarian reserve. These findings support the use of advanced visualization systems to improve precision and ergonomics in reproductive surgery.