Tips and tricks for robotic management of diffuse adenomyosis

Area of Science:

• Minimally Invasive Gynecologic Surgery
• Reproductive Endocrinology and Infertility
• Surgical Oncology

Background:

• Diffuse adenomyosis presents a significant challenge in gynecologic surgery, often impacting fertility and leading to chronic pelvic pain.
• Conventional treatments may be insufficient, necessitating advanced surgical approaches for uterus preservation.
• In vitro fertilization (IVF) cycles are frequently unsuccessful in patients with severe adenomyosis.

Purpose of the Study:

• To present a detailed, step-by-step surgical approach for managing diffuse adenomyosis using distinct techniques tailored to disease extent.
• To highlight critical surgical tips for minimizing blood loss and maximizing the complete excision of adenomyotic tissue.
• To showcase the utility of robotic-assisted surgery and indocyanine green dye in improving surgical precision and outcomes.

Main Methods:

• Two distinct cases of diffuse adenomyosis were surgically managed using tailored techniques: classic excision and a double flap approach.
• Robotic-assisted excision was employed to remove adenomyosis while preserving adequate myometrium and enabling uterine wall reconstruction.
• Intracavitary diluted indocyanine green dye was utilized to precisely delineate adenomyotic tissue and guide complete excision.

Main Results:

• Both surgical procedures were successfully completed without intraoperative or postoperative complications.
• Patients were discharged on the same day of surgery and reported no complaints at the 6-week postoperative follow-up.
• Postoperative recovery was uneventful, with plans for further imaging before resuming fertility treatments.

Conclusions:

• Uterus-sparing surgical techniques are a viable option for selected patients with diffuse adenomyosis unresponsive to medical management or repeated IVF.
• Accurate preoperative imaging is essential for disease mapping and selecting the optimal surgical strategy.
• Robotic platforms combined with indocyanine green dye enhance the precision and efficacy of diffuse adenomyosis excision, potentially improving fertility outcomes.