The objective of this study was to evaluate the clinical aspects of the levonorgestrel-releasing intrauterine system (LNG-IUS) in patients with large adenomyosis associated with dysmenorrhea and/or heavy menstrual bleeding (HMB). Data were collected retrospectively from 48 patients with large adenomyosis (gestational age ≥ 12 weeks during pelvic examination) diagnosed via transvaginal ultrasonography between January 2008 and December 2009. Clinical outcomes, including symptomatic changes of dysmenorrhea and HMB, uterine volume change, complications, and the overall success rate were evaluated in each patient after treatment with the LNG-IUS. The patients' mean age was 41.7 ± 6.1 years, and the median follow-up duration was 20 months (range, 3-50 months). Significant improvements (p < 0.01) in dysmenorrhea and HMB were observed. There was no significant change in the uterine volume. The most common side effects were prolonged vaginal spotting (n = 28, 58.3%) and LNG-IUS expulsion (n = 18, 37.5%). Five (10.4%) patients underwent premature LNG-IUS removal and eight (16.7%) patients underwent hysterectomy. The overall success rate of the LNG-IUS was 68.8%. The LNG-IUS is a suitable alternative treatment option for the management of dysmenorrhea and HMB prior to hysterectomy, for patients with large adenomyosis.

Objective: To compare the operative outcomes, postoperative pain, and subsequent convalescence after laparoendoscopic single-site surgery (LESS) or conventional laparoscopic surgery for adnexal preservation. Study design: From December 2009 to September 2010, 63 patients underwent LESS (n = 33) or a conventional laparoscopic surgery (n = 30) for cyst enucleation. The overall operative outcomes including postoperative pain measurement using the visual analog scale (VAS) were evaluated (time points 6, 24, and 24 hours). The convalescence data included data obtained from questionnaires on the need for analgesics and on patient-reported time to recovery end points. Results: The preoperative characteristics did not significantly differ between the two groups. The postoperative hemoglobin drop was higher in the LESS group than in the conventional laparoscopic surgery group (P = 0.048). Postoperative pain at each VAS time point, oral analgesic requirement, intramuscular analgesic requirement, and the number of days until return to work were similar in both groups. Conclusion: In adnexa-preserving surgery performed in reproductive-age women, the operative outcomes, including satisfaction of the patients and convalescence after surgery, are comparable for LESS and conventional laparoscopy. LESS may be a feasible and a promising alternative method for scarless abdominal surgery in the treatment of young women with adnexal cysts

Choi SH, et al. Yonsei Med J. 2023 Mar;64(3):204-212. https://doi.org/10.3349/ymj.2022.0278

This study aimed to demonstrate the feasibility of ureteral navigation using intraoperative indocyanine green (ICG) and near-infrared fluorescence (NIRF) imaging during complex laparoscopic or robot-assisted gynecologic surgery (LRAGS). Twenty-six patients at high risk of ureteral injury with complex pelvic pathology (CPP) due to pelvic organ prolapse (POP), multiple myomas, large intraligamentary or cervical myoma, severe pelvic adhesions, or cervical atresia underwent LRAGS. All patients underwent cystoscopic intraureteral ICG instillation before LRAGS and ureteral navigation under NIRF imaging intraoperatively. Both ureteral pathways were identified from the pelvic brim downwards through NIRF imaging in all patients, even though some were not visualized under the white light mode. The fluorescent ureters were visualized immediately after the beginning of surgery and typically lasted for >5 h during surgery. There were no cases of iatrogenic ureteral injury. The hemoglobin decrement was 1.47 ± 1.13 g/dL, and no transfusion was required. In our study, both ureters in all patients were identified with ICG-NIRF imaging during LRAGS, and these techniques made surgeries easier and safer. Despite the CPP, there was no ureteral injury or transfusion following surgery. Further prospective studies are needed to introduce intraoperative ureteral guidelines for ICG-NIRF imaging during LRAGS with CPP.

Kim SJ, et al. Yonsei Med J. 2022 May;63(5):446-451. https://doi.org/10.3349/ymj.2022.63.5.446