Iseikai Hospital, Japan
Title: The treatment of adenomyosis using a specifically developed transabdominal ultrasound probe attachment for transcervical microwave adenomyolysis
Biography: Yasushi Kanaoka
Statement of the Problem: Hysterectomy is a standard treatment for symptomatic uterine adenomyosis refractory to conservative therapy. However, most premenopausal women with menorrhagia and dysmenorrhea caused by adenomyosis will not consider hysterectomy if an effective alternative is available. Transcervical microwave adenomyolysis (TCMAM), i.e., transcervical interstitial microwave irradiation, can effectively necrotize adenomyosis tissue and relieve symptoms.
Methodology & Theoretical Orientation: A new transabdominal ultrasound probe attachment was specifically manufactured, to ensure safe insertion of a microwave applicator tip into the uterine wall. Sixty candidates for hysterectomy for treatment of adenomyosis associated with menorrhagia were treated with TCMAM using an attachment for transcervical puncture with simultaneous microwave endometrial ablation (MEA), as an alternative to hysterectomy. Primary outcomes were changes in venous hemoglobin level and uterine body volume before and after treatment. Secondary outcome were the visual analogue scale (VAS) scores for menorrhagia and dysmenorrhea after treatment.
Findings: The newly developed attachment makes transcervical puncture very easy and accurate. At 3 months after surgery, the average hemoglobin level significantly increased. At 12 months, the uterine body significantly decreased to 52% of the volume before treatment. The VAS scores after treatment indicated significant improvement in menorrhagia and dysmenorrhea.
Conclusions: TCMAM combined with MEA reduced uterine body volume and relieved menorrhagia and dysmenorrhea caused by adenomyosis. This strategy is an affordable alternative to hysterectomy for the treatment of adenomyosis