Adenomyomectomy by the Triple-Flap Method

Adenomyosis tissue lacks a definite surgical plane, making its removal extremely difficult. In place of the classical V-shaped resection method, a variety of cytoreductive surgeries have been attempted to eradicate completely the disease while easing symptoms and conserving fertility. Although adenomyomectomy is effective in treating symptoms and preserving fertility, its postoperative risks include a thin uterine wall, which may lead to uterine rupture, abnormal placentation, and increased spontaneous abortion. The triple-flap method of adenomyomectomy addresses these issues by emphasizing the complete excision of adenomyotic tissue and a reconstruction of the uterine wall that avoids overlapping suture lines in six steps. Step 1: diagnostic laparoscopy; step 2: exteriorization of the uterus and placement of a tourniquet around the proximal cervix; step 3: bisection of the uterus/adenomyosis; step 4: excision of adenomyotic tissue; step 5: reconstruction of the uterine wall by the triple-flap method; and step 6: final laparoscopy and adhesion prevention. The procedure was performed between June 1998 and August 2017, involving 113 women suffering from very severe adenomyosis. The procedure resulted in a dramatic reduction of adenomyotic symptoms, and 32 women out of 62 who wished to conceive following the procedure went to term and were delivered by elective cesarean section without the devastating complication of uterine rupture. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

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I would like to thank Drs. S. J. Silber, M. DeRosa, T. Kakinuma, M. Nagaishi, K. Kato, and S. Teramoto for their help in developing this new procedure. I would also like to thank K. Nakazato and A. Pinnington for their help in the preparation of the manuscript. Author information Authors and Affiliations Editor information Editors and Affiliations Rights and permissions Copyright information © 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG About this chapter Cite this chapter Osada, H. (2022). Adenomyomectomy by the Triple-Flap Method. In: Lindheim, S.R., Petrozza, J.C. (eds) Reproductive Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-05240-8_16 Download citation DOI: https://doi.org/10.1007/978-3-031-05240-8_16 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-031-05239-2 Online ISBN: 978-3-031-05240-8 eBook Packages: MedicineMedicine (R0)