A Randomized Controlled Trial of High-Intensity Focused Ultrasound versus Laparoscopic Ablation for Symptomatic Intramural Adenomyosis

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 975–986

DOI: 10.46882/2026/IJOG/000562

Original Research Article

Title: A Randomized Controlled Trial of High-Intensity Focused Ultrasound versus Laparoscopic Ablation for Symptomatic Intramural Adenomyosis

Names of Authors: Min-Ji Kim¹, Sophie Dubois²

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, South Korea
² Service de Gynécologie, Centre Hospitalier Universitaire de Lyon, Lyon, France

Abstract:
Diffuse or focal intramural adenomyosis induces severe dysmenorrhea and heavy menstrual bleeding (HMB), posing therapeutic challenges for conservative tissue-sparing surgical interventions. This randomized controlled trial compared the 12-month efficacy, volume shrinkage index, and safety of ultrasound-guided High-Intensity Focused Ultrasound (HIFU) thermal ablation against Laparoscopic Adenomyomectomy/Ablation (LA). One hundred premenopausal women with confirmed focal intramural adenomyosis (lesion diameter 5 to 9 cm) were randomized in a 1:1 ratio (n = 50 per group). Primary endpoints were reductions in dysmenorrhea visual analog scale (VAS) scores and adenomyoma volume reduction rates at month 12. At the 12-month evaluation, both groups demonstrated equivalent, significant reductions in dysmenorrhea VAS scores from baseline (HIFU: -4.6 ± 1.2 points; LA: -4.9 ± 1.4 points, p = 0.18). The mean focal adenomyoma volume reduction rate was 64.2% ± 10.5% in the HIFU cohort, whereas the LA cohort achieved complete surgical resection (100%). However, the HIFU cohort demonstrated significantly shorter hospital stay durations (6.2 hours vs. 48.4 hours, p < 0.001) and an earlier return to work. Major procedural complications, including deep pelvic hematomas or wound infections, were absent in the HIFU group but occurred in 6.0% of the LA group (p = 0.041). Non-invasive HIFU ablation provides dysmenorrhea relief and health-related quality of life improvements equivalent to laparoscopic surgery, while minimizing perioperative morbidity and hospital stay requirements.

Keywords: Adenomyosis; High-Intensity Focused Ultrasound; Laparoscopic Surgery; Dysmenorrhea; Quality of Life; Thermal Ablation.

Manuscript Timeline: Received: June 25, 2026; Revised: August 20, 2026; Accepted: September 08, 2026; Published: September 15, 2026.

Citation: Kim MJ, Dubois S. A Randomized Controlled Trial of High-Intensity Focused Ultrasound versus Laparoscopic Ablation for Symptomatic Intramural Adenomyosis. International Journal of Obstetrics and Gynecology. 2026; 14(9): 975–986.

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