New surgical technique of laparoscopic resection of adenomyosis under real-time intraoperative ultrasound elastography guidance: A case report

Abstract

Detecting adenomyosis in the myometrium is a challenge since it is infiltrative with ill-defined margins and can be often confused with uterine fibroids. However, recent advances, such as ultrasound elastography, have enabled its detection in the myometrium, thereby facilitating its accurate diagnosis. We report our experience of performing complete laparoscopic resection of adenomyosis under real-time ultrasound elastography guidance in a 32-year-old woman who underwent laparoscopic adenomyomectomy following severe dysmenorrhea and heavy menstrual bleeding. Real-time ultrasound elastography was also utilized intraoperatively to detect residual adenomyosis. Complete adenomyosis resection and uterine reconstruction were achieved. Follow-up magnetic resonance imaging was conducted to confirm successful uterine reconstruction. The patient recovered rapidly with no complications. Intraoperative elastography-guided laparoscopic adenomyomectomy was feasible and effective in completely removing adenomyotic lesions.

A Case of Elastography-Assisted Laparoscopic Fertility Preservation for Severe Deep Endometriosis Causing Ureteral Stenosis and Subtype II Adenomyosis

“…We recently reported a case of subtype I adenomyosis treated using laparoscopic, conservative excision with intraoperative real-time elastography. After resection of the adenomyosis, the lesion was visualized using elastography, and the boundary between the adenomyosis and the normal myometrium was carefully and tactilely resected with scalpel and scissor forceps without using a power instrument, such as harmonic scalpels, such that only the adenomyosis lesion was being completely resected [18]. In this case, we used cold scalpels instead of a power instrument because prior experience demonstrated that electrosurgery induced thermal denaturation and prevented distinguishing between the adenomyosis and the normal endometrium.…”

“…The boundary between the adenomyosis and the normal myometrium was indistinct and could not be palpated with a power instrument, such as a harmonic scalpel. Therefore, we used a #11 scalpel as in our previous study [18] since the adenomyosis and the normal myometrium can be easily distinguished with a scalpel. A longitudinal incision was made in the uterine serosa, and the adenomyosis lesion was nucleated (Figure 3a,b).…”

“…Reproductive-aged women should be offered conservative surgeries when applicable and be informed that the excision of extensive adenomyosis is difficult and associated with a high recurrence rate [14][15][16][17]. We recently reported a case of subtype I adenomyosis treated using laparoscopic, conservative excision with intraoperative real-time elastography, with the adenomyosis lesion being completely resected [18]. Conversely, the proposed mechanism of DE, including subtype II, is that the lesion implants outside the uterus and infiltrates toward the inside of the myometrium [10,11].…”

Current and Prospective Treatment of Adenomyosis

“…Furthermore, Zheng et al found that resection combined with LNG-IUD was more effective in reducing menstrual flow when compared to the IUD alone ( p < 0.001), but no difference in pain reduction was noted ( p = 0.061) [ 59 ]. A case report by Ota et al was recently published investigating a new technique using real-time intraoperative ultrasound elastography guidance during laparoscopic resection of adenomyosis to preserve healthy uterine tissue while avoiding residual disease in the myometrium [ 60 ].…”

Optimization of diagnostic studies in patients with adenomiosis and/or hyperplastic processes of endometrium

“…Безліч нових технічних розробок з успіхом доповнюють інформацію, отриману під час УЗД: це, зокрема, поєднання B-режиму з кольоровим і спектральним доплерівським, створення 3D і 4D зображень при мультипараметричному УЗД [15,21,22,25]. Проте висока частота діагностичних помилок (20-40%), залежність деталізації структури міометрія і параметрів сонографіч-ного диференціювання аденоміозу від досвіду оператора і апаратури сприяють пошуку нових оптимальних методів діагностики [19].…”