Stepwise approach of hysteroscopic cytoreductive surgery for adenomyosis in patients with recurrent implantation failure

Rudi Campo, Campo R, Evy Gillet, Gillet E, Stephan Gordts, Gordts S, Marion Valkenburg, Valkenburg M, Helena Van Kerrebroeck, Van Kerrebroeck H, Alessa Sugihara, Ayako Sugihara, Sugihara A, Istvan Argay, Argay I, I Argay, Tanos P, Panayiotis Tanos
Fertility and sterility · 2024 · vol. 123(2) , pp. 370–372 · doi:10.1016/j.fertnstert.2024.10.051 · PMID:39515453 · W4404122019
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A stepwise hysteroscopic cytoreductive surgery for adenomyosis in patients with recurrent implantation failure demonstrated feasibility, minimal adhesions, and improved reproductive outcomes with successful pregnancies and deliveries.

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Abstract

OBJECTIVE: To study the value of hysteroscopic cytoreductive surgery for adenomyotic lesions to improve reproductive outcomes. We describe a feasible and novel minimal invasive stepwise approach, which did not result in postoperative adhesion formation and restored favorable reproductive outcomes. DESIGN: Video article. SUBJECTS: Patients aged <37 years, diagnosed with adenomyotic lesions by ultrasound and/or magnetic resonance imaging, who after a minimum of 6 months of medical treatment (gonadotrophin releasing hormone agonist or dienogest) failed to conceive with a minimum of two embryo transfer cycles of high-quality blastocysts were included. EXPOSURE: The procedure was performed under conscious sedation, level 3b in an ambulatory surgical center. All patients received hormonal suppressive treatment (Dienogest 2 mgr per day or Triptoreline 3.75 mgr. IM once a month). Institutional Review Board approval and patient consent had been received for the study. The surgical steps included the following: MAIN OUTCOME MEASURE(S): Feasibility, reproductive outcomes, and complications (adhesions and placental disorders). RESULT(S): Fifteen patients underwent surgery and had histological confirmation of adenomyosis. Second-look hysteroscopy was possible in 13 of 15 women (2 spontaneous pregnancies) with reassuring postoperative results, showing only mild lateral wall adhesions in three cases. Pregnancy was registered in 12 women: one early miscarriage; seven ongoing pregnancies; and four deliveries of healthy infants with normal birth weight and no placenta-related complications. CONCLUSION: (s): In contrast to the current beliefs, mini hysteroscopy can identify and selectively resect adenomyotic lesions. The described technique in this video in our series of patients resulted in optimal postoperative healing and excellent reproductive outcomes.

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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 (11)

Cited by (2)

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