title: Long-Term Efficacy of Laparoscopic or Robotic Adenomyomectomy with or without Medical Treatment for Severely Symptomatic Adenomyosis.
abstract: OBJECTIVE
  To determine the long-term efficacy of laparoscopic or robotic adenomyomectomy with or without gonadotropin-releasing hormone (GnRH) for the treatment of severely symptomatic adenomyosis.
  
  
  METHODS
  Between August 2008 and May 2011, we prospectively observed 33 patients who underwent laparoscopic or robotic adenomyomectomy with uterine artery ligation for the treatment of symptomatic adenomyosis. Seventeen patients (52%) received 3-course GnRH agonist treatment after the adenomyomectomy.
  
  
  RESULTS
  The mean operating time was 147.4 ± 52.0 min, and the mean blood loss was 36.1 ± 37.4 ml. Postoperative complications occurred in 5 patients, including 4 cases of febrile morbidity, 1 case of ileus and 1 case of pelvic abscess. Patients had statistically significant symptom relief during the 3-year follow-up period. Four of the 33 patients (12%) showed symptom relapse; 3 patients showed a relapse with dysmenorrhea and 1 patient showed a relapse with menorrhagia. There were no significant differences in terms of therapeutic outcomes between surgical-only and surgical-medical treatment.
  
  
  CONCLUSIONS
  Laparoscopic or robotic adenomyomectomy was feasible and safe for women with severely symptomatic adenomyosis who requested uterine preservation. Moreover, this procedure provided long-term symptom control, regardless of postoperative GnRH agonist administration.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University Medical Center, Daegu, Korea.
authors.forename: Gun Oh
authors.initials: GO
authors.lastname: Chong
authors.forename: Yoon Hee
authors.initials: YH
authors.lastname: Lee
authors.forename: Dae Gy
authors.initials: DG
authors.lastname: Hong
authors.forename: Young Lae
authors.initials: YL
authors.lastname: Cho
authors.forename: Yoon Soon
authors.initials: YS
authors.lastname: Lee
mesh_terms: D062788:Adenomyosis / Q000188:drug therapy* / Q000601:surgery*; D000328:Adult; D004412:Dysmenorrhea / Q000517:prevention & control; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008026:Ligation; D008595:Menorrhagia / Q000517:prevention & control; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012008:Recurrence; D012371:Robotics; D016896:Treatment Outcome; D055988:Uterine Artery / Q000601:surgery
chemical_list: D007987:Gonadotropin-Releasing Hormone