Objective: To investigate the familial heritability of endometriosis and to compare the clinical characteristics of patients with or without a family history of endometriosis. Methods: From January 2020 to June 2022, 850 patients with endometriosis confirmed by laparotomy or laparoscopy in Peking University Third Hospital were included in this study. Clinical data were collected, family history was followed up, and the differences of clinical indicators between patients with and without family history of endometriosis were compared. Results: A total of 850 patients were enrolled, with an average age of (33.8±7.0) years old, 315 (37.1%, 315/850) patients in stage Ⅲ and 496 (58.4%, 496/850) patients in stage Ⅳ. There were 100 patients with family history of endometriosis, accounting for 11.8% (100/850). Most of the 113 relatives involved were mothers, daughters and sisters (76.1%, 86/113), 81.5% (22/27) of the second and third degree relatives were maternal relatives. The median ages of patients with and without family history of endometriosis were 30 and 33 years old respectively at the time of diagnosis. The unmarried rate of patients with family history was higher [42.0% (42/100) vs 26.3% (197/750)]. The percentage of dysmenorrhea patients with family history was higher [89.0% (89/100) vs 55.5% (416/750)]. The medians of dysmenorrhea score in patients with and without family history were 6 and 2, and the median durations of dysmenorrhea were 10 and 1 years. There were significant differences in age, marital status, percentage of dysmenorrhea, dysmenorrhea score and duration (all P<0.001). The median levels of serum cancer antigen (CA) 125 in patients with family history and patients without family history at the time of diagnosis were 57.5 and 46.9 kU/L respectively, with a statistically significant difference (P<0.05). However, there were no significant differences between the two groups in nationality, bady mass index, menarche age, menstrual cycle, menstrual period, menstrual volume, serum CA_19-9 level, cyst location and size, stage, history of adverse pregnancy and childbirth, infertility, adenomyosis and deep infiltrating endometriosis (all P>0.05). By comparing the specific conditions of dysmenorrhea patients with and without family history of endometriosis, there were no significant differences between the two groups in terms of the age of onset of dysmenorrhea, duration of dysmenorrhea, primary and secondary dysmenorrhea, and progressive aggravation of dysmenorrhea (all P>0.05). The difference in the degree of dysmenorrhea in dysmenorrhea patients with family history of endometriosis was significant (P<0.001). Conclusions: The incidence of endometriosis has a familial tendency, and most of the involved relatives are the first degree relatives. Compared with patients without family history of endometriosis, endometriosis patients with family history are diagnosed at an earlier age, with higher percentage of dysmenorrhea, had more severe dysmenorrhea and higher serum CA₁₂₅ level.
Pregnancy ; Female ; Humans ; Adult ; Endometriosis/complications* ; Dysmenorrhea/etiology* ; Menstruation ; Menstrual Cycle ; Adenomyosis/complications*

Single port access surgery can be the next generation of minimally invasive surgery. It has been tried in various diseases of surgery, urology, and gynecology. It was introduced in Korea and its field is widening. Total hysterectomy is the most common operation in gynecology. However, single port total laparoscopic hysterectomy (TLH) had been hardly performed due to technical difficulties. Author has successfully performed single port transumbilical TLH and right adnexectomy in a patient who had adenomyosis, uterine myoma, and right ovarian serous cystadenoma. One laparoscope and 2 instruments were inserted in 3 cannulas of the port that was made up with a wound retractor and a surgical glove. Laparoscopic suturing was done after total hysterectomy and right adnexectomy. During the operation, only commonly used laparoscopic instruments (straight and rigid) were used. All the procedures were completed without any complications and there were neither postoperative complications nor visible scars. Author reports the first single port transumbilical TLH case in Korea that showed satisfying results.
Adenomyosis ; Catheters ; Cicatrix ; Cystadenoma, Serous ; Gloves, Surgical ; Gynecology ; Humans ; Hysterectomy ; Korea ; Laparoscopes ; Myoma ; Postoperative Complications ; Urology

OBJECTIVE: To compare clinical features and surgical outcomes of laparoscopic-assisted vaginal hysterectomy (LAVH) by the number of ports in the treatment of uterine myoma and adenomyosis. METHODS: Between 1st January 2009 and 31th March 2010, 50 patients underwent 5 mm-2 port LAVH and 10 mm-3 port LAVH respectively by same surgeon at Chosun university hospital. We compared clinical features and surgical outcomes. RESULTS: There was no difference in weight of uterus between the 5 mm-2 port LAVH group and the 10 mm-3 port LAVH group (465.2+/-206.9 g vs. 470.8+/-148.5 g) (Mean+/-S.D.), and in amounts of blood loss during procedure between the two groups (115.0+/-179.3 mL vs. 125.0+/-211.7 mL). The duration of procedure showed a difference between the two groups(55.1+/-12.0 minutes vs. 60.4+/-19.5 minutes) (p=0.03). In the 5 mm-2 port LAVH group, 2 of 50 (4%) converted to laparotomy, and 1 of 50 (2%) in the 10 mm-3 port LAVH group. There was no difference in length of postoperative hospital day between the two groups (5.8+/-1.0 days vs. 6.3+/-1.6 days). In the comparison of postoperative complications, 1 of 50 (2%) required readmission and reoperation for both of the two groups. CONCLUSION: We conclude that 5 mm-2 port LAVH could be a available method in the treatment of uterine myoma and adenomyosis.
Adenomyosis ; Female ; Humans ; Hysterectomy, Vaginal ; Laparotomy ; Myoma ; Postoperative Complications ; Reoperation ; Uterus

OBJECTIVE: A number of preexisting clinical conditions are generally accepted as contraindications for total vaginal hysterectomy. The purpose of this study was to evaluate the validity of these contraindications. METHODS: The TVH-A group consisted of 230 patients who have undergone vaginal hysterectomy. These patients (1) had a large uterus (>280 gm), (2) were either nulliparous or had no previous vaginal delivery, or (3) had a history of previous abdominal or vaginal operation. The TVH-B group was composed of patients who did not present with any contraindications when they underwent vaginal hysterectomy. Patients of the TAH group underwent abdominal hysterectomy. The records for all patients were analyzed according to age, weight, parity, primary diagnosis, uterine weight, duration of operation, blood loss, analgesia, hospital stay, and postsurgical complications. RESULTS: No significant difference in age and weight was observed between the three groups. The average number of vaginal deliveries performed was lower in the TVH-A group. Uterine myoma, carcinoma in situ, and adenomyosis were common preoperative diagnoses in all groups. The most common contraindication for total vaginal hysterectomy in the TVH-A group was history of previous operation (54.8%); large uterus (44.8%) and nulliparity (21.3%) ranked second and third, respectively. Durations of operation, hospital stay, and pain were longer, bleeding volume was greater, and incidence of postoperative complications was higher in the TAH group than in the other groups (p<0.01). Previous cesarean delivery did not affect various operative characteristics among women undergoing vaginal hysterectomy (p<0.01). CONCLUSION: Our data indicate that a history of previous operation, large uterus, and nulliparity rarely constitute contraindications to vaginal hysterectomy.
Adenomyosis ; Analgesia ; Carcinoma in Situ ; Diagnosis ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Incidence ; Leiomyoma ; Length of Stay ; Parity ; Postoperative Complications ; Uterus

Objective: To investigate the relationship between magnetic resonance imaging (MRI) imaging characteristics and clinical symptoms and therapeutic efficacy in adenomyosis patients. Methods: The clinical characteristics of the adenomyosis questionnaire was self-designed. This was a retrospective study. From September 2015 to September 2020, totally 459 patients were diagnosed with adenomyosis and underwent pelvic MRI examination at Peking University Third Hospital. Clinical characteristics and treatment were collected, MRI was used to determine the lesion location, and to measure the maximum lesion thickness, the maximum myometrium thickness, uterine cavity length, uterine volume, the minimum distance between the lesion and serosa or endometrium, and whether combined with ovarian endometrioma. The difference of MRI imaging characteristics in patients with adenomyosis and its relationship with clinical symptoms and therapeutic efficacy were analyzed. Results: (1) Among the 459 patients, the age was (39.1±6.4) years. There were 376 patients (81.9%, 376/459) with dysmenorrhea. Whether patients had dysmenorrhea were related to uterine cavity length, uterine volume, ratio of the maximum lesion thickness to the maximum myometrium thickness, and whether patients had ovarian endometrioma (all P<0.001). Multivariate analysis suggested that ovarian endometrioma was the risk factor for dysmenorrhea (OR=0.438, 95%CI: 0.226-0.850, P=0.015). There were 195 patients (42.5%, 195/459) with menorrhagia. Whether patients had menorrhagia were related to age, whether patients had ovarian endometrioma, uterine cavity length, the minimum distance between lesion and endometrium or serosa, uterine volume, ratio of the maximum lesion thickness to the maximum myometrium thickness (all P<0.001). Multivariate analysis suggested that ratio of the maximum lesion thickness to the maximum myometrium thickness was the risk factor for menorrhagia (OR=774.791, 95%CI: 3.500-1.715×10⁵, P=0.016). There were 145 patients (31.6%, 145/459) with infertility. Whether the patients had infertility were related to age, the minimum distance between lesion and endometrium or serosa, and whether patients had ovarian endometrioma (all P<0.01). Multivariate analysis suggested that young and large uterine volume were risk factors for infertility (OR=0.845, 95%CI: 0.809-0.882, P<0.001; OR=1.001, 95%CI: 1.000-1.002, P=0.009). (2) The success rate of in vitro fertilization-embryo transfer (IVF-ET) was 39.2% (20/51). Dysmenorrhea, high maximum visual analogue scale score and large uterine volume affected the success rate of IVF-ET (all P<0.05). The smaller the maximum lesion thickness, the smaller the distance between the lesion and serosa, the larger the distance between the lesion and endometrium, the smaller the uterine volume, and the smaller the ratio of the maximum lesion thickness to the maximum myometrium thickness, the better the therapeutic efficacy of progesterones (all P<0.05). Conclusions: Concomitant ovarian endometrioma increases the risk of dysmenorrhea in patients with adenomyosis. The ratio of the maximum lesion thickness to the maximum myometrium thickness is an independent risk factor for menorrhagia. Young and large uterine volume may increase the risk of infertility. Severe dysmenorrhea and large uterine volume affect the success rate of IVF-ET. The therapeutic efficacy of progesterones is relatively better when the lesion is small and far away from the endometrium.
Female ; Humans ; Adult ; Middle Aged ; Adenomyosis/pathology* ; Dysmenorrhea/therapy* ; Menorrhagia/pathology* ; Endometriosis/therapy* ; Retrospective Studies ; Infertility/complications* ; Magnetic Resonance Imaging

OBJECTIVE: This study was conducted to evaluate the clinical efficacy of simple total laparoscopic hysterectomy in the aspect of operation indication, operation time, hospitalization day, blood loss, and postoperative complications. METHODS: A retrospective evaluation for 312 women who undergone simplified total laparoscopic hysterectomy from January, 2002 to June, 2003 was done. RESULTS: The mean age of patients was 45.2 years, mean parity was 2.2, and mean uterine weight was 272.3 gm. The most common surgical indication was uterine myoma in 136 cases (43.5%), followed by adenomyosis in 90 cases (28.8%), myoma combined with adenomyosis in 52 cases (16.6%), uterine prolapse in 15 cases (4.8%), and HSIL 19 cases (6%) respectively. The most common concomitant operation was salpingooophorectomy in 53 cases (16.9%), followed by adhesiolysis in 40 cases (12.8%), colporraphy in 14 cases (4.4%), electrocauterization (ovary) in 4 cases (1.3%), pelvic floor suspension in 4 cases (1.3%), and TVT in 1 case (0.3%). The mean operation time was 107 minutes, and the average hospital day was 5.2 days. The preoperative and postoperative hemoglobin difference was 1.2 gm/dL. The complications of STLH were ureteral injury in 2 cases, intestinal injury in 1 case, and stump bleeding in 1 case. CONCLUSION: The most important factors for successful STLH were sufficiently trained laparoscopic team and the degree of pelvic adhesion. The most potential advantages of STLH are shorter duration of operation time, hospitalization, and less postoperative complications and more cost effectiveness. Therefore, STLH can be a new alternative option for hysterectomy and may replace the other methods of hysterectomy such as abdominal, vaginal and laparoscopic assisted vaginal hysterectomy (LAVH).
Adenomyosis ; Cost-Benefit Analysis ; Female ; Hemorrhage ; Hospitalization ; Humans ; Hysterectomy* ; Hysterectomy, Vaginal ; Leiomyoma ; Myoma ; Parity ; Pelvic Floor ; Postoperative Complications ; Retrospective Studies ; Ureter ; Uterine Prolapse

OBJECTIVE: The present study aimed to determine the differences in outcomes between natural orifice transluminal endoscopic surgery-assisted vaginal hysterectomy (NAVH) and conventional laparoscopy-assisted vaginal hysterectomy (LAVH). METHODS: We retrospectively reviewed the charts of patients who between July 2012 and September 2015, were diagnosed as having benign uterine disease such as uterine myoma, endometriosis, or adenomyosis and managed via NAVH or LAVH in a single-center (Eulji University Hospital). Data such as age, body weight, height, parity, operation time, intra/post-operative complications, and uterus weight were obtained from the clinical charts. NAVH and LAVH recipients were matched 1:3 in terms of baseline characteristics, and the 2 groups were compared regarding surgical outcomes. RESULTS: Of the 160 patients with benign uterine disease included in the present study. Forty received NAVH and remaining 120 received LAVH. There were significant differences between the groups regarding operation time and hemoglobin change. Notably, although the operation time was shorter for LAVH, hemoglobin change was lower for NAVH. Additionally, although maximum hospitalization duration was shorter for LAVH, the average length of hospitalization was similar between NAVH and LAVH. There were no significant differences between the groups in terms of other variables. CONCLUSION: NAVH may become a new alternative surgical method of choice for hysterectomy, as it represents a clinically feasible and safe approach; moreover is superior to LAVH in terms of bleeding loss.
Adenomyosis ; Body Weight ; Endometriosis ; Female ; Hemorrhage ; Hospitalization ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Laparoscopy ; Leiomyoma ; Methods ; Natural Orifice Endoscopic Surgery ; Parity ; Postoperative Complications ; Retrospective Studies ; Uterine Diseases ; Uterus

OBJECTIVE: We have performed Classic Intrafascial Supracervical Hysterectomy (CISH) since April 1993, so we are to report the clinical results of CISH for 10 years, and introduce the technical aspects of new CISH. METHODS: A retrospective analysis on 470 cases of CISH (conventioal and new method) was carried out including age, parity, operating time, blood loss, uterine weight, pathologic results, complications and postoperative recovery. RESULTS: The mean age was 44.8 years (range 25-68), parity 2.23 (0-9), operating time 131 minutes (70-310), mean blood loss 148 mL (20-1000) and mean uterine weight was 306 gram (90-880). The most common uterine pathology was uterine leiomyoma (49.3%) and there were adenomyosis (15.5%), leiomyoma with adenomyosis (12.5%), chronic cervicitis (5%) and so on. Intraoperative complications included one case of bladder injury due to thick adhesion and 6 cases of bleeding requiring transfusion. Postoperative complications included 5 cases of cervical coring site bleeding, 2 cases of febrile complications, 2 cases of trocar site bleeding, 1 case of transient nerve injury of lower extremity, and 1 case of urinary tract infection. The mean hospital stay was 5.3 days (3-10). two hundreds and seventy eight patients of 470 had been followed for cervical pathology, and no pathologic findings except 3 cases of mild dysplasia were shown. CONCLUSION: Classic intrafascial supracervical hysterectomy, a minimally invasive organ-preserving procedure indicated for benign uterine disease, is associated with few operative complications and low morbidity, and the disadvantages of conventional Semm's CISH technique can be overcome by new CISH technique using triple ligation method.
Adenomyosis ; Female ; Hemorrhage ; Humans ; Hysterectomy* ; Intraoperative Complications ; Leiomyoma ; Length of Stay ; Ligation ; Lower Extremity ; Parity ; Pathology ; Postoperative Complications ; Retrospective Studies ; Surgical Instruments ; Urinary Bladder ; Urinary Tract Infections ; Uterine Cervicitis ; Uterine Diseases

OBJECTIVETo explore the effects of uterine adenomyosis on the clinical outcomes of infertility patients treated with in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET).

METHODSA retrospective study was conducted of 61 IVF/ICSI-ET cycles as the study group, diagnosed with uterine adenomyosis by transvaginal ultrasound, and 164 IVF/ICSI-ET cycles of patients with tubal infertility as the control group. The baseline characteristics, ovary response and clinical outcomes were compared between the two groups.

RESULTSThe implantation rate, clinical pregnancy rate and live birth rate decreased significantly in the study group (P<0.05), and early abortion rate increased significantly (P<0.05). For patients with adenomyosis, GnRH-antagonist cycles tended to decrease clinical pregnancy rate and increase abortion rate (25.0% vs 45.0%, P=0.184; 66.7% vs 27.8%, P=0.247), and significantly decrease live birth rate (0% vs 30.8%, P=0.025), compared with GnRHa agonist cycles.

CONCLUSIONUterine adenomyosis decreases implantation rate, clinical pregnancy rate and birth rate, and increases abortion rate significantly in patients with IVF/ICSI-ET. GnRH-antagonist cycles have adverse effects on the outcomes of adenomyosis; GnRH agonist long protocol cycles may increase clinical pregnancy rate and decrease abortion rate.

Adenomyosis ; complications ; Embryo Implantation ; Embryo Transfer ; Female ; Fertilization in Vitro ; Gonadotropin-Releasing Hormone ; agonists ; antagonists & inhibitors ; Hormone Antagonists ; Humans ; Infertility, Female ; Pregnancy ; Pregnancy Complications ; physiopathology ; Pregnancy Rate ; Retrospective Studies ; Sperm Injections, Intracytoplasmic

Objectives: We performed this study to review the clinical availability of the classical intrafascial SEMM hysterectomy (CISH), and report our experience for 2 years restrospectively. METHODS: From March 1999 to February 2001, 100 cases of CISH were performed at the Department of Obstetrics and Gynecology, College of Medicine, Kangdong Sacred Heart Hospital, Hallym university. We performed this procedure by 3 steps. The dissection of uterus was done by classical suture methods (including extracorporeal and intracorporeal suture techniques) to uterine isthmic portion. And then transvaginal cylindrical coring out of the cervical tissue was done using a cervix corer, the Calibrated Uterine Resection Tools (CURT) for resection of cervical tissue especially transformation zone. Finally, the dissected uterus was extracted by using a Serrated Edged Macro-Morcellator (SEMM) without colpotomy. We reviewed the patient's data retrospectively and made phone calls to each patients. RESULTS: The indications for CISH, based on the pre-and intraoperative diagnosis, were leiomyoma, adenomyosis, endometrial hyperplasia and chronic pelvic inflammatory disease or pelvic pain, in order of frequency. The mean operative time was 126 minutes and the mean hemoglobin change was 1.27 gm/dL. The mean hospital days were 5.7 days and the mean age of the patients was 44.6 years old. There were no definite intra- and postoperative complications except for 3 cases of CO2 retentions and 2 cases of delayed bleeding on cervical stump. The mean days to first sexual contact after surgery were 34.5 days. In view of sexual feeling, 86% of the patients didn't feel any difference and only 13% felt worse than before. During postoperative follow-up, the cervical cytologic study were found no endocervical cells at all of 44 checked patients. CONCLUSION: The CISH procedures can be safely performed by well-trained laparoscopists, and this technique minimally alters the anatomy and integrity of the pelvic floor and vagina. Therefore the reductions of surgical morbidity, blood loss, hospitalization and postoperatve discomfort were obtained. Through the preservation of the anatomical relations of the pelvic floor and the function of female sexuality, this technique is the new proposal in gynecologic surgery.
Adenomyosis ; Cervix Uteri ; Colpotomy ; Diagnosis ; Endometrial Hyperplasia ; Female ; Follow-Up Studies ; Gynecologic Surgical Procedures ; Gynecology ; Heart ; Hemorrhage ; Hospitalization ; Humans ; Hysterectomy* ; Leiomyoma ; Obstetrics ; Operative Time ; Pelvic Floor ; Pelvic Inflammatory Disease ; Pelvic Pain ; Postoperative Complications ; Retrospective Studies ; Sexuality ; Sutures ; Uterus ; Vagina