2440 Efficacy of Hand Assisted Laparoscopic Adenomyomectomy with Manipulation of Uterine Artery Comparing with Classical Laparoscopic and Laparotomic Adenomyomectomy

Abstract

Study Objective To assess the safety and benefit of Hand-assisted laparoscopic (HALS) adenomyomectomy compared with laparoscopic and laparotomic adenomyomectomy. Design Single-center, nonrandomized, comparative study. Setting University hospital, tertiary referral center. Patients or Participants 20 patients underwent HALS adenomyomectomy with bilateral uterine artery ligation (BUAL) or transient occlusion of uterine artery (TOUA). HALS group was compared with laparoscopic adenomyomectomy (n=82) and laparotomic adenomyomectomy (n=170) with or without BUAL/ TOUA between January 2016 and January 2019. Interventions HALS adenomyomectomy was performed via laparoscopic and/or extracorporeal approach through suprapubic incision (about 5cm). Other groups underwent laparoscopic adenomyomectomy or laparotomic adenomyomectomy alone. Measurements and Main Results HALS and laparotomic groups were comparable with average estimated blood loss (217.5±136.0 vs, 193.6±193.0 mL, p=0.858), weight of removed mass (89.0 ±75.2 vs 108.2±91.9 g, p=0.699), postoperative hospital day (HD) (4.6±1.1 vs 4.7±0.8 days, p=0.922). Laparoscopic group was lower in all of them (EBL 119.5±79.6 ml, mass weight 39.3±25.9 g, HD 3.6±0.8 days). The three groups did not differ significantly in transfusion rates, hemoglobin change, febrile morbidity, and perioperative complications. Additional procedures were more frequently performed in HALS (0.33±0.48) than other groups such as myomectomy, pelvic adhesiolyis, adnexa & pelvic endometriosis excision (vs. laparosopy 0.16±0.36, p=0.024; vs. laparotomy 0.15±0.36, p=0.017). The mean operating time was longer in HALS group (182.5±38.1 min), compared with other groups (vs. Laparoscopy 99.9±40.6min, p Conclusion HALS adenomyomectomy with BUAL/ TOUA allows for complete excision of adenomyosis via extracorporeal & intracorporeal procedures while retaining the advantages of minimally invasive surgery. Furthermore, this approach could easily perform the additional pelvic surgery for benign uterine and adnexal pathology without compromising surgical outcomes.