OBJECTIVE To demonstrate an innovative idea for a four-petal method for performing laparoscopic adenomyomectomy on a patient with focal-type adenomyosis. DESIGN A step-by-step explanation of the technique with narrated video footage. SETTING University hospital. PATIENT(S) A 38-year-old female with a 7 × 4 cm adenomyoma at the anterior uterine wall. INTERVENTION(S) Laparoscopic adenomyomectomy began with a cruciate incision to turn the adenomyoma into the shape of a blooming four-petal flower to fully expose the tumor and maximize the removal of adenomyotic tissue. During excision of the lesion, around a 1 cm thickness of the myometrium was preserved at the subendometrial region and around a 0.5 cm thickness of the serosa flap was also left in each "petal." Suture repair in the method introduced is different from closing the wound by approximation of myometrium to myometrium as in traditional myomectomy; instead, herein we repaired the adenomyomectomy wound by anchoring the serosal flap to the subendometrial tissue, with care taken to avoid dead space. MAIN OUTCOME MEASURE(S) Subjective clinical symptoms as well as serial ultrasonographic measurement of the uterine size, shape, and wall thickness. RESULT(S) The specimen removed was 92 g in weight. The symptoms have dramatically decreased since the procedure and dysmenorrhea improved from visual analog scale 8 to 1 postoperatively. Besides achieving satisfactory symptomatic relief, the ultrasonographic measurement of the myometrium was of adequate thickness (2.3 cm) after the operation and did not increase in a serial follow-up of 33 months. CONCLUSION(S) The four-petal method of adenomyomectomy with cruciate incision offers full exposure to the localized adenomyosis. It greatly facilitates a balance between the maximized resection of the lesions and tailored reserves of myometrium. Subsequent repair by anchoring the serosal flap to the subendometrial tissue ensures adequate thickness of the uterine wall after the operation.

中文翻译：

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四瓣法腹腔镜子宫腺肌瘤切除术

目的展示四瓣法对局灶型子宫腺肌病患者进行腹腔镜子宫腺肌瘤切除术的创新理念。设计 使用叙述的视频片段逐步解释该技术。设置大学医院。患者 (S) 一名 38 岁女性，子宫前壁有一个 7 × 4 cm 的子宫腺肌瘤。干预（S） 腹腔镜子宫腺肌瘤切除术以十字形切口开始，将子宫腺肌瘤变成盛开的四瓣花的形状，以充分暴露肿瘤并最大限度地去除子宫腺肌组织。在切除病灶期间，子宫内膜下区域保留了大约 1 厘米厚的子宫肌层，每个“花瓣”中还保留了大约 0.5 厘米厚的浆膜瓣。所介绍的缝合修复方法不同于传统的子宫肌瘤切除术中将子宫肌层逼近子宫肌层来缝合伤口；相反，在此我们通过将浆膜瓣固定到子宫内膜下组织来修复子宫腺肌瘤切除术伤口，并注意避免死腔。主要结果测量 主观临床症状以及对子宫大小、形状和壁厚的连续超声测量。结果 取出的样品重 92 克。手术后症状明显减轻，痛经从视觉模拟评分 8 改善到术后 1。除了获得令人满意的症状缓解外，手术后子宫肌层的超声测量具有足够的厚度（2.3 cm），并且在 33 个月的连续随访中没有增加。结论(S) 十字形切口子宫腺肌瘤切除术的四瓣法可充分暴露局部子宫腺肌病。它极大地促进了病变的最大化切除和子宫肌层的定制储备之间的平衡。随后通过将浆膜瓣固定在子宫内膜下组织上进行修复，以确保手术后子宫壁有足够的厚度。