Conservative surgery of uterine adenomyosis via laparoscopic versus laparotomic approach in a single institution.

Aims: To evaluate the surgical outcomes of both approach methods (laparoscopy vs laparotomy) and to suggest the proper surgical approach according to type of uterine adenomyosis (focal vs diffuse).
Methods: We retrospectively analyzed 224 cases of uterine adenomyomectomy, 116 laparotomic and 108 laparoscopic, performed between July 2011 and June 2016 by a single surgeon (Y. S. K.). In all 224 cases, the surgeon had used transient occlusion of the uterine artery (TOUA). Surgical outcomes included weight of specimen, operating time, estimated blood loss and intraoperative injury to other organs. Postoperative clinical outcomes included symptom improvement (dysmenorrhea, menorrhagia and others) and recurrence.
Results: All patients in the laparoscopic group had been diagnosed with focal uterine adenomyosis, and most in the laparotomic group (85.3%) had been diagnosed with diffuse type. The largest lesion diameters were 6.48 cm in the laparotomic group and 4.34 cm in the laparotomic group. Operation time and estimated blood loss were 116.12 min and 222.67 mL in the laparotomic group and 75.09 min, respectively, and 155.33 mL in the laparoscopic group. There was no case of laparotomic conversion in patients with laparoscopic adenomyomectomy.
Conclusion: Conservative surgery is effective to reduce the symptoms of adenomyosis regardless of approach method. For near-complete excision of adenomyosis, the diffuse type is recommended to be treated with laparotomic adenomyomectomy, and focal lesions less than 5 cm can be treated with laparoscopic conservative surgery.
(© 2018 Japan Society of Obstetrics and Gynecology.)