Hysteroscopic excision of symptomatic myometrial adenomyosis: feasibility and effectiveness

Xia, Wei; Zhang, Duo; Zhu, Qian; Zhang, Huiyu; Yang, Siqin; Ma, Jue; Pan, Hongjie; Tong, Tong; Sun, Jing; Zhang, Jian

doi:10.1111/1471-0528.14673

Cited by 11 publications

(18 citation statements)

References 18 publications

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“…Future studies should include a large population of women with a preoperative transvaginal ultrasound measure of endometrial penetration before undergoing TCRE. Ultrasound-guided resection [31] and routine IUD insertion after resection may further improve the outcome after endometrial ablation [32,33].…”

Section: Commentmentioning

confidence: 99%

The effect of transcervical endometrial resection on clinical symptoms related to intrinsic adenomyosis and junctional zone changes

Rasmussen

Hansen

Dahl

et al. 2019

European Journal of Obstetrics & Gynecology and Reproductiv

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Objectives To assess the effect of transcervical endometrial resection on clinical symptoms related to histopathological findings of the junctional zone. Study design This prospective study took place at a university hospital. Premenopausal women suffering from abnormal uterine bleeding and/or pelvic pain and scheduled for transcervical endometrial resection were enrolled (n = 112). Histopathological findings of the endomyometrial biopsies were categorized as follows: Adenomyosis of the inner myometrium (intrinsic adenomyosis): ≥ 2 mm myometrial invasion without contact to the basal endometrium, serrated junctional zone: > 3 mm myometrial invasion with contact to the basal endometrium and linear junctional zone: No or marginal myometrial invasion (≤ 3 mm) with contact to the basal endometrium. All study participants received a baseline and two follow-up questionnaires (6 and 18 months after surgery) regarding symptom severity, health-related quality of life and pelvic pain. Data regarding reintervention surgery was obtained from the National Database Patoweb . The rate of reintervention surgery and the improvement in symptom severity, health-related quality of life and pelvic pain were correlated to histopathological findings. Results Twenty-four patients had intrinsic adenomyosis, 31 had serrated junctional zone and 57 had linear junctional zone. Fifteen patients (13%) underwent reintervention surgery; three (20%) within 6 months, nine (60%) between 6–18 months and three (20%) > 18 months after transcervical endometrial resection. Reintervention surgery was more common in women with intrinsic adenomyosis compared to women without (33% (95% CI: 16–55) vs 8% (95% CI: 3–16)) (p-value: < .05). Nine patients (38%) with intrinsic adenomyosis were asymptomatic based on low symptom severity score, high health-related quality of life and no pelvic pain at 18 months follow-up. Patients with linear junctional zone had a higher improvement in symptom severity and health-related quality of life than patients with intrinsic adenomyosis or serrated junctional zone at 6 months follow-up after surgery (p-value < .05). However, there was no significant difference in pelvic pain reduction. Conclusion The effect of transcervical endometrial resection may depend upon the degree of junctional zone changes, and patients with intrinsic adenomyosis are more likely to undergo reintervention surgery than patients with either linear or serrated junctional zone. However, intrinsic adenomyosis may also be successfully treated with endometrial resection.

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Section: Commentmentioning

confidence: 99%

The effect of transcervical endometrial resection on clinical symptoms related to intrinsic adenomyosis and junctional zone changes

Rasmussen

Hansen

Dahl

et al. 2019

European Journal of Obstetrics & Gynecology and Reproductiv

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“…Therefore, she underwent hysteroscopic excision of myometrial adenomyotic lesions combined with intraoperative replacement of LNG-IUS, as reported previously. 30 The most obvious advantage of hysteroscopic resection of adenomyotic lesions is that it is especially appropriate for adenomyosis in which adenomyotic lesions are located in the inner muscular layer. Until now, the patient was very satisfied with the MVJ score of two.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic adenomyomectomy combined with levonorgestrel‐releasing intrauterine system in the treatment of adenomyosis: Feasibility and effectiveness

Sun

Zhang

You

et al. 2020

J of Obstet and Gynaecol

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Aim To evaluate the clinical efficacy and safety of laparoscopic adenomyomectomy combined with intraoperative replacement of levonorgestrel‐releasing intrauterine system (LNG‐IUS) in the treatment of symptomatic adenomyosis. Methods This is a case‐series study in a university medical center. A total of 52 patients with symptomatic adenomyosis were treated by laparoscopic adenomyomectomy combined with intraoperative replacement of LNG‐IUS from January 2015 to July 2018. Visual analog scale, menstrual flow and uterine volume were compared before and after the surgery (3, 12 and 24 months). Meanwhile, LNG‐IUS‐induced adverse reactions (e.g. irregular vaginal bleeding, amenorrhea, expulsion, and perforation) were also recorded. Results All operations were successfully completed via laparoscopy without conversion to laparotomy. No severe complications were noted during the surgical procedure or follow‐up period. The mean postoperative visual analog scale and menstrual flow scores and the volume of the uterus were significantly decreased (all P < 0.001) at 3, 12, and 24 months postoperatively, compared with preoperative scores. The clinical effective rates among the patients with dysmenorrhea were 98%, 96% and 96% at 3, 12 and 24 months after the operation, respectively. And the clinical effectiveness rate of menorrhagia was 97.6%, 95.2% and 95.2% at 3, 12 and 24 months after treatment, respectively. Among all related adverse reactions, amenorrhea was the most common (n = 12, 23.1%). There was one case of LNG‐IUS perforation (1.9%) and two cases of expulsion (3.8%). Conclusion Laparoscopic adenomyomectomy combined with intraoperative replacement of LNG‐IUS is a novel and effective conservative surgical procedure for symptomatic adenomyosis treatment.

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“…Compared with other surgery procedures [ 11 , 14 – 16 ], the greatest advantage of this operation of U-shaped myometrial excavation and modified suture approach with uterus preservation was full consideration of the uterine anatomy. We noticed that once the uterus was excised along the median sagittal plane, the adenomyosis lesion was entirely exposed to us.…”

Section: Discussionmentioning

confidence: 99%

A New Surgical Method of U-Shaped Myometrial Excavation and Modified Suture Approach with Uterus Preservation for Diffuse Adenomyosis

Jun-Min

Zhu

Zhao

et al. 2018

BioMed Research International

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Objective To evaluate the feasibility, safety, and efficacy of a new surgical method of U-shaped myometrial excavation and modified suture approach with uterus preservation for diffuse adenomyosis. Methods From January 2012 to December 2014, 198 patients with diffuse adenomyosis were surgically treated using this novel procedure in Zhengzhou Hua-Shan Hospital. Degree of dysmenorrhea, menstrual blood volume, serum CA 125, and uterine size before and at 1 month, 3 months, 6 months, 12 months, and 24 months after surgery were compared. Results Postoperatively, VAS score of dysmenorrhea, menstrual blood volume, serum CA 125 level, and uterine size significantly decreased at 1 month, 3 months, 6 months, 12 months, and 24 months from presurgical levels (all p < .001), but there were no differences at the follow-up time points. Two patients recurred at 18 months and 23 months after surgery, but both recovered after repeat surgery. Interestingly, 2 other patients recrudesced at 10 months and 12 months after surgery. In addition, only one patient was found to have a postoperative anaemia with fever, conservatively managed without surgery. Conclusion U-shaped myometrial excavation and modified suture approach with uterus preservation is a safe and feasible surgical approach to treat diffuse adenomyosis, with favourable outcomes.

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Hysteroscopic excision of symptomatic myometrial adenomyosis: feasibility and effectiveness

Abstract: Hysteroscopic excision is feasible for patients with symptomatic adenomyosisis.

Cited by 11 publications

References 18 publications

The effect of transcervical endometrial resection on clinical symptoms related to intrinsic adenomyosis and junctional zone changes

The effect of transcervical endometrial resection on clinical symptoms related to intrinsic adenomyosis and junctional zone changes

Laparoscopic adenomyomectomy combined with levonorgestrel‐releasing intrauterine system in the treatment of adenomyosis: Feasibility and effectiveness

A New Surgical Method of U-Shaped Myometrial Excavation and Modified Suture Approach with Uterus Preservation for Diffuse Adenomyosis

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