Evaluation of the course of clinical symptoms and reproductive outcomes after laser drilling of the uterus with a holmium laser in patients of reproductive age
Ishchenko A.I., Ishchenko A.A., Zuev V.M., Gadaeva I.V., Malyuta E.G., Dzhibladze T.A., Isaev M.P., Obosyan L.B., Khokhlova I.D., Minashkina E.V., Tevlina E.V., Verbitsky M.V.
Adenomyosis is a medical and social problem associated not only with a deterioration in the quality of life of reproductive and perimenopausal women, but is also one of the causes of infertility and miscarriage in young patients.
Objective: To evaluate the course of clinical symptoms and reproductive outcomes after laser drilling of the uterus with a holmium laser in patients of reproductive age.
Materials and methods: The study included 470 patients with uterine factor infertility due to diffuse and/or nodular adenomyosis Grade 2 and Grade 2–3 (MUSA 2022), treated during the period of 2000–2024. The patients underwent laser drilling of the uterus with a holmium laser using a laparoscopic approach.
Results: During the follow-up period after organ-preserving surgery, clinical symptoms and reproductive outcomes were assessed. Ultrasound and MRI were used to objectify the data. Six months after surgery most patients demonstrated a significant reduction in the severity of dysmenorrhea (from 8.10 to 2.0 according to the NRS scale). Menstrual blood loss also markedly decreased from 153.1 (80) ml to 67.0 ml. Pregnancy occurred in 127/337 patients under the follow-up. No intra- or postoperative complications were noted.
Conclusion: The obtained data demonstrate a significant improvement in clinical symptoms (decrease in the severity of dysmenorrhea, menstrual blood loss, and uterine size) in patients with adenomyosis. Reproductive outcomes also improved, which did not show statistical significance after Bonferroni correction, therefore requiring further confirmation with control groups.
Authors’ contributions: Ishchenko A.I., Zuev V.M., Isaev M.P. – study concept and design; Dzhibladze T.A., Ishchenko A.A., Obosyan L.B., Malyuta E.G., Minashkina E.V., Gadaeva I.V. – material collection and processing; Obosyan L.B., Tevlina E.V., Verbitsky M.V. – statistical data processing; Obosyan L.B., Gadaeva I.V., Dzhibladze T.A. – text composition; Khokhlova I.D., Gadaeva I.V. – text editing.
Conflicts of interest: The authors declare no conflicts of interest.
Funding: The study had no sponsorship.
Ethical Approval: The study was reviewed and approved by the Ethics Committee of the I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University).
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Ishchenko A.I., Ishchenko A.A., Zuev V.M., Gadaeva I.V., Malyuta E.G., Dzhibladze T.A., Isaev M.P., Obosyan L.B., Khokhlova I.D., Minashkina E.V., Tevlina E.V., Verbitsky M.V. Evaluation
of the course of clinical symptoms and reproductive outcomes after laser drilling of
the uterus with a holmium laser in patients of reproductive age.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (10): 107-116 (in Russian)
https://dx.doi.org/10.18565/aig.2025.195
Keywords
adenomyosis
holmium laser
organ-sparing treatment
fertility
reproductive outcomes
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Received 17.07.2025
Accepted 21.10.2025
About the Authors
Anatoly I. Ishchenko, Dr. Med. Sci., Professor, Professor at the Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine,I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), 119048, Russia, Moscow, Trubetskaya str., 8, bld. 2,
+7(499)248-69-56, 7205502@mail.ru, https://orcid.org/0000-0003-3338-1113
Anton A. Ishchenko, PhD, Head of the Center for Gynecology and Reproductive Technologies, National Medical Research Center for Treatment and Rehabilitation,
Ministry of Health of Russia, 125367, Russia, Moscow, Ivankovskoye Shosse, 3, +7(499)450-03-93, ra2001_2001@mail.ru, https://orcid.org/0000-0002-4476-4972
Vladimir M. Zuev, Dr. Med. Sci., Professor, Professor at the Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine,
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), 119048, Russia, Moscow, Trubetskaya str., 8, bld. 2,
+7(499)248-69-56, vlzuev@bk.ru, https ://orcid.org/0000-0001-8715-2020
Irina V. Gadaeva, PhD, Associate Professor at the Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), 119048, Russia, Moscow, Trubetskaya str., 8, bld. 2, +7(499)248-69-56, irina090765@gmail.com, https://orcid.org/0000-0003-0144-4984
Elena G. Malyuta, PhD, Head of Gynecological Department, National Medical Research Center for Treatment and Rehabilitation, Ministry of Health of Russia, 125367, Russia, Moscow, Ivankovskoye Shosse, 3, +7(495)730-98-89, egma@list.ru, https://orcid.org/0000-0003-0098-0830
Tea A. Dzhibladze, Dr. Med. Sci., Professor, Professor at the Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov
First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), 119048, Moscow, Trubetskaya str., 8, bld. 2, +7(499)248-69-56, djiba@bk.ru, https://orcid.org/0000-0003-1540-5628
Mikhail P. Isaev, PhD, General Director, MedOptoTech LLC, 117342, Russia, Moscow, Butlerova str., 17B, office 334, +7(925)748-95-68, medoptotec@yandex.ru,
https://orcid.org/0009-0009-6995-7381
Lilia B. Obosyan, Resident at the Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), 119048, Russia, Moscow, Trubetskaya str., 8, bld. 2, +7(925)196-17-78, lilia070500@mail.ru,
https://orcid.org/0000-0002-1316-6291
Irina D. Khokhlova, PhD, Associate Professor at the Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), 119048, Russia, Moscow, Trubetskaya str., 8, bld. 2, +7(499)248-69-56, irhohlova5@gmail.com, https://orcid.org/0000-0001-8547-6750
Elena V. Minashkina, Doctor at the Ultrasound Diagnostics Department of the Obstetrics and Gynecology Clinic of the Sechenov Center for Motherhood and Childhood, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), 119048, Russia, Moscow, Elansky str., 2, bld. 1, +7(916)600-11-99, as1199@list.ru, https://orcid.org/0009-0004-3448-7944
Ekaterina V. Tevlina, Teaching Assistant at the Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), 119048, Russia, Moscow, Trubetskaya str., 8, bld. 2, +7(903)689-67-39, tevlina.ekaterina@gmail.com, https://orcid.org/0009-0003-5235-1814
Maxim V. Verbitsky, Clinical Resident at the Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), 119048, Russia, Moscow, Trubetskaya str., 8, bld. 2, 7(909)167-88-81, MVS-7-99@yandex.ru, https://orcid.org/0009-0006-0749-5538
Corresponding author: Tea A. Dzhibladze, djiba@bk.ru
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