Design: A narrated, surgical video demonstrating a step-wise approach in the laparoscopic resection of an uterine adenomyoma

Setting: Tertiary care academic hospital institution

Patients or Participants: A 44 year-old G1P1001 presented with a history of uterine fibroids and myomectomy, abnormal uterine bleeding, pelvic pain and infertility. She was referred by a fertility specialist for a 4.3 cm ill-defined intramural fibroid and possible adenomyosis seen on MRI. The patient desired her future fertility and planned for an embryo transfer following surgical evaluation and management of the possible fibroid or focal adenomyosis.

Interventions: A diagnostic hysteroscopy, laparoscopic adenomyomectomy, and chromopertubation were performed in order to preserve this patient's future fertility. To minimize blood loss, the uterine arteries were temporarily ligated with vascular clips at their origin bilaterally, and diluted vasopressin was injected at the site of resection. The uterine defect was laparoscopically sutured in multiple layers.

Measurements and Main Results: The patient's surgery was uncomplicated with minimal blood loss. The pathology report of the excised specimen was consistent with adenomyosis. The patient was counseled to delay embryo transfer for at least 3-6 months postoperatively.

Conclusion: In this video, we demonstrate a step-wise, fertility-sparing method in the laparoscopic resection of an adenomyosis.