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PubMed This is a summary of 17 peer-reviewed journal articles Updated
Minimally Invasive Gynecologic Surgery

Building Your Care Team & First Visit Prep

At a Glance

When seeking treatment for adenomyosis, it is crucial to consult a Minimally Invasive Gynecologic Surgeon (MIGS) and build a multidisciplinary care team. Prepare for your first visit by bringing raw DICOM imaging discs, previous surgical reports, and a detailed symptom log.

Navigating a complex condition like adenomyosis requires moving beyond standard gynecological care. While a general OB/GYN is excellent for routine health, they may not have the specialized tools or high-volume surgical experience required to manage deep myometrial invasion or perform complex uterine-sparing procedures [1][2]. Building a multidisciplinary team ensures that your treatment is based on a coordinated, expert view of your unique biology [3].

The Value of a Specialist

For adenomyosis, the “gold standard” specialist is often a fellowship-trained Minimally Invasive Gynecologic Surgeon (MIGS).

  • Surgical Proficiency: MIGS specialists undergo years of additional training in advanced laparoscopic and robotic techniques. They are significantly more proficient at managing complex cases, such as “bulky” or enlarged uteri, through tiny incisions [1][4].
  • Uterine-Sparing Expertise: If your goal is to avoid a hysterectomy, you need a surgeon experienced in specialized techniques like the “double-flap” or “Pumpkin” methods of adenomyomectomy [5][6]. These methods allow for the removal of diseased tissue while carefully rebuilding the uterine wall to preserve its integrity [7].

Why You Need a Multidisciplinary Team

Adenomyosis often coexists with endometriosis or chronic pelvic pain, making a “team” approach essential [8]. A strong care team typically includes:

  1. A MIGS Specialist: To lead the surgical or hormonal strategy [3].
  2. A Specialized Radiologist: Who is trained in the MUSA criteria to identify subtle signs of adenomyosis that a general radiologist might miss [9][10].
  3. A Pain Management Specialist: To help address the “nerve wind-up” that often accompanies years of chronic pelvic pain.

Preparing for Your First Consultation

A specialist visit is most productive when you provide the “raw data” of your history. Do not rely on your previous doctor to send over everything you need.

  • Imaging Discs (DICOM Files): Bring the actual CD or digital files of your MRI and Ultrasounds. Specialists need to see the raw images—the DICOM files—to personally measure your junctional zone and map out the lesions, rather than just reading another doctor’s summary [11][12].
  • The Symptom Tracker: Bring a detailed log of your last 2–3 cycles. Note the number of pads/tampons used on your heaviest days and the specific timing of your pain (e.g., “starts 3 days before bleeding”). This helps the specialist categorize your condition under the PALM-COEIN system for abnormal bleeding [13][14].
  • Previous Operative Reports: If you have had a laparoscopy before—even if you were told everything was “clear”—the specialist needs the actual surgeon’s notes. Often, signs of adenomyosis are visible to a trained eye even when the surgery was focused on something else [15][16].

Taking the Lead and Finding Support

Remember, you are the most important member of your care team. Seeking a specialist is not about “firing” your current doctor; it is about accessing the specific level of expertise your condition requires [17]. Coming prepared with your records and specific questions allows you to shift from a passive patient to an empowered partner in your own healing [3].

Additionally, dealing with the reality of chronic pain and potential fertility issues can be incredibly isolating. Consider seeking out mental health support or joining patient advocacy and support groups to connect with others on the same journey.

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Common questions in this guide

Why should I see a Minimally Invasive Gynecologic Surgeon (MIGS) for adenomyosis?
A MIGS has advanced training in laparoscopic and robotic techniques necessary to manage an enlarged uterus. They are experienced in complex, uterine-sparing surgeries that remove diseased tissue while preserving healthy uterine muscle.
What imaging files should I bring to my first specialist appointment?
You should bring the raw DICOM files of your MRI and ultrasounds on a disc or digital drive. Specialists need the raw images to personally map out lesions and measure your junctional zone, rather than relying on another doctor's written summary.
Why do I need a multidisciplinary care team for adenomyosis?
Adenomyosis often coexists with endometriosis and chronic pain, requiring a team approach for complete care. A strong team typically includes a surgical specialist, a radiologist trained to spot subtle signs of the disease, and a pelvic pain specialist.
How should I track my adenomyosis symptoms before seeing a doctor?
Keep a detailed log of your last two to three menstrual cycles before your visit. Note the exact timing of your pain and the number of pads or tampons used on your heaviest days, which helps the specialist accurately categorize your bleeding patterns.
What are the double-flap and Pumpkin surgical methods?
The double-flap and Pumpkin methods are specialized, uterine-sparing surgical techniques. They allow expert surgeons to remove adenomyosis tissue while carefully rebuilding the uterine wall, which is ideal for patients seeking an alternative to hysterectomy.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Are you a fellowship-trained Minimally Invasive Gynecologic Surgeon (MIGS), and what percentage of your practice is dedicated to adenomyosis?
  2. 2.When you review my imaging, do you look at the raw DICOM files yourself or rely solely on the radiologist's written report?
  3. 3.For uterine-sparing surgery, which specific techniques (like the 'double-flap' or 'Pumpkin' method) do you use to remove lesions while preserving healthy muscle?
  4. 4.Do you work with a multidisciplinary team, such as specialized radiologists and pelvic pain specialists, to coordinate my care?
  5. 5.What are your success rates for symptom improvement versus the risk of recurrence with the treatments you've recommended for me?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (17)
  1. 1

    Comparing Surgical Experience and Skill Using a High-Fidelity, Total Laparoscopic Hysterectomy Model.

    Arora C, Menzies A, Han ES, et al.

    Obstetrics and gynecology 2020; (136(1)):97-108 doi:10.1097/AOG.0000000000003897.

    PMID: 32541295
  2. 2

    Ob/Gyn resident self-perceived preparedness for minimally invasive surgery.

    Klebanoff JS, Marfori CQ, Vargas MV, et al.

    BMC medical education 2020; (20(1)):185 doi:10.1186/s12909-020-02090-9.

    PMID: 32503585
  3. 3

    Recommendations for the implementation and conduct of multidisciplinary team meetings for those providing endometriosis and adenomyosis care - a Delphi consensus of the European Endometriosis League (EEL).

    Burla L, Kalaitzopoulos DR, Samartzis N, et al.

    Facts, views & vision in ObGyn 2024; (16(3)):337-350 doi:10.52054/FVVO.16.3.038.

    PMID: 39357865
  4. 4

    Essentials in Minimally Invasive Gynecology Manual Skills Construct Validation Trial.

    Munro MG, Advincula AP, Banks EH, et al.

    Obstetrics and gynecology 2020; (136(1)):83-96 doi:10.1097/AOG.0000000000003936.

    PMID: 32541289
  5. 5

    Uterus-preserving surgery for diffuse adenomyosis via transumbilical single-port laparoscopy: combining dual-flap reconstruction and temporary uterine artery occlusion.

    Cao Y, Tian J, Liu X, Nie J

    Fertility and sterility 2026; (125(3)):536-539 doi:10.1016/j.fertnstert.2025.12.014.

    PMID: 41443365
  6. 6

    The Pumpkin method - An innovative uterus-preserving surgery for large complex adenomyosis: A preliminary experience.

    Kung CH, Leung-Chit Tsang L, Chen WH, et al.

    Taiwanese journal of obstetrics & gynecology 2025; (64(6)):1009-1016 doi:10.1016/j.tjog.2025.07.024.

    PMID: 41213746
  7. 7

    Comparisons of the efficacy and recurrence of adenomyomectomy for severe uterine diffuse adenomyosis via laparotomy versus laparoscopy: a long-term result in a single institution.

    Zhu L, Chen S, Che X, et al.

    Journal of pain research 2019; (12()):1917-1924 doi:10.2147/JPR.S205561.

    PMID: 31303783
  8. 8

    Adenomyosis: the missed disease.

    Santulli P, Vannuccini S, Bourdon M, et al.

    Reproductive biomedicine online 2025; (50(4)):104837 doi:10.1016/j.rbmo.2025.104837.

    PMID: 40287215
  9. 9

    Assessing the impact of a regional multidisciplinary team meeting for endometriosis using the CovotemⓇ online platform.

    Caroff A, Scheffler F, Bulle C, et al.

    Journal of gynecology obstetrics and human reproduction 2025; (54(7)):102978 doi:10.1016/j.jogoh.2025.102978.

    PMID: 40383261
  10. 10

    A sonographic classification of adenomyosis: interobserver reproducibility in the evaluation of type and degree of the myometrial involvement.

    Lazzeri L, Morosetti G, Centini G, et al.

    Fertility and sterility 2018; (110(6)):1154-1161.e3 doi:10.1016/j.fertnstert.2018.06.031.

    PMID: 30396560
  11. 11

    Imaging Diagnosis of Adenomyosis.

    O'Shea A, Figueiredo G, Lee SI

    Seminars in reproductive medicine 2020; (38(2-03)):119-128 doi:10.1055/s-0040-1719017.

    PMID: 33197946
  12. 12

    Endometriosis: clinical features, MR imaging findings and pathologic correlation.

    Foti PV, Farina R, Palmucci S, et al.

    Insights into imaging 2018; (9(2)):149-172 doi:10.1007/s13244-017-0591-0.

    PMID: 29450853
  13. 13

    Adenomyosis diagnosis among adolescents and young women with dysmenorrhoea and heavy menstrual bleeding.

    Vannuccini S, Meleca C, Toscano F, et al.

    Reproductive biomedicine online 2024; (48(5)):103768 doi:10.1016/j.rbmo.2023.103768.

    PMID: 38432071
  14. 14

    Introduction: Uterine adenomyosis, another enigmatic disease of our time.

    Donnez J, Donnez O, Dolmans MM

    Fertility and sterility 2018; (109(3)):369-370 doi:10.1016/j.fertnstert.2018.01.035.

    PMID: 29526476
  15. 15

    Method used to identify adenomyosis and potentially undiagnosed adenomyosis in a large, U.S. electronic health record database.

    Loughlin AM, Chiuve SE, Reznor G, et al.

    Pharmacoepidemiology and drug safety 2021; (30(12)):1675-1686 doi:10.1002/pds.5333.

    PMID: 34292640
  16. 16

    Diagnosing adenomyosis: an integrated clinical and imaging approach.

    Chapron C, Vannuccini S, Santulli P, et al.

    Human reproduction update 2020; (26(3)):392-411 doi:10.1093/humupd/dmz049.

    PMID: 32097456
  17. 17

    Enhancing endometriosis care with telehealth: Opportunities and challenges.

    Perelmuter S, Shin JH

    Journal of telemedicine and telecare 2025; (31(10)):1413-1417 doi:10.1177/1357633X241287969.

    PMID: 39410856

This page provides educational information on building an adenomyosis care team and preparing for medical appointments. It is not a substitute for professional medical advice, and you should always consult your healthcare provider regarding your specific care plan.

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