Laparoscopic Bipolar Coagulation for the Conservative Treatment of Adenomyomas

We assessed the effectiveness of laparoscopic bipolar coagulation in 20 women with severe dysmenorrhea, chronic menorrhagia, and a magnetic resonance imaging diagnosis of adenomyomata. In addition, nine women underwent transcervical endomyometrial resection; three (33.3%) of these women underwent concomitant submucous leiomyoma resection. One woman (5.0%) had resection of submucous leiomyomas without endomyometrial resection. The mean (± SEM) total uterine volume before leuprolide acetate administration was 433 ± 29 cm3; this was reduced to 239 ± 11 cm3 after 3 months of drug therapy, a 44.8% reduction. This volume was further reduced to 156 ± 20 cm3 (p <0.0001) 7 to 12 months postoperatively, a 64.0% reduction from baseline. Twelve months postoperatively 16 women (80.0%) had satisfactory resolution of menorrhagia, and 14 (70%) had satisfactory resolution of dysmenorrhea. Three patients (15.0%) required hysterectomy, two (10.0%) required gonadotropin-releasing hormone agonist add-back therapy to resolve recurrent menorrhagia, and two (10.0%) required endometrial resection after bipolar coagulation of adenomyomata failed to resolve menorrhagia. Conservative treatment obviated the need for major surgery in most women (85.0%) with adenomyomata.