Adenomyosis is a condition where the tissue that normally lines the uterus, the endometrium, begins to grow into the muscular wall of the uterus. This displacement can cause the uterine walls to thicken, leading to heavy menstrual bleeding and severe pelvic pain. For individuals experiencing these symptoms, laparoscopic surgery presents a modern, minimally invasive approach to both diagnose and treat adenomyosis.
Laparoscopy as a Diagnostic and Treatment Tool
While imaging tests like transvaginal ultrasounds and MRIs can indicate adenomyosis by showing a thickened uterine wall, the most conclusive diagnosis comes from a pathologist’s examination of uterine tissue. Laparoscopy plays a role in obtaining this tissue. During the procedure, a surgeon can visually inspect the uterus for signs of the condition, which helps guide the surgical plan.
The primary goal of the surgery is to remove the adenomyotic tissue causing symptoms. Whether a portion of the uterine muscle is excised or the entire uterus is removed, the tissue is sent for histological analysis. This confirms the diagnosis and simultaneously alleviates the source of the pain and bleeding.
Types of Laparoscopic Surgery for Adenomyosis
The type of laparoscopic surgery recommended depends on the severity of symptoms and the desire for future fertility. The two main options are a laparoscopic adenomyomectomy and a laparoscopic hysterectomy.
A laparoscopic adenomyomectomy is a uterus-sparing procedure designed to remove adenomyotic lesions, known as adenomyomas, from the muscular wall of the uterus. This surgery is the preferred option for those who wish to preserve their uterus for future pregnancies. The surgeon excises the affected tissue while reconstructing the uterine wall to maintain its integrity.
This approach is most suitable for focal adenomyosis, where the diseased tissue is confined to a specific area. In contrast, a laparoscopic hysterectomy involves the complete removal of the uterus. This procedure is reserved for individuals with severe, diffuse adenomyosis, where the condition is widespread throughout the uterine muscle.
A hysterectomy is recommended for those who have completed childbearing or do not desire future pregnancy, as it eliminates the ability to carry a child.
The Laparoscopic Procedure and Recovery
Laparoscopic surgery begins with the administration of general anesthesia. The surgeon makes several small incisions in the abdomen, typically around the navel. A laparoscope, a thin tube with a high-definition camera and light, is inserted through one incision, providing a clear view of the pelvic organs on a monitor.
To create a visible working space, the abdominal cavity is inflated with carbon dioxide gas. This lifts the abdominal wall away from the internal organs, giving the surgeon room to maneuver. Through the other small incisions, specialized surgical instruments are inserted to perform the procedure.
Recovery from laparoscopic surgery is faster and involves less pain than traditional open surgery. The hospital stay is short, with many patients returning home the same day or after one night. Patients are encouraged to start walking soon after the procedure to promote circulation and can return to light activities within one to two weeks.
Effectiveness and Post-Surgery Considerations
Both laparoscopic adenomyomectomy and hysterectomy are highly effective at providing relief from chronic pelvic pain and heavy menstrual bleeding. The choice of procedure, however, has different long-term implications.
A laparoscopic hysterectomy is considered a permanent cure for adenomyosis because removing the uterus entirely eliminates the possibility of recurrence. For an adenomyomectomy, while effective, there is a chance that symptoms could return over time if some adenomyotic tissue was left behind or if new areas develop.
A central consideration is fertility. A hysterectomy results in the inability to become pregnant. Conversely, an adenomyomectomy is performed to preserve the uterus and the potential for pregnancy, though successful outcomes are not guaranteed.