Design: Level II, Canadian Task Force

Setting: National Referral Center, Department of Operative Gynecology

Patients or Participants: 150 patients of reproductive age with adenomiosis were admitted for surgical treatment and enrolled in cohort study. Groups were divided according to the form of adenomyosis (diffuse, nodular, or cystic). All participants had previous medical treatment, which was ineffective.

Interventions: Preoperative and intraoperative navigation in laparoscopic uterine reconstruction with utilization of new 3D- model of the adenomyotic uterus combined with the data of functional MRI and MR-elastography in patients with various forms of adenomyosis, interested in uterine preservation and following otherwise standard perioperative protocol.

Measurements and Main Results: Newly created thin-slice 3-D uterine model allowed for studying of the structural features and anatomical patterns in patients with adenomyosis, including the determination of the exact boundaries of the pathological process, the thickness of the uterine wall, the thickness of the Junctional Zone, density of diffuse and nodular adenomyosis, and circulation; and resulted in the optimization of the surgical tactic, reduction of intraoperative blood loss, reduced intraoperative decision-making time, and duration of surgery. All patients had improved quality of life (reduction of pain syndrome, menstrual blood loss, reproductive outcomes). 40% of patients had combined endometriosis and adenomyosis and 7% had congenital uterine malformations.

Conclusion: Newly created 3-D uterine model combined with the data obtained with functional MRI and MR-elastography allowed for higher level of precision in preoperative and intraoperative navigation of direction and extent of surgical resection/excision, enhanced by reliable assessment of precise nuances of myometrial circulation and adenomyotic involvement, leading to reliable and safe reconstruction of myometrium in patients with advanced adenomyosis, requiring surgical resection/excision.