Today, we’re speaking with Dr. Andrea Vidali and Dr. Marcello Ceccaroni about a technique called AdenoDue. This procedure aims to tackle two common and often interconnected conditions—adenomyosis and endometriosis—in one minimally invasive surgery.
Q: Could you briefly explain what adenomyosis and endometriosis are and why they’re so challenging?
Dr. Vidali: Certainly, adenomyosis is when endometrial-like tissue grows inside the uterine muscle (the myometrium). This often causes an enlarged uterus, painful periods (dysmenorrhea), and heavy bleeding. Meanwhile, endometriosis involves similar endometrial-like cells that implant outside the uterus—on the ovaries, pelvic lining, or elsewhere—causing pain, inflammation, and sometimes (around 30% of cases) fertility issues. When a patient suffers from both, the symptoms can double up, affecting pain levels and making it more difficult to get pregnant.
Dr. Ceccaroni: Yes, and to complicate things further, adenomyosis has historically been tough to treat if a woman wants to keep her uterus. Surgical options like adenomyomectomy can weaken the uterine wall, while hormonal treatments only mask symptoms and cannot be taken while looking for pregnancy. Endometriosis is typically handled through laparoscopic surgery, but that alone may not fix problems if adenomyosis remains untreated in the uterus. An untreated Adenomyosis can both maintain persistent pelvic pain and affect fertility, then increasing the rate of a possible recurrence.
Q: So what exactly is AdenoDue, and why is it unique?
Dr. Vidali: AdenoDue is our dual approach to treating both adenomyosis and endometriosis in one surgery. It’s “dual” because it uses:
- Ultrasound-guided focal Destruction of adenomyosis tissue (using either radiofrequency ablation or microwave ablation).
- Laparoscopic inspection and excision of endometriosis lesions (such as on the ovaries or pelvic peritoneum).
What’s special is that it happens simultaneously, under one anesthesia, rather than two separate procedures months apart.
Dr. Ceccaroni: We rely on real-time imaging—specifically a transvaginal pelvic ultrasound and uterine mapping—to precisely target the adenomyotic areas in the uterus while I (or Dr. Vidali) treat the adenomyosis using a specific RFA/microwave needle and simultaneously remove endometriosis through a laparoscopy. This means we can see inside the uterine muscle with ultrasound, ensuring we only destroy the diseased tissue. Meanwhile, we check from the outside laparoscopically to keep surrounding structures, such as the bowel or bladder, safe.
Q: How does this approach benefit a woman who wants to maintain fertility?
Dr. Ceccaroni: First, because we destroy the adenomyosis tissue by focused heat, rather than cutting large portions of the uterine wall, it tends to preserve the uterus’s strength. There’s no big uterine incision to stitch up, which can lower the risk of complications in future pregnancies. These combined procedures are very helpful in increasing fertility rates.
Dr. Vidali: In fact, treating both endometriosis and adenomyosis can significantly improve fertility prospects. For instance, endometriosis can create scar tissue around the ovaries and tubes. Meanwhile, adenomyosis can lead to implantation problems in the uterus or let the inflamed uterus release chemical proteins, called cytokines, that can affect the number and the quality of oocytes.
AdenoDue tackles both fronts: it restores pelvic anatomy by removing endometriosis and pelvic/tubal adhesions, and it deactivates adenomyosis within the uterus, allowing for a better environment for pregnancy.
Q: You mentioned radiofrequency or microwave ablation. What’s the difference?
Dr. Vidali: Radiofrequency ablation (RFA) uses a high-frequency electrical current to generate heat in the targeted tissue, causing it to shrink or be destroyed. Microwave ablation (MWA), on the other hand, uses electromagnetic waves. Some studies suggest MWA can create larger, more consistent zones of heat faster, which might be more efficient in some cases.
Dr. Ceccaroni: Yes, both effectively destroy adenomyosis tissue in a focal way under ultrasound guidance. Which one we choose may depend on available equipment, lesion size, or familiarity with the technique. What matters most is that we carefully target the diseased area and spare healthy uterine muscle. We also have to add that the energy used to destroy the active adenomyotic areas in the uterus, but the physiological uterine fibrotic reactions, during the healing processes in the subsequent 6 months, are crucial in transforming these previously inflamed areas into healthier, stronger, and stable ones.
Q: Could you share any results or success stories?
Dr. Vidali: Sure. We already published more than one study with one of the largest series in the world of patients treated with this combined approach (laparoscopic endometriosis excision and concomitant radio-frequency adenomyosis ablation. In our patient population—131 individuals with confirmed adenomyosis and endometriosis—110 completed full follow-up. Regarding the fertility issues, of the 32 actively trying to conceive afterward, 14 pregnancies occurred in 11 women (which is about a 32% pregnancy rate). Notably, around 64% (9 out of those 14 pregnancies) happened without IVF. There were several term deliveries, including vaginal births, and only one emergency cesarean at 27 weeks. We also documented a few early miscarriages and a single ectopic pregnancy, but no uterine ruptures or major complications preventing future pregnancy.
Dr. Ceccaroni: Regarding symptom relief, Abnormal Uterine Bleedings (AUB), dysmenorrhea (painful periods), dyspareunia (pain during intercourse), dyschezia (pain with bowel movements), and chronic pelvic pain all showed statistically significant reductions after surgery. This synergy confirms that dealing with endometriosis lesions laparoscopically, plus ablating adenomyotic tissue in the uterus, can dramatically decrease pain levels and help restore normal functions.
Q: Is it safe for future pregnancies? Any risks?
Dr. Ceccaroni: We’ve seen healthy term deliveries, which suggests uterine integrity is well-preserved. The technique aims to avoid large uterine incisions, so the risk of complications like uterine rupture appears very low, but is reported in the literature. Of course, every patient is unique, so we evaluate each case—size of lesions, depth of infiltration, overall health—before recommending AdenoDue.
Dr. Vidali: It’s a surgical procedure, so there are always some risks (bleeding, infection, anesthesia complications), but in experienced hands, it’s relatively safe. The synergy of laparoscopic and ultrasound-guided surgical steps can lower the chance of damaging other structures.
Q: What does recovery look like?
Dr. Vidali: Typically, it’s similar to a routine laparoscopic procedure. Many patients go home the same day or the next, depending on the complexity of endometriosis work. They may have some mild pain or cramping related to the ablation sites in the uterus, plus the usual laparoscopic post-op soreness in the abdomen or shoulders (from the gas used). We usually recommend a couple of weeks of light activity.
Dr. Ceccaroni: Yes, and we keep a close eye on healing, especially if the patient hopes to conceive soon. Generally, we advise waiting at least 6 months (the average time of healing processes)before trying to get pregnant, allowing the uterus to recover fully.
Furthermore, we always recommend a pelvic transvaginal ultrasound with uterine mapping before starting to look for pregnancy and a routine follow-up of the pregnancy along its course, associated with a careful mapping of the uterus.
Q: Any final words for someone considering AdenoDue?
Dr. Ceccaroni: If you’ve been diagnosed with both adenomyosis and endometriosis, and you want a fertility-friendly treatment, AdenoDue is a minimally invasive option that targets both issues in a single session. Remember that adenomyosis is never present alone and, especially when chronic pelvic pain, dyspareunia, and/or fertility issues are present, there is always a concomitant associated (and many times undiagnosed) endometriosis, either nodules/or adhesions.
Dr. Vidali: Exactly. AdenoDue combines the proven laparoscopic approach for endometriosis with high-precision, ultrasound-guided ablation for adenomyosis. Our results show promise not only for reducing pain but also for allowing many patients to conceive naturally. Of course, every case is unique—so a thorough evaluation is essential to confirm the proper indications and if it’s right for you.
Thank you both for clarifying the AdenoDue method. It sounds like a comprehensive, forward-thinking procedure for patients dealing with these conditions at once. We appreciate your time and look forward to seeing more of your ongoing research and success stories!
