Surgical techniques for excision of juvenile cystic adenomyoma

This video demonstrates surgical treatment of juvenile cystic adenomyoma in adolescents with chronic pelvic pain, including temporary arterial ligation, complete ureterolysis, enucleation of glandular tissue, and excision of coexistent endometriosis.
Surgical techniques for excision of juvenile cystic adenomyoma
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VOLUME 118, ISSUE 4, P810-811

Authors:

Megan S. Orlando, M.D., Angelina Carey-Love, M.D., Marjan Attaran, M.D., Cara R. King, DO, M.S.

Abstract:

Objective

To review causes of pelvic pain among adolescents and discuss surgical techniques for safe and effective resection of juvenile cystic adenomyomas.


Design

Case report.


Setting

Academic medical center.


Patients

We present a 16-year-old patient with chronic pelvic pain and ultrasound evidence of a 2.4 cm adenomyoma. The lesion was thought specifically to represent a juvenile cystic adenomyoma, defined as a cystic lesion >1 cm occurring in women younger than 30 years with severe dysmenorrhea that is distinct from the uterine cavity and surrounded by hypertrophic myometrium.


Intervention

Given minimal relief from medical therapy and high suspicion for coexistent endometriosis, our patient elected to undergo laparoscopic resection of adenomyoma and excision of pelvic lesions.


Main Outcome Measures

Preoperative considerations discussed in this video include imaging to identify the location of the lesion and adjacent structures, such as the uterine vessels, discontinuation of gonadotropin-releasing hormone agonist for adequate intraoperative visualization, and the high likelihood of encountering endometriosis at operation.


Results

We review the following surgical techniques: maximize visualization with the use of a uterine manipulator and temporary oophoropexy, optimize hemostasis via temporary uterine artery ligation and control of collateral blood vessels, complete ureterolysis, meticulous enucleation of adenomyoma, and excision of coexistent endometriotic lesions. Surgical findings demonstrated a 2 cm lesion along the left lower uterine segment and red-brown lesions along bilateral ovarian fossa, pathologically confirmed as adenomyoma and superficial endometriosis, respectively.


Conclusion

This video presents strategies for safe and effective adenomyoma resection and treatment of refractory chronic pelvic pain in an adolescent.

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