Laparoscopic Management of a Juvenile Cystic Adenomyoma

Abstract

<h3>Study Objective</h3> To demonstrate how to diagnose and surgically manage an adenomyotic cyst by a robotic assisted laparoscopic approach. <h3>Design</h3> Stepwise demonstration of the technique with narrated video footage. <h3>Setting</h3> Operating theatre. <h3>Patients or Participants</h3> A 17-year-old patient with acute pelvic pain in the setting of chronic dysmenorrhea associated with a 4 cm cystic lesion in the endometrium on MRI consistent with a juvenile cystic adenomyoma. After no improvement with hormonal management, the patient opted for laparoscopic exploration and removal. <h3>Interventions</h3> MRI imaging was used to identify the adenomyotic cyst. Upon laparoscopy, the surgical site was injected with vasopressin for hemostasis. Sharp and blunt dissection was used to minimize trauma and thermal injury to the surrounding myometrium. Chromopertubation was used verify no cavity entry after removal. Lastly, the myometrium was closed in multiple layers to prevent hematoma formation. <h3>Measurements and Main Results</h3> Successful outpatient procedure with improved pain post-operatively. <h3>Conclusion</h3> This video shows techniques to identify and perform a minimally invasive fertility preserving resection of a juvenile cystic adenomyoma.