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.
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