Laparoscopic assisted adenomyomectomy using double flap method

Abstract

ObjectiveThe purpose of this study was to evaluate postoperative prognosis and progression in patients who received laparoscopic-assisted adenomyomectomy using the double flap method.MethodsThe pelvic cavity was explored by the conventional laparoscopic method, and drainage was achieved through a 5-mm trocar. After a small incision in the abdomen, the uterus was incised from the fundus to the upper cervical margin until exposing the endometrial cavity. Adenomyotic tissue was removed using a scalpel, scissors, or monopolar electrical bovie. The endometrial cavity was repaired with interrupted sutures using 2-0 vicryl. One side of the serosal flap was used to cover the endometrial side of the uterus. The second serosal flap covered the first flap after removal of the serosal surface of the first flap.ResultsFrom January 2008 to March 2012, there were 11 cases of laparoscopic-assisted adenomyomectomy at Chungnam National University Hospital. Nine cases were analyzed, excluding two cases with less than one year of follow-up. The average patient age was 37.0 years and average follow-up duration was 32.8 months. All patients showed improvement in dysmenorrhea (P < 0.001) and hypermenorrhea (P = 0.001) after surgery and were evaluated by visual analogue scale score. However, symptoms of adenomyosis were aggravated in three patients. Adenomyosis was progressed in the side opposite the site of operation. One patient required a total laparoscopic hysterectomy 27 months after surgery.ConclusionLaparoscopic-assisted adenomyomectomy using the double flap method is effective for uterine reduction and relief of dysmenorrhea and hypermenorrhea. Conservative management and careful follow-up are needed because adenomyosis can recur or progress in some patients.

Efficacy of laparoscopic adenomyomectomy using double-flap method for diffuse uterine adenomyosis

“…Kishi et al treated 102 patients with adenomyosis who had a desire for pregnancy by laparoscopic adenomyomectomy using the conventional method, and the clinical pregnancy rates in women with age ≤39 years and ≥ 40 year were 41.3% and 3.7%, respectively [ 40 ]. In our study, 10 patients who wished to conceive after surgery did not want to have a pregnancy so far, because their age were relatively older, and they have had children, which is in agreement with the study of Kim et al [ 17 ]. Actually, our study and the study of Kim et al contain less infertility patients compared with the studies of Kishi et al and Saremi et al [ 17 , 39 , 40 ].…”

“…It is indicated that the surgical efficacy of laparoscopic adenomyomectomy for the treatment of diffuse uterine adenomyosis can decrease over time. Therefore, long-term drug therapy such as Mirena (or oral contraceptives) is recommeneded after adenomyomectomy for the treatment of diffuse uterine adenomyosis [ 17 , 37 ].…”

“…After adenomyotic lesions were removed (Figure 1 A and E), the endometrial lining was approximated with interrupted sutures of 3–0 Vicryl (Figure 1 B and F). The myometrium and serosa of the bisected uterus were sutured with 2–0 Vicryl by using the double-flap method described by Kim et al [ 17 ], but not by using the triple-flap method proposed by Osada et al [ 16 ]. Namely, the first flap in one side wall of the uterus (including the serosa and the myometrium) was brought into the second flap in another side of the uterine wall (including the endometrium and the myometrium) such that the other side wall of the uterus (including the endometrium and the myometrium) was covered (Figure 1 C and G).…”

“…Partial adenomyomectomy including wedge resection of the uterine wall, transverse H incision technique, and asymmetric dissection of uterus to treat diffuse adenomyosis, can improve clinical symptoms; however, these techniques are frequently associated with adenomyosis recurrence and spontaneous uterine rupture in pregnancy [ 2 , 11 - 14 ]. The complete excision of adenomyosis by employing several techniques, such as overlapping flaps and triple-flap method to treat diffuse adenomyosis, can achieve good results; nevertheless, these techniques are difficult to implement, particularly laparoscopy [ 15 - 17 ]. These findings suggest that the development of a new surgical technique is a major concern to improve the convenience of laparoscopic conservative surgery to treat diffuse adenomyosis; with these novel techniques, adenomyotic lesions should be excised during surgery and uterine wall integrity should be retained.…”

Long-Term Efficacy of Laparoscopic or Robotic Adenomyomectomy with or without Medical Treatment for Severely Symptomatic Adenomyosis

“…An alternative conservative surgical treatment for women who prefer to preserve the uterus is adenomyomectomy via laparotomy or laparoscopy. This procedure effectively relieves dysmenorrhea and menorrhagia [6,7,8]. One recent study showed that postoperative GnRH agonist administration reduces the recurrence of symptoms such as menorrhagia or dysmenorrhea [9].…”