Robotic-assisted excision of diffuse adenomyosis.

Area of Science:

• Gynecology
• Minimally Invasive Surgery
• Reproductive Medicine

Background:

• Adenomyosis is a chronic condition where endometrial tissue grows into the uterine muscle (myometrium).
• While hysterectomy is curative, fertility-sparing surgical options are crucial for patients wishing to preserve reproductive function.
• Medical treatments, Assisted Reproductive Technology (ART), and surgery can collectively enhance patient outcomes.

Purpose of the Study:

• To present a detailed video guide of robotic-assisted excision for diffuse adenomyosis impacting the posterior uterine wall.
• To showcase a uterus-sparing surgical technique for managing adenomyosis.

Main Methods:

• Utilized a robotic surgical platform for precise excision of adenomyosis.
• Employed intracavitary indocyanine green (ICG) fluorescence guidance during the procedure.
• Focused on a uterus-sparing approach for diffuse posterior wall adenomyosis.

Main Results:

• A case study of a 38-year-old nulligravid patient with chronic pelvic pain and infertility undergoing the procedure.
• The surgery achieved minimal blood loss (60 ml) and a same-day discharge with no complications.
• The patient had a history of two unsuccessful In Vitro Fertilization (IVF) cycles prior to surgery.

Conclusions:

• Robotic-assisted surgery is a beneficial option for select patients with diffuse adenomyosis.
• This technique, combined with advanced surgical methods, enables extensive adenomyosis excision with low morbidity.
• Favorable outcomes can be achieved, supporting fertility preservation in eligible patients.