Surgical Treatments for Adenomyosis

The objective of this prospective study performed at Juntendo University School of Medicine was to evaluate a novel method of laparoscopic adenomyomectomy (LA). The subjects were 76 women with adenomyosis who wished to conserve fertility. Two methods of LA and hysteroplasty were used: wedge resection (WR) and the double flap method (DF). WR was performed on 22 women with exteriorly growing focal adenomyosis close to the serosal membrane, and DF was performed on 54 women with adenomyosis growing interiorly close to the endometrium. WR was performed by making a V-shaped notch to remove the adenomyotic nodule and surrounding serosa with a electric cautery. The remaining muscle layer was sutured so that hysteroplasty could be performed. For the DF procedure, after a transverse incision, the adenomyotic nodule was removed, with the remaining serosal tissue serving as the upper and lower flaps, which were overlapped and sutured. For the operative outcome in the WR and DF groups, the average surgical duration was 118.6 ± 43.3 min and 144.0 ± 44.5 min, and the estimated blood loss was 172.1 ± 175.2 mL and 245.3 ± 232.3 mL, respectively. The visual analog scale of dysmenorrhea and hypermenorrhea was significantly decreased after surgery, and this trend continued for more than 3 years. Investigation by second-look laparoscopy showed that 3 out of 24 patients (12.5%) had de novo adhesion to the adnexa and 12 patients out of them (50%) had postoperative adhesions to the incision site of the uterus. All patients exhibited tubal patency with an indigo carmine solution used for chromotubation, but wound thinning was observed in only one patient by leakage of it. The postoperative pregnancy rate was 38.8% (12 out of 31 infertile patients), 73.3% (11 out of 15 pregnancies) of which resulted in live births. There were no severe complications during pregnancy and delivery. In conclusion, LA was found to be safe and useful for minimally invasive surgery to conserve fertility. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

Mochimaru A, Aoki S, Oba MS, Kurasawa K, Takahashi T, Hirahara F. Adverse pregnancy outcomes associated with adenomyosis with uterine enlargement. J Obstet Gynaecol Res. 2015;41(4):529–33. Reinhold C, Tafazoli F, Wang L. Imaging features of adenomyosis. Hum Reprod Update. 1998;4(4):337–49. Takeuchi H, Kitade M, Kikuchi I, Shimanuki H, Kumakiri J, Takeda S. Influencing factors of adhesion development and the efficacy of adhesion-preventing agents in patients undergoing laparoscopic myomectomy as evaluated by a second-look laparoscopy. Fertil Steril. 2008;89(5):1247–53. Shimanuki H, Takeuchi H, Kitade M, Kikuchi I, Kumakiri J, Kinoshita K. The effect of vasopressin on local and general circulation during laparoscopic surgery. J Minim Invasive Gynecol. 2006;13(3):190–4. Wood C. Surgical and medical treatment of adenomyosis. Hum Reprod Update. 1998;4(4):323–36. Morita M, Asakawa Y, Nakakuma M, Kubo H. Laparoscopic excision of myometrial adenomyomas in patients with adenomyosis uteri and main symptoms of severe dysmenorrhea and hypermenorrhea. J Am Assoc Gynecol Laparosc. 2004;11(1):86–9. Chung YJ, Kang SY, Choi MR, Cho HH, Kim JH, Kim MR. Robot-assisted laparoscopic adenomyomectomy for patients who want to preserve fertility. Yonsei Med J. 2016;57(6):1531–4. Takeuchi H, Kitade M, Kikuchi I, Shimanuki H, Kumakiri J, Kitano T, et al. Laparoscopic adenomyomectomy and hysteroplasty: a novel method. J Minim Invasive Gynecol. 2006;13(2):150–4. Hyams LL. Adenomyosis; its conservative surgical treatment (hysteroplasty) in young women. N Y State J Med. 1952;52(22):2778–84. Osada H, Silber S, Kakinuma T, Nagaishi M, Kato K, Kato O. Surgical procedure to conserve the uterus for future pregnancy in patients suffering from massive adenomyosis. Reprod Biomed Online. 2011;22(1):94–9. Huang X, Huang Q, Chen S, Zhang J, Lin K, Zhang X. Efficacy of laparoscopic adenomyomectomy using double-flap method for diffuse uterine adenomyosis. BMC Womens Health. 2015;15:24. Takeuchi H, Kuwatsuru R. The indications, surgical techniques, and limitations of laparoscopic myomectomy. JSLS. 2003;7(2):89–95. Takeuchi H, Shimanuki H, Kobori H, Kitade M, Kikuchi I, Kinoshita K. Effect of vasopressin on blood flow and RI of the uterine artery during laparoscopic myomectomy. J Minim Invasive Gynecol. 2005;12(1):10–1. Author information Authors and Affiliations Corresponding author Editor information Editors and Affiliations Rights and permissions Copyright information © 2018 Springer Nature Singapore Pte Ltd. About this chapter Cite this chapter Kitade, M. et al. (2018). Surgical Treatments for Adenomyosis. In: Sugino, N. (eds) Uterine Fibroids and Adenomyosis. Comprehensive Gynecology and Obstetrics. Springer, Singapore. https://doi.org/10.1007/978-981-10-7167-6_11 Download citation DOI: https://doi.org/10.1007/978-981-10-7167-6_11 Published: Publisher Name: Springer, Singapore Print ISBN: 978-981-10-7166-9 Online ISBN: 978-981-10-7167-6 eBook Packages: MedicineMedicine (R0)