Evaluation of the course of clinical symptoms and reproductive outcomes after laser drilling of the uterus with a holmium laser in patients of reproductive age

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Resumo

Adenomyosis is a medical and social problem associated not only with a deterioration in the quality of life of reproductive and perimenopausal women, but is also one of the causes of infertility and miscarriage in young patients.

Objective: To evaluate the course of clinical symptoms and reproductive outcomes after laser drilling of the uterus with a holmium laser in patients of reproductive age.

Materials and methods: The study included 470 patients with uterine factor infertility due to diffuse and/or nodular adenomyosis Grade 2 and Grade 2–3 (MUSA 2022), treated during the period of 2000–2024. The patients underwent laser drilling of the uterus with a holmium laser using a laparoscopic approach.

Results: During the follow-up period after organ-preserving surgery, clinical symptoms and reproductive outcomes were assessed. Ultrasound and MRI were used to objectify the data. Six months after surgery most patients demonstrated a significant reduction in the severity of dysmenorrhea (from 8.10 to 2.0 according to the NRS scale). Menstrual blood loss also markedly decreased from 153.1 (80) ml to 67.0 ml. Pregnancy occurred in 127/337 patients under the follow-up. No intra- or postoperative complications were noted.

Conclusion: The obtained data demonstrate a significant improvement in clinical symptoms (decrease in the severity of dysmenorrhea, menstrual blood loss, and uterine size) in patients with adenomyosis. Reproductive outcomes also improved, which did not show statistical significance after Bonferroni correction, therefore requiring further confirmation with control groups.

Sobre autores

Anatoly Ishchenko

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: 7205502@mail.ru
ORCID ID: 0000-0003-3338-1113

Dr. Med. Sci., Professor, Professor at the Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine

Rússia, Moscow

Anton Ishchenko

National Medical Research Center for Treatment and Rehabilitation, Ministry of Health of Russia

Email: ra2001_2001@mail.ru
ORCID ID: 0000-0002-4476-4972

PhD, Head of the Center for Gynecology and Reproductive Technologies

Rússia, Moscow

Vladimir Zuev

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: vlzuev@bk.ru
ORCID ID: 0000-0001-8715-2020

Dr. Med. Sci., Professor, Professor at the Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine

Rússia, Moscow

Irina Gadaeva

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: irina090765@gmail.com
ORCID ID: 0000-0003-0144-4984

PhD, Associate Professor at the Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine

Rússia, Moscow

Elena Malyuta

National Medical Research Center for Treatment and Rehabilitation, Ministry of Health of Russia

Email: egma@list.ru
ORCID ID: 0000-0003-0098-0830

PhD, Head of Gynecological Department

Rússia, Moscow

Tea Dzhibladze

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Autor responsável pela correspondência
Email: djiba@bk.ru
ORCID ID: 0000-0003-1540-5628

Dr. Med. Sci., Professor, Professor at the Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine

Rússia, Moscow

Mikhail Isaev

MedOptoTech LLC

Email: medoptotec@yandex.ru
ORCID ID: 0009-0009-6995-7381

PhD, General Director

Rússia, Moscow

Lilia Obosyan

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: lilia070500@mail.ru
ORCID ID: 0000-0002-1316-6291

Resident at the Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine

Rússia, Moscow

Irina Khokhlova

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: irhohlova5@gmail.com
ORCID ID: 0000-0001-8547-6750

PhD, Associate Professor at the Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine

Rússia, Moscow

Elena Minashkina

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: as1199@list.ru
ORCID ID: 0009-0004-3548-7944

Doctor at the Ultrasound Diagnostics Department of the Obstetrics and Gynecology Clinic of the Sechenov Center for Motherhood and Childhood

Rússia, Moscow

Ekaterina Tevlina

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: tevlina.ekaterina@gmail.com
ORCID ID: 0009-0003-5235-1814

Teaching Assistant at the Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine

Rússia, Moscow

Maxim Verbitsky

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: MVS-7-99@yandex.ru
ORCID ID: 0009-0006-0749-5538

Clinical Resident at the Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine

Rússia, Moscow

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2. Fig. 1. Schematic representation of laser drilling: 1 - laparoscopic approach; 2 - Ho:YAG laser fiber inserted through the working channel of the aquapurator; 3 - visualization of the pathological lesion followed by laser drilling; 4 - intraoperative ultrasound navigation

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3. Fig. 2. Dynamics of uterine size reduction after laser drilling for adenomyosis, as measured by ultrasound monitoring. The graph shows the reduction in length, anterior-posterior diameter, and width of the uterus 5 days, 3 and 9 months after the procedure.

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4. Fig. 3. Ultrasound monitoring. A. Transvaginal ultrasound before treatment: irregular transition line (unclear border between the endometrium and myometrium); myometrium of heterogeneous structure (small hyperechoic areas and myometrial cysts); asymmetric thickening of the uterine walls. B. Transvaginal ultrasound 3 months after laser drilling: the transition zone is more uniform, less pronounced; less pronounced inhomogeneity of the myometrium; Dopplerography: initial restoration of perfusion. C. Transvaginal ultrasound 9 months after laser drilling: the endometrial contour is clearer (a clear border between the endometrium and myometrium is visualized); myometrium of homogeneous structure (the number of hyperechoic inclusions has decreased). pronounced vascularization (on Romeg Boppler, multiple vascular signals in the myometrium are a positive prognostic sign for implantation)

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5. Fig. 4. Analysis of the CNB depending on the degree of spread of adenomyosis

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