Laparoscopic adenomyomectomy under transient occlusion of uterine arteries with an endoscopic vascular clip.

BACKGROUND: To introduce the safe and effective surgical technique of laparoscopic adenomyomectomy with transient occlusion of uterine arteries (TOUA) in patients with symptomatic uterine adenomyoma.

SUBJECTS AND METHODS: In a prospective case study, we examined all cases of laparoscopic adenomyomectomy with TOUA performed by a single surgeon at Ulsan University Hospital, Ulsan, Korea, between May 2011 and September 2012. Surgical outcomes included operative time, intraoperative injury of blood vessels, nerves, and pelvic organs, as well as intraoperative blood loss. We assessed the degree of improvement in dysmenorrhea and menorrhagia and the recurrence of adenomyomic lesions by ultrasonography at the 6-month follow-up after laparoscopic adenomyomectomy with TOUA.

RESULTS: Thirty-four women who were refractory to medical treatment or who wanted surgical treatment for preserving their uterus underwent laparoscopic adenomyomectomy with TOUA using an endoscopic vascular clip. The mean age was 43.79 ± 4.94 years. The mean diameter of the adenomyomas was 5.29 ± 1.82 cm. The mean TOUA time, operation time, and hospital stay were 7.33 ± 4.12 minutes, 84.09 ± 31.48 minutes, and 3.82 ± 1.24 days, respectively. The mean estimated blood loss was 148.18 ± 93.99 mL, and no injury to the uterine arteries or pelvic nerves occurred. No cases of conversion to a laparotomy or major complications occurred. At the 6-month follow-up, complete remission of dysmenorrhea and menorrhagia occurred in 72.2% and 87.5% of patients, respectively.

CONCLUSIONS: Laparoscopic adenomyomectomy with TOUA could be a safe and effective surgical method for women with symptomatic uterine adenomyoma who want to preserve their fertility.