title: Conservative adenomyomectomy with transient occlusion of uterine arteries for diffuse uterine adenomyosis.
abstract: OBJECTIVE
  This study aimed to determine the feasibility and safety of adenomyomectomy with transient occlusion of uterine arteries (TOUA) in patients with symptomatic diffuse uterine adenomyosis.
  
  
  METHODS
  Twenty-six patients with symptomatic diffuse uterine adenomyosis underwent adenomyomectomy with TOUA by a single surgeon at Ulsan University Hospital between May 2011 and September 2012. Surgical outcomes included operative time, intraoperative injury to blood vessels, nerves, and pelvic organs and operative blood loss. We assessed the degree of improvement in dysmenorrhea and menorrhagia at the 4-month follow-up after completion of adjuvant gonadotrophin-releasing hormone agonist.
  
  
  RESULTS
  The mean age of patients was 37.73 years (range, 27-49 years). The mean total surgical time was 95.0 min (range, 60-145 min; SD, 34.49). The mean estimated blood loss was 191.54 mL (range, 80-400 mL; SD, 110.91) and there were no cases of injury to the uterine arteries or pelvic nerves. The mean time of TOUA was 9.79 min (range, 6-16 min; SD, 2.74). The mean duration of hospital stay was 5.65 days (range, 4-7 days; SD, 0.85). There were no major complications requiring reoperation or readministration during the mean follow-up period of 13.5 months. At the 7-month follow-up after adenomyomectomy with TOUA, complete remission of dysmenorrhea and menorrhagia was observed in 94.4% and 100% of patients, respectively.
  
  
  CONCLUSIONS
  Adenomyomectomy with TOUA could be a safe and effective surgical method in women with symptomatic diffuse uterine adenomyosis to preserve fertility.
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, University of Ulsan, Ulsan University Hospital, Ulsan, Korea.
authors.forename: Yong-Soon
authors.initials: YS
authors.lastname: Kwon
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, University of Ulsan, Ulsan University Hospital, Ulsan, Korea.
authors.forename: Hyun Jin
authors.initials: HJ
authors.lastname: Roh
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, University of Ulsan, Ulsan University Hospital, Ulsan, Korea.
authors.forename: Jun Woo
authors.initials: JW
authors.lastname: Ahn
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, University of Ulsan, Ulsan University Hospital, Ulsan, Korea.
authors.forename: Sang-Hun
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Uijeongbu St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea.
authors.forename: Kyong Shil
authors.initials: KS
authors.lastname: Im
mesh_terms: D062788:Adenomyosis / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control; D004412:Dysmenorrhea / Q000209:etiology / Q000517:prevention & control; D004717:Endometrium / Q000098:blood supply / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay; D008595:Menorrhagia / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D009215:Myometrium / Q000098:blood supply / Q000601:surgery*; D061646:Operative Time; D059351:Organ Sparing Treatments / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D056910:Republic of Korea; D060205:Therapeutic Occlusion / Q000009:adverse effects / Q000379:methods*; D055988:Uterine Artery
keywords: adenomyomectomy; diffuse uterine adenomyosis; preservation of uterus; transient occlusion of uterine arteries