The Pumpkin method - An innovative uterus-preserving surgery for large complex adenomyosis: A preliminary experience

To introduce and evaluate the surgical feasibility, safety, and recovery outcomes of the "Pumpkin method," a novel, multiflap adenomyomectomy technique for patients with large and complex adenomyosis.

This prospective observational study enrolled 10 consecutive women with large, refractory adenomyosis (unresponsive to hormonal therapy) and fertility concerns. All patients underwent uterus-preserving laparotomic surgery using the newly developed "Pumpkin method," involving multiple longitudinal uterine incisions to excise adenomyotic tissue. The resulting arch bridge-like flaps were reconstructed using interrupted and mattress sutures, forming a "pumpkin-like" appearance resembling Yayoi Kusama's sculptural art. Preoperative and postoperative evaluations included magnetic resonance imaging (MRI), and serum cancer antigen 125 (CA-125) and anti-Müllerian hormone (AMH) levels.

Six-month postoperative MRI demonstrated significant adenomyosis regression (residual lesions ≤2 cm) with preserved uterine morphology, adequate myometrial thickness, and an intact endometrium. CA-125 levels decreased significantly (P = 0.008), indicating reduced adenomyotic tumor activity, while AMH levels remained stable (P = 0.110), suggesting preservation of the ovarian reserve. At a mean follow-up of 30.5 months, nine patients reported sustained improvement in menstrual symptoms. One patient achieved an uncomplicated term twin pregnancy; however, one patient required a hysterectomy 30 months after surgery due to recurrent symptoms.

The "Pumpkin method" provides a feasible and effective approach for adenomyosis debulking, combining multiflap excision with meticulous reconstruction to restore uterine anatomy without major technical difficulties. Further studies with larger cohorts are warranted to validate reproductive outcomes and long-term efficacy.