Laparoscopic Adenomyomectomy under Real-Time Intraoperative Ultrasound Elastography Guidance: A Case Series and Feasibility Study

Abstract

Background: This study aimed to examine the clinical characteristics of 11 patients undergoing laparoscopic adenomyomectomy guided by intraoperative ultrasound elastography and this technique’s feasibility. Patients and Methods: Eleven patients undergoing laparoscopic adenomyomectomy using ultrasound elastography for adenomyosis at Kawasaki Medical School Hospital in Okayama, Japan between March 2020 and February 2021 were enrolled. Operative outcomes included operative time, operative bleeding, resected weight, operation complications, percent change in hemoglobin (Hb) values, and uterine volume pre- and postoperatively. Dysmenorrhea improvement was evaluated by changes in visual analog scale (VAS) scores pre- and 6- and 12-months postoperatively. Results: The median operative time and bleeding volume was 125 min (range, 88–188 min) and 150 mL (10–450 mL), respectively. The median resected weight was 5.0 g (1.5–180 g). No intraoperative or postoperative blood transfusions or perioperative complications were observed. The median changes in uterine volume, Hb value, and VAS score were −49% (−65 to −28%), −3% (−11 to 35%), and −80% (−100 to −50%), respectively. The median follow-up period post-surgery was 14 months (7–30 months). Adenomyosis recurrence was not observed in the patients during the follow-up period. Conclusions: Laparoscopic adenomyomectomy using ultrasound elastography guidance is minimally invasive and resects as many adenomyotic lesions as possible.

Keywords

• adenomyomectomy
• adenomyosis
• elastography
• laparoscopic surgery