THE ROLE OF LAPAROSCOPIC SURGERY IN ADENOMYOSIS IN INFERTILITY

Maya Mewengkang

Department of Obstetrics and Gynecology, Universitas Sam Ratulangi, Prof DR. R.D. Kandou Central
General Hospital

Telp: +628124303917, Email: mayamewengkang@gmail.com

Abstract

Introduction

Uterine endometriosis or Adenomyosis is a condition where the presence of heterotopic

endometrial glands and stroma in the myometrium, which is a common cause of menorrhagia
and dysmenorrhea. Definitive treatment is hysterectomy. But alternative treatment including
contrasepsi pills, danazole, agonist GnRH, LNG-IUS, ablation/ resection endometrial, uterine
artery embolization, and guided ultrasound magnetic resonance can also be considered. There
are many approaches to ademomyosis surgery. The goal of surgical treatment is to remove as
much as possible of the abnormal tissue and maintain as much healthy tissue as possible.

Method

Literature review was conducted on several scientific publications regarding the surgical
approach to uterine adenomyosis

Results
medical approach using aromatase inhibitors can only reduce the size of the lesion but has not
been resolved adenomisis lesions. Meanwhile the surgical approach with laparotomy and
laparoscopy did not have a significant difference in results. Resection of adenomyosis by
laparoscopic method of adenomyomectomy and hysteroplasty showed good results, where tumor
size could be significantly reduced without weakness in uterine tissue. This approach is expected
to be a therapeutic option for adenomyosis.
 Figure 1. Laparoscopic procedure for adenomyomectomy (Takeuchi, et al., 2006)
Discussion
There are alternative treatment including oral pills, danazol, GnRH, LNG-IUS agonists,
endometrial ablation / resection, arterial embolization and magnetic resonance guided focused
ultrasound. However surgical is the definitive treatment of adenomyosis.
The study using medical aromatase inhibitors can only reduce the size of the lesion but has not
been resolved adenomisis lesions. Instead resection can eliminate lesions even though
recurrence can occur after 1 year. Classification of surgical procedures is carried out based on
the extent of healthy myometrial tissue and maintaining postoperative uterine wall integrity.
Frequent difficulties in operating decisions are a diagnosis of the extent of excision, technical
problems, mixed complications, pregnancy after adenomyomectomy. Surgical techniques are
laparotomy and laparoscopy. The main difficulty in adenomyosis surgery is knowing the
boundary between healthy tissue and diseased tissue. Adenomyolysis can reduce uterine capacity
by replacing myometrial tissue and other supporting tissues, so that it can intervene in the
composition of the toto fibers and the structure of three-dimensional collagen. In this case, scar
tissue is an independent factor in causing changes in the structure of the uterus. Pregnancy after
surgery or myolysis is susceptible to complications because of that it needs to be carefully
followed up.
The method of laparoscopic adenomyomectomy and hysteroplasty was performing by a closed
method, carried out cystecomy in adenomyosis with endometerioma and adhesion reduction and
removal of endometriotic lesions in the vicinity of the douglas cavity. GnRH administration
reduces the size of adenomyotic tissue and facilitates surgical procedures. However, the
boundary between the adenomotic tissue and the normal muscle layer is unclear and this
increases the risk of incomplete surgery.

Conclusions
Treatment of adenomyosis by laparoscopic adenomyomectomy and hysteroplasty method. In
this procedure, it must be ensured that there is sufficient uterine wall strength if the patient
intends to become pregnant after surgery. This method can maintain the normal muscle layer
as much as possible on the serosal membrane, because it can increase the strength of the
muscle layer. This technique is expected to be the main choice in resection of
adenomyomectomy because it is safer and more effective.
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Keywords : Adenomyosis, Operative Approach, Adenomyomectomy, Hysteroplasty