Surgical Treatment of Adenomyosis

Purpose of review This paper aims to discuss the state of the art of the conservative surgical treatment of adenomyosis. Recent findings Medical treatment for adenomyosis is usually the first step, but some patients do not respond. Hysterectomy using minimally invasive techniques is the gold-standard treatment for those patients that do not desire pregnancies. Although there is no definitive evidence to support conservative surgical treatment for adenomyosis, many authors described good results in women who wish to preserve fertility. Summary Although hysterectomy is the main form of treatment, conservative options should be offered to women who wish to maintain their fertility. Several excisional and non-excisional techniques can be indicated for selected patients with promising results, always keeping in mind the risks of uterine rupture and recurrence with these techniques. Access this article We’re sorry, something doesn't seem to be working properly. Please try refreshing the page. If that doesn't work, please contact support so we can address the problem. Similar content being viewed by others

Papers of particular interest, published recently, have been highlighted as: • Of importance Vannuccini S, Petraglia F. Recent advances in understanding and managing adenomyosis. F1000 Res. 2019. https://doi.org/10.12688/f1000research.17242.1. Oliveira MAP, Crispi CP Jr, Brollo LC, Crispi CP, De Wilde RL. Surgery in adenomyosis. Arch Gynecol Obstet. 2018;297:581–9. Osada H. Uterine adenomyosis and adenomyoma: the surgical approach. Fertil Steril. 2018;109:406–17. Abbott JA. Adenomyosis and Abnormal Uterine Bleeding (AUB-A)-Pathogenesis, diagnosis, and management. Best Pract Res Clin Obstet Gynaecol. 2017;40:68–81. Pepas L, Deguara C, Davis C. Update on the surgical management of adenomyosis. Curr Opin Obstet Gynecol. 2012;24:259–64. Younes G, Tulandi T. Conservative Surgery for Adenomyosis and Results: A Systematic Review. J Minim Invasive Gynecol. 2018;25:265–76. Dasrilsyah RA, Shan LP, Kwang NB, Shafiee MN, Omar MH. Spontaneous conception following GnRHa and progestogen therapy in adenomyosis. Horm Mol Biol Clin Investig. 2016;27:77–9. Kishi Y, Yabuta M, Taniguchi F. Who will benefit from uterus-sparing surgery in adenomyosis-associated subfertility?. Fertil Steril. 2014;102:802-807.e1. • Ma J, Brown B, Liang E. Long-term durability of uterine artery embolisation for treatment of symptomatic adenomyosis. Aust N Z J Obstet Gynaecol. 2020;61:290–6. Findings from this study showed a cumulative success rate of 80% with uterine artery embolization, which should be considered as an alternative to hysterectomy to treat adenomyosis. Szubert M, Koziróg E, Olszak O, Krygier-Kurz K, Kazmierczak J, Wilczynski J. Adenomyosis and Infertility—Review of Medical and Surgical Approaches. Int J Environ Res Public Health. 2021;18:1235. • Lin XL, Hai N, Zhang J, Han ZY, Yu J, Liu FY, Dong XJ, Liang P. Comparison between microwave ablation and radiofrequency ablation for treating symptomatic uterine adenomyosis. Int J Hyperthermia. 2020;37:151–6. The findings of this study showed the safety and effectiveness of microwave ablation and radiofrequency in the treatment of adenomyosis. Scarperi S, Pontrelli G, Campana C, Steinkasserer M, Ercoli A, Minelli L, Bergamini V, Ceccaroni M. Laparoscopic Radiofrequency Thermal Ablation for Uterine Adenomyosis. JSLS. 2015. https://doi.org/10.4293/JSLS.2015.00071. Nam J-H. Pregnancy and symptomatic relief following ultrasound-guided transvaginal radiofrequency ablation in patients with adenomyosis. J Obstet Gynaecol Res. 2020;46:124–32. Dueholm M. Minimally invasive treatment of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2018;51:119–37. Hyams LL. Adenomyosis; its conservative surgical treatment (hysteroplasty) in young women. N Y State J Med. 1952;52:2778–84. Chen J, Porter AE, Kho KA. Current and future surgical and interventional management options for adenomyosis. Semin Reprod Med. 2020;38:157–67. Fujishita A, Masuzaki H, Khan KN, Kitajima M, Ishimaru T. Modified reduction surgery for adenomyosis. A preliminary report of the transverse H incision technique. Gynecol Obstet Invest. 2004;57:132–8. 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;22:94–9. Kim J-K, Shin C-S, Ko Y-B, Nam S-Y, Yim H-S, Lee K-H. Laparoscopic assisted adenomyomectomy using double flap method. Obstet Gynecol Sci. 2014;57:128–35. 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. Zhu L, Chen S, Che X, Xu P, Huang X, Zhang X. Comparisons of the efficacy and recurrence of adenomyomectomy for severe uterine diffuse adenomyosis via laparotomy versus laparoscopy: a long-term result in a single institution. J Pain Res. 2019;12:1917–24. • Ahn JW, You S-G, Go EB, Lee SH, Kim JS, Cho HJ, Roh HJ. Minimally invasive adenomyomectomy via a laparoscopic-assisted approach compared to a laparoscopic or laparotomic approach. Taiwan J Obstet Gynecol. 2021;60:1005–10. The findings of this study demonstrated that adenomyomectomy allows for maximal debulking of adenomyosis while retaining the advantages of the laparoscopic approach. Tan J, Moriarty S, Taskin O, Allaire C, Williams C, Yong P, Bedaiwy MA. Reproductive outcomes after fertility-sparing surgery for focal and diffuse adenomyosis: a systematic review. J Minim Invasive Gynecol. 2018;25:608–21. Kwack J-Y, Kwon Y-S. Conservative surgery of diffuse adenomyosis with TOUA: Single surgeon experience of one hundred sixteen cases and report of fertility outcomes. Kaohsiung J Med Sci. 2018;34:290–4. Yu W, Liu G, Liu C, Zhang Z. Recurrence-associated factors of laparoscopic adenomyomectomy for severely symptomatic adenomyoma. Oncol Lett. 2018;16:3430–8. Nagao Y, Osato K, Kubo M, Kawamura T, Ikeda T, Yamawaki T. Spontaneous uterine rupture in the 35th week of gestation after laparoscopic adenomyomectomy. Int Med Case Rep J. 2015:1. Wada S-I, Kudo M, Minakami H. Spontaneous uterine rupture of a twin pregnancy after a laparoscopic adenomyomectomy: A case report. J Minim Invasive Gynecol. 2006;13:166–8. Ukita S, Koshiyama M, Yamaguchi A, Ueda M, Ukita M, Hishikawa K, Kakui K, Kim T. Total uterine rupture during pregnancy after an adenomyomectomy. American Journal of Case Reports, The. 2011;12:106–9. Cobellis L, Pecori E, Cobellis G. Comparison of intramural myomectomy scar after laparotomy or laparoscopy. Int J Gynaecol Obstet. 2004;84:87–8. Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of Interest None of the authors have any conflict of interest. Research Involving Human and Animal Participants As a review manuscript, this article does not contain any studies with human participants or animals performed by any of the authors. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This article is part of the Topical Collection on Uterine Fibroids and Endometrial Lesions Rights and permissions About this article Cite this article Oliveira, M.A.P., Brollo, L.C., Soares, T. et al. Surgical Treatment of Adenomyosis. Curr Obstet Gynecol Rep 11, 180–185 (2022). https://doi.org/10.1007/s13669-022-00335-6 Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s13669-022-00335-6