Mirena for Adenomyosis: A Fertility-Sparing Alternative to Surgery

We welcome fellowships for robotic and minimal access training at Artemis — candidates can come and work with us for three to six months. How quickly someone masters the robot depends heavily on the laparoscopic experience they already bring; learning it from scratch is a much bigger challenge. There's also a structured simulator programme, roughly 100 hours, before formal certification on a cadaver, though the real prerequisite for anyone wanting to become a robotic surgeon is solid expertise in minimal access surgery first.

It depends on the case. For a straightforward third-degree prolapse, vaginal hysterectomy alone works well without robotic assistance. But if the patient also needs her ovaries removed, reaching them vaginally is technically difficult and risks bleeding — in those cases robotic or laparoscopic hysterectomy is the better option. There's also an advantage for recurrence: women with prolapse usually have lax pelvic ligaments, so we want to add a vault suspension at the same time. The traditional vaginal approach for that was a bloody technique with weeks of pain afterward; with the robot we can do the vault suspension from above with far greater precision and much less blood loss.

Yes, absolutely. We accept fellows at Artemis for different durations — three months or six months. The fellowship can accommodate gynaecologists and general surgeons who perform gynaecological procedures, starting from the basic level of minimal access surgery.

She'd already had a hysteroscopy and D&C confirming Stage 1, Grade 1 endometrial cancer — meaning it hadn't spread — so a radical hysterectomy alone would be curative. The real challenge wasn't the surgery itself, it was the anaesthesia, because the head-down position adds pressure to lungs already compromised by her sarcoidosis. More broadly, outcomes in malignant conditions depend heavily on careful case selection — Stage 1 endometrial cancer and very early cervical cancers can generally be managed robotically, but larger ovarian masses usually can't. We also run a weekly multidisciplinary team meeting with oncology, radiation oncology and the surgical team to decide on adjuvant therapy once histopathology comes back, since even some Stage 1 cancers benefit from a few sessions of chemotherapy or radiotherapy to prevent recurrence.

I recall a case from early in my training, at a government referral centre with a very high patient volume, where an abdominal pregnancy went undetected until around eight and a half months. We were fortunate to save both mother and baby, but there was significant bleeding because the placenta had implanted within the abdomen — we removed as much as we could safely, she spent 10 to 12 days in intensive care, and we used methotrexate afterward to help the residual placental tissue resorb. Abdominal pregnancy at a late gestational age is one of the most challenging obstetric emergencies you can face.

Yes. Adenomyosis, a form of endometriosis within the muscle wall of the uterus, can affect young women as well, making fertility-sparing treatment essential in these cases.

Mirena is a hormonal, T-shaped intrauterine device, similar in shape to the copper coil used for contraception.

It has an 80 to 85 percent success rate for adenomyosis, with results typically visible within three to four months.

It can remain in place for five years and be changed when needed, or removed easily by any gynaecologist anywhere in the world if the patient decides to try for a pregnancy.

Oral or intramuscular hormone treatment carries greater side effects and is considered acceptable only as a short-term interim measure, not a long-term solution, whereas Mirena delivers hormones locally with fewer side effects.