Complex Endometriosis Center

Focal adenomyosis is characterized by relatively limited involvement of the myometrium (uterine muscle). If the lesion is close to the uterine cavity, it can be excised by hysteroscopy, namely via the natural route, on an outpatient basis. If a focal lesion is found to invade the myometrium to a greater depth, adenomyomectomy may be contemplated.

However, this surgery runs the risk of bleeding because there is no plane of cleavage, as there is for myomas. In order to limit the risk of bleeding, we temporarily reduce vascularization in the uterus by applying bulldog clips to the uterine arteries before incising the myometrium (25). Once the suture is complete, the clips are removed. This approach reduces blood loss during the procedure and limits the need for postoperative blood transfusion.