Adenomyomectomy via laparotomy has long been the surgical treatment for symptomatic women wishing to retain their fertility. However, the disadvantages of surgery via laparotomy is it causes more tissue damage, a large abdominal incision, and more adhesions formation (which can actually cause more harm in terms of fertility). Therefore, laparoscopic adenomyomectomy may be a better alternative by virtue of minimal abdominal access, ‘microsurgery’ and less tissue damage. Careful selection of patients, with preoperative transvaginal scan to accurately identify the location of adenomyosis is vital. This ensures that only a small incision needs to be made over the area of adenomyosis. The surgical procedure involves excising adenomyotic tissue (wedge-shaped removal) laparoscopically and reconstruction of the uterine wall. There are various techniques in terms of closure following resection. Meticulous stitching and repair is of paramount importance in these operations. The technique needs to be meticulous to reduce spontaneous uterine rupture, adhesion and recurrence rates. Laparoscopic adenomyomectomy has also been shown to reduce dysmenorrhea post surgery.

However, the on-going challenge with laparoscopy is to excise enough diseased adenomyotic tissue while ensuring proper closure. Also, the laparoscopic approach does not allow for tactile feedback, thereby limiting the assessment of the extent of the disease.

In conclusion, laparoscopic adenomyomectomy is a conservative and effective option to treat adenomyosis with preservation of the uterus. Even though the benefits of adenomyomectomy have yet to be definitively established, laparoscopic surgery poses a viable alternative to laparotomy.