The Pumpkin method - An innovative uterus-preserving surgery for large complex adenomyosis: A preliminary experience

Kung CH, Chiao-Hsin Kung, Leo Leung‐Chit Tsang, Leung-Chit Tsang L, Leo Leung-Chit Tsang, Chen WH, Wen‐Hsin Chen, Wen-Hsin Chen, Yu-Min Chou, Chou YM, Yi-Lin Chou, Tsai CC, Ching‐Chang Tsai, Ching-Chang Tsai, Fu‐Tsai Kung, Fu-Tsai Kung, Kung FT
Taiwanese journal of obstetrics & gynecology · 2025 · vol. 64(6) , pp. 1009–1016 · doi:10.1016/j.tjog.2025.07.024 · PMID:41213746 · W4416040905
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The "Pumpkin method," a novel multiflap adenomyomectomy technique, demonstrated feasible uterus preservation with adenomyosis regression and symptom improvement in 10 patients, though one required hysterectomy for recurrence.

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Abstract

OBJECTIVE: To introduce and evaluate the surgical feasibility, safety, and recovery outcomes of the "Pumpkin method," a novel, multiflap adenomyomectomy technique for patients with large and complex adenomyosis. MATERIALS AND METHODS: This prospective observational study enrolled 10 consecutive women with large, refractory adenomyosis (unresponsive to hormonal therapy) and fertility concerns. All patients underwent uterus-preserving laparotomic surgery using the newly developed "Pumpkin method," involving multiple longitudinal uterine incisions to excise adenomyotic tissue. The resulting arch bridge-like flaps were reconstructed using interrupted and mattress sutures, forming a "pumpkin-like" appearance resembling Yayoi Kusama's sculptural art. Preoperative and postoperative evaluations included magnetic resonance imaging (MRI), and serum cancer antigen 125 (CA-125) and anti-Müllerian hormone (AMH) levels. RESULTS: Six-month postoperative MRI demonstrated significant adenomyosis regression (residual lesions ≤2 cm) with preserved uterine morphology, adequate myometrial thickness, and an intact endometrium. CA-125 levels decreased significantly (P = 0.008), indicating reduced adenomyotic tumor activity, while AMH levels remained stable (P = 0.110), suggesting preservation of the ovarian reserve. At a mean follow-up of 30.5 months, nine patients reported sustained improvement in menstrual symptoms. One patient achieved an uncomplicated term twin pregnancy; however, one patient required a hysterectomy 30 months after surgery due to recurrent symptoms. CONCLUSION: The "Pumpkin method" provides a feasible and effective approach for adenomyosis debulking, combining multiflap excision with meticulous reconstruction to restore uterine anatomy without major technical difficulties. Further studies with larger cohorts are warranted to validate reproductive outcomes and long-term efficacy.

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Condition tags

adenomyosis

MeSH descriptors

Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis

Citation neighborhood (2-hop)

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

References (18)

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