Three-dimensional modeling and intraoperative navigation in the diagnosis and treatment of various forms of adenomyosis

Objective. Optimization of diagnostic methods for studying the myometrium in adenomyosis using magnetic resonance imaging (MRI) and subsequent construction of a three-dimensional model of the uterus using computer-assisted technologies to optimize surgical treatment. Material and methods. An analysis of a comprehensive examination and treatment of 20 patients observed at the Department of Operative Gynecology at the Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology. Two groups of patients were recruited: Group 1 — 10 patients with nodular adenomyosis; Group 2 — 10 patients with diffuse adenomyosis. Concomitant pathology (external genital endometriosis, uterine fibroids, ovarian cysts, adhesions in the pelvis) was detected in 18 of 20 patients. The main complaints of the patients were: pain syndrome, heavy menstrual bleeding, intermenstrual bleeding, history of miscarriage and infertility. The preliminary stage (stage 1) of the study included a standard protocol of gynecological ultrasound examination (US) of the pelvic organs, stage 2 — a protocol for MRI followed by construction of a three-dimensional model of the uterus using computer-assisted technologies and subsequent surgical treatment. Results. The accuracy of the diagnostic MRI study followed by construction of a three-dimensional model of the uterus is higher than when conducting standard gynecological ultrasound and MRI, which allows for precise selection of treatment tactics for a specific patient, optimization of access to the surgical field, more radical excision of adenomyosis foci with maximum preservation of healthy myometrial tissue using intraoperative navigation, reduction of intraoperative blood loss and improvement of the functional results of the surgical treatment. Conclusion. The obtained data and results can be used now and in the near future in the work of specialists in radiologists, obstetricians and gynecologists, surgeons and oncologists.