Laparoscopic bipolar coagulation for the conservative treatment of adenomyomata.

STUDY OBJECTIVE

To assess the effectiveness of treating adenomyomata with laparoscopic bipolar coagulation.

DESIGN

Prospective, observational study. Setting. The gynecology department of a community hospital.

PATIENTS

Ten women, each with severe dysmenorrhea, chronic menorrhagia, and adenomyomata diagnosed by magnetic resonance imaging.

INTERVENTIONS

Laparoscopic bipolar coagulation of adenomyomata.

MEASUREMENTS AND MAIN RESULTS

The mean (+/- SEM) total adenomyoma volume before leuprolide acetate administration was 119 +/- 16 cm3 (range 6-190 cm3); after 3 months of therapy this was reduced to 86 +/- 8 cm3 (range 6-162 cm3, p <0. 0001) a 27.7% reduction. Further reduction occurred 7 to 12 months postoperatively to 31 +/- 3.4 cm3 (range 3-155 cm3, p <0.0001), a 73.9% reduction from baseline. Twelve months postoperatively, seven (70.0%, p <0.05) women had continued resolution or significant reduction of dysmenorrhea and resolution of menorrhagia. One woman (10.0%) with unresolved dysmenorrhea and menorrhagia required hysterectomy, and two (20.0%) with recurrent menorrhagia required resection of the endomyometrium; one continued to have menorrhagia but refused further surgical or medical treatment.

CONCLUSIONS

Conservative treatment obviated the need for major surgery in 90% of women with adenomyomata, but further evaluation of this technique is necessary to determine its definitive role.