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KMID : 1143220210640030332
Obstetrics & Gynecology Science
2021 Volume.64 No. 3 p.332 ~ p.335
Efficient myometrial defect closure in a layer by layer fashion after robot-assisted laparoscopic adenomyomectomy: a novel technique
Hijazi Ayah

Chung Youn-Jee
Al Sinan Najeeba
Park Kyung-Min
Ko Min-Ji
Song Jae-Yen
Kim Mee-Ran
Abstract
Objectives: In this video, we present our novel technique for myometrial defect closure following robot-assisted laparoscopic adenomyomectomy.

Methods: A narrated video demonstration of our technique. Our patient was a 47-year-old single woman with severe dysmenorrhea, who did not respond to medical therapy and wished to preserve her uterus. Surgery was performed after thorough counseling and obtaining informed consent from the patient (Institutional Review Board number: KC17OESI0238; approval date: March 19, 2018). After removal of the adenomyotic tissue during surgical intervention, the myometrial defect was closed in three steps. First, the defect between the anterior and posterior innermost myometrial layers was closed using a 2-0 Stratafix suture, CT-1 (circle taper) needle (Ethicon, Somerville, NJ, USA). Next, the two sides were approximated using a 2-0 PDS¢ç (polydioxanone) Suture (Ethicon, Somerville, NJ, USA) and V-34 (TAPERCUT¢ç) surgical needle (Ethicon, Somerville, NJ, USA). Finally, the serosa was sutured in a baseball fashion using a 2-0 PDS suture, slim half-circle [SH] needle (Ethicon, Somerville, NJ, USA).

Results: The patient had no postoperative complications, and her pain was greatly improved. The CA125 level decreased from 434 U/mL to 45.99 U/mL, and the transvaginal ultrasound showed a reduction in posterior myometrial thickness from 5.61 cm to 2.69 cm.

Conclusion: This technique maintained the integrity of the endometrial cavity, posterior myometrial thickness, and uterine layer alignment. We believe that it is a feasible technique and may be a solution for adenomyosis in patients seeking for fertility preservation.
KEYWORD
Adenomyosis, Myometrium, Surgical procedures, Robotic
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