Evaluation of the course of clinical symptoms and reproductive outcomes after laser drilling of the uterus with a holmium laser in patients of reproductive age

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Resumo

Adenomyosis is a medical and social problem associated not only with a deterioration in the quality of life of reproductive and perimenopausal women, but is also one of the causes of infertility and miscarriage in young patients.

Objective: To evaluate the course of clinical symptoms and reproductive outcomes after laser drilling of the uterus with a holmium laser in patients of reproductive age.

Materials and methods: The study included 470 patients with uterine factor infertility due to diffuse and/or nodular adenomyosis Grade 2 and Grade 2–3 (MUSA 2022), treated during the period of 2000–2024. The patients underwent laser drilling of the uterus with a holmium laser using a laparoscopic approach.

Results: During the follow-up period after organ-preserving surgery, clinical symptoms and reproductive outcomes were assessed. Ultrasound and MRI were used to objectify the data. Six months after surgery most patients demonstrated a significant reduction in the severity of dysmenorrhea (from 8.10 to 2.0 according to the NRS scale). Menstrual blood loss also markedly decreased from 153.1 (80) ml to 67.0 ml. Pregnancy occurred in 127/337 patients under the follow-up. No intra- or postoperative complications were noted.

Conclusion: The obtained data demonstrate a significant improvement in clinical symptoms (decrease in the severity of dysmenorrhea, menstrual blood loss, and uterine size) in patients with adenomyosis. Reproductive outcomes also improved, which did not show statistical significance after Bonferroni correction, therefore requiring further confirmation with control groups.

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Sobre autores

Anatoly Ishchenko

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: 7205502@mail.ru
ORCID ID: 0000-0003-3338-1113

Dr. Med. Sci., Professor, Professor at the Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine

Rússia, Moscow

Anton Ishchenko

National Medical Research Center for Treatment and Rehabilitation, Ministry of Health of Russia

Email: ra2001_2001@mail.ru
ORCID ID: 0000-0002-4476-4972

PhD, Head of the Center for Gynecology and Reproductive Technologies

Rússia, Moscow

Vladimir Zuev

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: vlzuev@bk.ru
ORCID ID: 0000-0001-8715-2020

Dr. Med. Sci., Professor, Professor at the Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine

Rússia, Moscow

Irina Gadaeva

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: irina090765@gmail.com
ORCID ID: 0000-0003-0144-4984

PhD, Associate Professor at the Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine

Rússia, Moscow

Elena Malyuta

National Medical Research Center for Treatment and Rehabilitation, Ministry of Health of Russia

Email: egma@list.ru
ORCID ID: 0000-0003-0098-0830

PhD, Head of Gynecological Department

Rússia, Moscow

Tea Dzhibladze

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Autor responsável pela correspondência
Email: djiba@bk.ru
ORCID ID: 0000-0003-1540-5628

Dr. Med. Sci., Professor, Professor at the Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine

Rússia, Moscow

Mikhail Isaev

MedOptoTech LLC

Email: medoptotec@yandex.ru
ORCID ID: 0009-0009-6995-7381

PhD, General Director

Rússia, Moscow

Lilia Obosyan

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: lilia070500@mail.ru
ORCID ID: 0000-0002-1316-6291

Resident at the Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine

Rússia, Moscow

Irina Khokhlova

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: irhohlova5@gmail.com
ORCID ID: 0000-0001-8547-6750

PhD, Associate Professor at the Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine

Rússia, Moscow

Elena Minashkina

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: as1199@list.ru
ORCID ID: 0009-0004-3548-7944

Doctor at the Ultrasound Diagnostics Department of the Obstetrics and Gynecology Clinic of the Sechenov Center for Motherhood and Childhood

Rússia, Moscow

Ekaterina Tevlina

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: tevlina.ekaterina@gmail.com
ORCID ID: 0009-0003-5235-1814

Teaching Assistant at the Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine

Rússia, Moscow

Maxim Verbitsky

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: MVS-7-99@yandex.ru
ORCID ID: 0009-0006-0749-5538

Clinical Resident at the Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine

Rússia, Moscow

Bibliografia

  1. Mavrelos D., Holland T.K., O'Donovan O., Khalil M., Ploumpidis G., Jurkovic D. et al. The impact of adenomyosis on the outcome of IVF-embryo transfer. Reprod. Biomed. Online. 2017; 35(5): 549-54. https://dx.doi.org/10.1016/j.rbmo.2017.06.026
  2. Dueholm M. Uterine adenomyosis and infertility, review of reproductive outcome after in vitro fertilization and surgery. Acta Obstet. Gynecol. Scand. 2017; 96(6): 715-26. https://dx.doi.org/10.1111/aogs.13158
  3. Vercellini P., Consonni D., Dridi D., Bracco B., Frattaruolo M.P., Somigliana E. Uterine adenomyosis and in vitro fertilization outcome: a systematic review and meta-analysis. Hum. Reprod. 2014; 29(5): 964-77. https://dx.doi.org/10.1093/humrep/deu041
  4. Wang P.H., Liu W.M., Fuh J.L., Cheng M.H., Chao H.T. Comparison of surgery alone and combined surgical-medical treatment in the management of symptomatic uterine adenomyoma. Fertil. Steril. 2009; 92(3): 876-85. https://dx.doi.org/10.1016/j.fertnstert.2008.07.1744
  5. Bourdon M., Santulli P., Oliveira J., Marcellin L., Maignien C., Melka L. et al. Focal adenomyosis is associated with primary infertility. Fertil. Steril. 2020; 114(6): 1271-7. https://dx.doi.org/10.1016/j.fertnstert.2020.06.018
  6. Chapron C., Vannuccini S., Santulli P., Abrão M.S., Carmona F., Fraser I.S. et al. Diagnosing adenomyosis: an integrated clinical and imaging approach. Hum. Reprod. Update. 2020; 26(3): 392-411. https://dx.doi.org/10.1093/humupd/dmz049
  7. Bergeron C., Amant F., Ferenczy A. Pathology and physiopathology of adenomyosis. Best Pract. Res. Clin. Obstet. Gynaecol. 2006; 20(4): 511-21. https://dx.doi.org/10.1016/j.bpobgyn.2006.01.016
  8. Dueholm M., Lundorf E., Hansen E.S., Sørensen J.S., Ledertoug S., Olesen F. Magnetic resonance imaging and transvaginal ultrasonography for the diagnosis of adenomyosis. Fertil. Steril. 2001; 76(3): 588-94. https://dx.doi.org/10.1016/s0015-0282(01)01962-8
  9. Pinzauti S., Lazzeri L., Tosti C., Centini G., Orlandini C., Luisi S. et al. Transvaginal sonographic features of diffuse adenomyosis in 18-30-year-old nulligravid women without endometriosis: association with symptoms. Ultrasound Obstet. Gynecol. 2015; 46(6): 730-6. https://dx.doi.org/10.1002/uog.14834
  10. Munro M.G., Critchley H.O.D., Broder M.S., Fraser I.S., FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int. J. Gynaecol. Obstet. 2011; 113(1): 3-13. https://dx.doi.org/10.1016/j.ijgo.2010.11.011
  11. Cozzolino M., Cosentino M., Loiudice L., Martire F.G., Galliano D., Pellicer A. et al. Impact of adenomyosis on in vitro fertilization outcomes in women undergoing donor oocyte transfers: a prospective observational study. Fertil. Steril. 2024; 121(3): 480-8. https://dx.doi.org/10.1016/j.fertnstert.2023.11.034
  12. Cozzolino M., Tartaglia S., Pellegrini L., Troiano G., Rizzo G., Petraglia F. The effect of uterine adenomyosis on IVF outcomes: a systematic review and meta-analysis. Reprod. Sci. 2022; 29(11): 3177-93. https://dx.doi.org/10.1007/s43032-021-00818-6
  13. Li Y.T., Chen S.F., Chang W.H., Wang P.H. Pregnancy outcome in women with type I adenomyosis undergoing adenomyomectomy. Taiwan. J. Obstet. Gynecol. 2021; 60(3): 399-400. https://dx.doi.org/10.1016/j.tjog.2021.03.003
  14. Juárez-Barber E., Cozzolino M., Corachán A., Alecsandru D., Pellicer N., Pellicer A. et al. Adjustment of progesterone administration after endometrial transcriptomic analysis does not improve reproductive outcomes in women with adenomyosis. Reprod. Biomed. Online. 2023; 46(1): 99-106. https://dx.doi.org/10.1016/j.rbmo.2022.09.007
  15. Harada T., Taniguchi F., Guo S.W., Choi Y.M., Biberoglu K.O., Tsai S.J.S. et al. The Asian society of endometriosis and adenomyosis guidelines for managing adenomyosis. Reprod. Med. Biol. 2023; 22(1): e12535. https://dx.doi.org/10.1002/rmb2.12535
  16. Benetti-Pinto C.L., Mira T.A.A. de, Yela D.A., Teatin-Juliato C.R., Brito L.G.O. Pharmacological treatment for symptomatic adenomyosis: a systematic review. Rev. Bras. Ginecol. Obstet. 2019; 41(9): 564-74. https://dx.doi.org/10.1055/s-0039-1695737
  17. Socarrás M.R., del Álamo J.F., Sancha F.G. Long live holmium! Eur. Urol. Open Sci. 2022; 48: 28-30. https://dx.doi.org/10.1016/j.euros.2022.07.012
  18. Bhatta N., Isaacson K., Bhatta K.M., Anderson R.R., Schiff I. Comparative study of different laser systems. Fertil. Steril. 1994; 61(4): 581-91. https://dx.doi.org/10.1016/s0015-0282(16)56629-1
  19. Harmsen M.J., Van den Bosch T., de Leeuw R.A., Dueholm M., Exacoustos C., Valentin L. et al. Consensus on revised definitions of morphological uterus sonographic assessment (MUSA) features of adenomyosis: results of modified Delphi procedure. Ultrasound Obstet. Gynecol. 2022; 60(1): 118-31. https://dx.doi.org/10.1002/uog.24786
  20. Ищенко А.И., Жуманова Е.Н., Ищенко А.А., Горбенко О.Ю., Чунаева Е.А., Агаджанян Э.С., Савельева Я.С. Современные подходы в диагностике и органосохраняющем лечении аденомиоза. Акушерство, гинекология и репродукция. 2013; 7(3): 30-4. [Ishchenko A.I., Zhumanova E.N., Ishchenko A.A., Gorbenko O.Yu., Chunaeva E.A., Aghajanyan E.S., Savelieva Yа.S. Modern approaches in the diagnosis and conserving therapy of adenomyosis. Obstetrics, Gynecology and Reproduction. 2013; 7(3): 30-4 (in Russian)].
  21. Dason E.S., Maxim M., Sanders A., Papillon-Smith J., Ng D., Chan C. et al. Guideline No. 437: Diagnosis and Management of Adenomyosis. J. Obstet. Gynaecol. Can. 2023; 45(6): 417-29.e1. https://dx.doi.org/10.1016/j.jogc.2023.04.008
  22. Selntigia A., Molinaro P., Tartaglia S., Pellicer A., Galliano D., Cozzolino M. Adenomyosis: an update concerning diagnosis, treatment, and fertility. J. Clin. Med. 2024; 13(17): 5224. https://dx.doi.org/10.3390/jcm13175224
  23. Kim J.K., Shin C.S., Ko Y.B., Nam S.Y., Yim H.S., Lee K.H. Laparoscopic assisted adenomyomectomy using double flap method. Obstet. Gynecol. Sci. 2014; 57(2): 128-35. https://dx.doi.org/10.5468/ogs.2014.57.2.128
  24. Fujishita A., Masuzaki H., Khan K.N., Kitajima M., Ishimaru T. Modified reduction surgery for adenomyosis. A preliminary report of the transverse H incision technique. Gynecol. Obstet. Invest. 2004; 57(3): 132-8. https://dx.doi.org/10.1159/000075830
  25. Dai Z., Feng X., Gao L., Huang M. Local excision of uterine adenomyomas: a report of 86 cases with follow-up analyses. Eur. J. Obstet. Gynecol. Reprod. Biol. 2012; 161(1): 84-7. https://dx.doi.org/10.1016/j.ejogrb.2011.11.028
  26. Saremi A., Bahrami H., Salehian P., Hakak N., Pooladi A. Treatment of adenomyomectomy in women with severe uterine adenomyosis using a novel technique. Reprod. Biomed. Online. 2014; 28(6): 753-60. https://dx.doi.org/10.1016/j.rbmo.2014.02.008
  27. Takeuchi H., Kitade M., Kikuchi I., Shimanuki H., Kumakiri J., Kitano T. et al. Laparoscopic adenomyomectomy and hysteroplasty: a novel method. J. Minim. Invasive Gynecol. 2006; 13(2): 150-4. https://dx.doi.org/10.1016/j.jmig.2005.12.004
  28. Zhou Y., Shen L., Wang Y., Yang M., Chen Z., Zhang X. Long-term pregnancy outcomes of patients with diffuse adenomyosis after double-flap adenomyomectomy. J. Clin. Med. 2022; 11(12): 3489. https://dx.doi.org/10.3390/jcm11123489
  29. Jiang L., Han Y., Song Z., Li Y. Pregnancy outcomes after uterus-sparing operative treatment for adenomyosis: a systematic review and meta-analysis. J. Minim. Invasive Gynecol. 2023; 30(7): 543-54. https://dx.doi.org/10.1016/j.jmig.2023.03.015
  30. Tan J., Moriarty S., Taskin O., Allaire C., Williams C., Yong P. et al. Reproductive outcomes after fertility-sparing surgery for focal and diffuse adenomyosis: a systematic review. J. Minim. Invasive Gynecol. 2018; 25(4): 608-21. https://dx.doi.org/10.1016/j.jmig.2017.12.020

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2. Fig. 1. Schematic representation of laser drilling: 1 - laparoscopic approach; 2 - Ho:YAG laser fiber inserted through the working channel of the aquapurator; 3 - visualization of the pathological lesion followed by laser drilling; 4 - intraoperative ultrasound navigation

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3. Fig. 2. Dynamics of uterine size reduction after laser drilling for adenomyosis, as measured by ultrasound monitoring. The graph shows the reduction in length, anterior-posterior diameter, and width of the uterus 5 days, 3 and 9 months after the procedure.

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4. Fig. 3. Ultrasound monitoring. A. Transvaginal ultrasound before treatment: irregular transition line (unclear border between the endometrium and myometrium); myometrium of heterogeneous structure (small hyperechoic areas and myometrial cysts); asymmetric thickening of the uterine walls. B. Transvaginal ultrasound 3 months after laser drilling: the transition zone is more uniform, less pronounced; less pronounced inhomogeneity of the myometrium; Dopplerography: initial restoration of perfusion. C. Transvaginal ultrasound 9 months after laser drilling: the endometrial contour is clearer (a clear border between the endometrium and myometrium is visualized); myometrium of homogeneous structure (the number of hyperechoic inclusions has decreased). pronounced vascularization (on Romeg Boppler, multiple vascular signals in the myometrium are a positive prognostic sign for implantation)

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5. Fig. 4. Analysis of the CNB depending on the degree of spread of adenomyosis

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