Alumi Laparoscopic Discussion Board

How to manage uterine cystic adenomyosis by laparoscopic surgery?
Discussion in 'All Categories' started by Dr. Avantika Kaur - Jul 4th, 2021 6:20 am.
Dr. Avantika Kaur
Dr. Avantika Kaur
Dear Sir,

Please give some insight into the management of uterine cystic adenomyosis by laparoscopic surgery.
re: How to manage uterine cystic adenomyosis by laparoscopic surgery? by Dr R K Mishra - Jul 4th, 2021 7:57 am
Dr R K Mishra
Dr R K Mishra
Uterine Adenomyosis is the presence of endometrial glands and stroma in the context of the myometrium, with nearby smooth muscular tissue hyperplasia. It may be diffuse adenomyosis cystic adenomyosis. Diffuse adenomyosis occurs a lot more typically, as well as cystic adenomyosis stands for a rare entity as well as is more frequently encountered in more youthful people. Large adenomyotic cysts are lined with eutopic practical endometrium-like cells and are defined by cyclic modifications with epithelial peeling and hemorrhagic infarction of surrounding smooth muscle mass. The individuals with adenomyotic cysts might have crucial medical manifestations of pelvic discomfort, serious dysmenorrhea, and also may have no gynecologic medical treatment.

Diagnosis, as well as therapy of these situations, will be difficult to overcome. A laparoscopic procedure is a method of prioritizing these diseases, so laparoscopic surgical treatment is thought about more effective for this situation. At laparoscopy, the uterine adenomyosis should be determined. The adenomyotic tissues should be excised from the surrounding myometrium, the procedure must not permeate the uterine cavity, and also the injury ought to be closed with two-layer continual sutures.

Cystic adenomyosis within the uterine muscle is not usual, and cystic adenomyosis is quite uncommon. Uterine cysts are classified into 2 primary types:

1. Congenital
2. Acquired

Acquired cysts include cystic deterioration of uterine leiomyoma, cystic adenomyosis, as well as serosal cysts. Ultrasound is the front runner for the medical diagnosis of adenomyosis, but MRI is extra useful for the diagnosis. Raised serum CA-125 levels have actually been proposed as a diagnostic tool for cystic adenomyosis. Product CA-125 levels are normally elevated in these patients. In today's situation, an extreme increase in serum CA-125 level should be observed before surgical procedure, which reduced after growth elimination, consistent with the previous records.

Since many patients with cystic adenomyosis are young females, a minimally invasive treatment, such as laparoscopic excision, is considered more suitable. Laparoscopic excision can substantially boost the connected dysmenorrhea and increase the probability of effective pregnancy. Hormonal treatment with GnRH agonists or oral contraceptives should be given post-operatively.

We should offer to the patient a single 3.75-mg dose of gonadotropin-releasing hormonal agent (GnRH) analog as a subcutaneous shot for three cycles, which was excellent to boost the effect of surgical treatment and also eliminate the signs of dysmenorrhea.

Cystic adenomyosis is rare. It can be asymptomatic or show modern dysmenorrhea. Ultrasonography and MRI are complementary diagnostic devices. CA125 can be utilized as a preoperative diagnostic index and also post-operative follow-up. Surgical Laparoscopic or da Vinci Robotic excision is the favored treatment approach. GnRHa can be made use of as a complementary therapy technique.
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