A novel technique for myometrial defect closure after robot-assisted laparoscopic adenomyomectomy: A retrospective cohort study

Abstract

Objective: To introduce our novel technique for myometrial defect closure after adenomyomectomy. Materials and methods: A retrospective cohort study. A total of 40 patients with adenomyosis who visited our clinic between October 2012 and January 2018 were recruited. Of those 34 patients were eligible for analysis. Results: The mean thickness of the affected uterine wall before surgery was 4.02 cm ± 1.11, dropping to 2.37 cm ± 0.84 postoperatively. This led to a mean drop of 41% in the thickness of the affected wall, which was found to be significant using a paired t-test (p < 0.0001). The mean preoperative pain score was 8.68 ± 1.12, while the postoperative mean was 0.06 ± 0.34. The mean preoperative CA 125 was 121.73 ± 117.29, dropping to 6.95 ± 2.60 postoperatively. This was found to be significantly lower using both the Wilcoxon Signed Rank and Sign tests (p = 0.0156). Conclusion: Myometrial defect closure in a layer-by-layer fashion after robot-assisted laparoscopic adenomyomectomy is a reproducible technique. This uterine conserving method was effective in reducing our patients’ pain. It may be the solution to maintaining adequate myometrial wall thickness, uterine layer alignment, and endometrial integrity.

Keywords

• Adenomyomectomy
• Adenomyosis
• Robot-assisted laparoscopy