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1.
Study Objective
To demonstrate a simplified technique of performing laparoscopic sacrohysteropexy for uterine prolapse.Design
A technical video demonstrating a simplified method of laparoscopic sacrohysteropexy (Canadian Task force classification level III).Setting
The benign gynecology department at a university hospital.Interventions
A 38-year old woman with grade 3 uterine descent presented requesting surgical management for symptomatic prolapse.Conclusion
Laparoscopic sacrohysteropexy is becoming an increasingly popular alternative to hysterectomy to treat uterine prolapse in women. We present a novel approach of performing laparoscopic sacrohysteropexy that differs from previously described methods 1, 2; it is shorter, simpler, and reduces possible complications. Key differences include the mesh type, site of attachment, and dissection of the peritoneum while creating the possibility of future vaginal delivery after pregnancy. Our simplified technique uses a polyvinylidene fluoride mesh woven with a square weave secured to the posterior aspect of the cervix under a layer of visceral peritoneum. Because there is no longitudinal give of the mesh, unlike polypropylene meshes with a diamond weave, a wrap method [2] is not required. No dissection of the broad ligament and bladder is needed, eliminating the risk of bladder perforation and anterior mesh erosion with fewer adhesions and simplifying hysterectomy if required in the future. We also uniquely “tunnel” the peritoneum, reducing the size of defect for suture closure, and reperitonize the mesh. Previous methods restrict cervical dilatation and require women to have cesarean sections. The method described in the video allows women to deliver vaginally and, in the event of late miscarriage, avoid the need for hysterotomy. We have performed 25 cases with 1 mild cystocoele recurrence requiring no surgery, 1 reoperation for posterior compartment repair, and 1 case of cervical elongation requiring Manchester repair. No cases of recurrent uterine prolapse have occurred. 相似文献2.
3.
Berta Díaz-Feijoo Melisa Bradbury Assumpció Pérez-Benavente Silvia Franco-Camps Antonio Gil-Moreno 《Journal of minimally invasive gynecology》2018,25(7):1144-1145
Study Objective
To show the feasibility and safety of nerve-preserving laparoscopic radical hysterectomy (type C1 Querleu-Morrow Classification [1]) for the treatment of early cervical cancer.Design
A surgical video article (Canadian Task Force classification III).Setting
A university hospital (University Hospital of Barcelona, Barcelona, Spain).Patients
Nerve-preserving radical hysterectomy is performed in a patient with Fédération Internationale de Gynécologie et d'Obstétrique stage 1B1 cervical cancer with deep stromal invasion.Interventions
Three steps are fundamental for the removal of the cérvix with a safe oncologic margin and preservation of the pelvic autonomic nerves [2].1. Step 1: for the correct preservation of the pelvic splanchnic nerves (ventral roots from spinal nerves S2-S4) and the inferior hypogastric plexus during the section of the paracervix, it is essential to identify the deep uterine vein. This vein will correspond with the inferior limit of the dissection.2. Step 2: during the dissection of the uterosacral ligament and after dissecting the Okabayashi space, the inferior hypogastric nerve is isolated. This nerve runs 2?cm parallel below the uterosacral ligament in the peritoneal leaf of the broad ligament.3. Step 3: during the section of the vesicouterine ligament, the lateral side must be preserved because it includes the medial and inferior vesical veins that drain to the deep uterine vein.Conclusion
Nerve-sparing laparoscopic radical hysterectomy is an attractive surgical approach for early-stage cervical cancer. Direct visualization of the pelvic autonomic nervous system (sympathetic and parasympathetic branches) innervating the bladder and rectum makes the nerve-sparing approach a safe and feasible procedure. 相似文献4.
5.
Study Objective
To demonstrate a minimal invasive surgical (MIS) technique for curative excision of extensive secondary disseminated peritoneal leiomyomatosis (DPL).Design
The Institutional Review Board of Human Investigation and Ethics Committee of Chang Gung Medical Foundation ruled that approval was not required for this study.Patient
Woman aged 46 years.Interventions, Measurements, and Main Results
In MIS the myoma has to be divided into small fragments for piecemeal retrieval through a small incision [1] with a widely used technique called morcellation (confined or unconfined) [2]. DPL is a rare sequellae after laparoscopic morcellation. Because this entity is rarely reported, this video demonstrates laparoscopic technique for safe removal of DPL post laparoscopic myomectomy and morcellation. A 46-year-old woman with a past history of laparoscopic myomectomy with specimen retrieval by a power morcellation 8 years ago presented with abdominal discomfort. Computed tomography revealed multiple iso-dense lesions in the uterine corpus and pelvic cavity. Upon laparoscopy multiple nodules were identified at the previous myomectomy scar, pelvic peritoneum, ovarian surface, and over the small bowel. A total laparoscopic hysterectomy with bilateral salpingo-oophorectomy along with excision of all visible lesions was performed.Conclusions
In this video we demonstrate a safe retroperitoneal approach for complete excision of DPL. Laparoscopic hysterectomy or myomectomy with unconfined morcellation appears to be associated with the risk of DPL [3]. Complete tissue fragment retrieval will minimize the sequelae of morcellation. Hence, myoma remnants should be carefully extracted and confined morcellation should be considered. Because DPL causes significant distortion of pelvic anatomy, thorough knowledge of pelvic surgical anatomy and retroperitoneal approach for complete excision of all lesions is recommended. 相似文献6.
Konstantinos Nirgianakis Susanne Lanz Sara Imboden Mathias Worni Michael D. Mueller 《Journal of minimally invasive gynecology》2018,25(5):771-772
Study Objective
To present an unusual consequence of laparoscopic treatment of diaphragmatic endometriosis, to discuss the possible etiologies, and to propose proper management.Design
A step-by-step explanation of 2 surgeries of the same patient using intraoperative video sequences (Canadian Task Force classification III).Setting
University hospital.Patient
A 32-year-old woman.Interventions
Two Laparoscopic surgeries.Measurements and Main Results
Endometriosis is estimated to affect 11% of the population 1, 2, with an estimated 12% of these patients having extrapelvic endometriosis [3]. When the diaphragm is involved, the disease potentially causes severe and debilitating symptoms such as catamenial chest or shoulder pain. Serious complications may involve pneumothorax and hemopneumothorax 4, 5, 6. Diaphragmatic endometriosis is more common than realized and has been shown to occur simultaneously in 50% to 80% of cases with pelvic endometriosis 7, 8. A 32-year-old woman was admitted to our hospital with severe disabling dysmenorrhea and right shoulder pain. Despite progestin, nonsteroidal anti-inflammatory drug, and opioid treatment, pain relief remained inadequate. A laparoscopy was performed revealing diaphragmatic endometriosis, which was completely excised. A revision was necessary 14 months later because of pain recurrence in the right hemithorax and suspicion of new or persistent endometriotic lesions. The laparoscopy revealed small diaphragm fenestrations that were closed after exclusion of recurrent diaphragmatic or pleural endometriosis. No chest tube was placed, and the postoperative course was uneventful. Hormonal suppressive treatment was continued. Since the operation the patient has been pain free. Institutional Review Board/Ethics Committee ruled that approval was not required for this study (Req-2017-00415).Conclusion
The diaphragm fenestrations were possibly the result of tissue necrosis caused by thermocoagulation after excision of deep endometriotic lesions during the first surgery. Using a CO2 laser for the vaporization of superficial lesions is favorable because of the smaller depth of penetration compared with electrocautery and better access to hard to reach areas 9, 10. Endometriotic lesions involving the entire thickness of the diaphragm should be completely excised and the defect repaired with either sutures or staples 11, 12, 13. 相似文献7.
Núria Sarasa Castelló Alexandra Toth Michel Canis Revaz Botchorishvilli 《Journal of minimally invasive gynecology》2018,25(6):957-958
Study Objective
We detected mesh erosion and serious postoperative complications in 3 women after performing laparoscopic promontofixation (LPF) using glue for mesh fixation. Glue, largely used in hernia surgery repair, is proposed by some gynecologic surgeons because it saves time and is easier to use than traditional sutures. We report 3 cases of postoperative complications after LPF in which glue had been used and provide research in the published literature about the use of glue in LPF.Methods
A research of glue use in gynecology mesh fixation was performed through PubMed on October 2016. The search was done using the Medical Subject Heading terms “POP” & “Laparoscopy” & “surgical Mesh” and the word either “glue” or “adhesive. Only 2 articles were found: Willecocq et al [1] and Estrade et al [2]. Neither study focused on postoperative complications. In this publication, we accurately edited video surgeries with an instructive purpose.Setting
University Hospital of Clermont-Ferrand, France.Case Reports
Patient A, a 65-year-old woman, complained of pelvic pain and vaginal discharge 1 month after LPF (polypropylene mesh and glue had been used). Wall mesh exposure and purulent discharge were noted. She received antibiotics and underwent mesh ablation surgery; debris of the glue was easily identified. Patient B, a 65-year-old lady with previous hysterectomy consulted for a bulging feeling in her vagina (classification: cystocele +2; rectocele +3 stage). An LPF was performed using polypropylene soft nonabsorbable mesh and glue. One month later, an apical defect of vaginal epithelialization was detected; she received long estrogenic local treatment but had to undergo surgery when presenting malodorous discharge and mesh exposure. The exposed mesh was removed, and pieces of glue were identified, having avoided mesh attachment. Patient C had a previous abdominal hysterectomy and promontofixation using a polyester mesh with glue. She consulted to us for vaginal mesh erosion covered with purulent discharge 3.5 years after LPF in another center. At the surgery, 1?cm of the prosthesis was identified in the vagina, dissected, and sutured. One year later, she consulted for dyspareunia and purulent discharge; vaginal rigid mesh exposure with an epithelization defect and inflammatory signs was seen. During laparoscopy, prosthetic exposition and glue debris on the prosthesis were identified.Discussion
In all 3 cases, debris of glue were identified in the no integrated mesh area. The suggested reasons of exposure can be the excessive amount of surgical glue applied. Moreover, a large amount of glue may be impairing tissue ingrowth through the mesh pores, causing low fibrosis and poor tissue integration [3].Conclusion
Glue seems to prevent fibrosis from occurring. Its use in pelvic organ prolapse laparoscopic mesh fixation should be done with caution. No prospective studies reporting long-term comorbidities and results have been published. 相似文献8.
Berna Haliloglu Peker Erdin Ilter Hakan Peker Aygen Celik Ali Gursoy Onur Gunaldi 《Journal of minimally invasive gynecology》2018,25(7):1146-1147
Study Objective
To demonstrate laparoscopic sacrohysteropexy for a case of uterine prolapse in a 12 weeks, 3 days pregnant woman. To our knowledge this is the first case of laparoscopic sacrohysteropexy performed at 12 weeks of gestation to be reported in literature.Design
A step-by-step explanation of the surgical procedure (Canadian Task Force classification III).Setting
Maltepe University Hospital.Patient
A 37-year-old pregnant woman.Intervention
Laparoscopic sacrohysteropexy. Institutional Review Board ruled that approval was not required for this study.Measurements and Main Results
Uterine prolapse is very rare condition, manifesting in an estimated 10 000 to 15 000 pregnancies [1]. The management plan must be individualized, and the obstetrician should aware of possible complications, such as preterm labor, high incidence of abortion, cervical ulceration, and cervical dystocia. In general, bedrest, good genital hygiene, and pessary use is recommended. Alternatively, in cases where conservative solutions have failed, laparoscopic surgery in the pregnant patient may be considered. To date, only 1 case of laparoscopic promontohysteropexy at 10th weeks of gestation was reported by Pirtea et al [2]. A 37-year-old woman, at 12 weeks and 3 days of gestation, with stage III pelvic organ prolapse was referred to our clinic. Conservative management with pessary failed. The patient underwent laparoscopic sacrohysteropexy after written informed consent form was obtained. In exploration, uterine manipulation was difficult because of softness and large size of the uterus. First, the sigmoid colon was suspended at the abdominal wall to gain an adequate surgical field. The promontorium was dissected and the parietal peritoneum incised on the right pelvic side wall after ureter visualization. A polypropylene mesh was fixed to the cervix at the level of the uterosacral ligaments. The other edge of the mesh was fixed at the level of the promontory using the Uplift device (Neomedic International, Barcelona, Spain). Then, the peritoneum was sutured to cover the mesh. The patient was discharged 2 days after surgery. At the examination the pelvic floor was detected to be normal. The patient delivered a healthy baby weighing 3030?g by cesarean section at 38 weeks of gestation. The position of the mesh was controlled during surgery. There was no peritoneal fold detected on the cervical part of mesh; however, no adhesion was observed.Conclusion
Laparoscopic sacrohysteropexy may be an alternative and safe approach, if conservative treatment fails, for pelvic organ prolapse during pregnancy. 相似文献9.
Study Objective
To demonstrate a mesh-free laparoscopic uterosacral suture sacrohysteropexy (LUSSH).Design
Technical video demonstrating LUSSH for uterine prolapse (Canadian Task Force classification III).Setting
University hospital.Patient
A 37-year-old woman with grade 3 uterine descent requested uterine-sparing surgery for symptomatic prolapse. The patient declined all mesh procedures.Intervention
Mesh-free laparoscopic uterosacral suture sacrohysteropexy (LUSSH).Measurements and Main Results
Laparoscopic sacrohysteropexy is a uterine-preserving technique for uterine prolapse with high cure rates (92%) but with a mesh erosion risk of up to 2.5% 1, 2. Complications have resulted in reclassification of transvaginal meshes as restricted-use high-risk medical devices 3, 4. Sacrospinous hysteropexy and uterosacral ligament suspension are mesh-free alternatives, but they have increased rates of anterior-compartment failures and a 20% recurrence rate in the latter 5, 6. Laparoscopic suture sacrohysteropexy has been described with reported success rates of 95% [7]. This video demonstrates a modified-technique offering a simple, robust, and reproducible mesh-free approach to uterine-preserving prolapse surgery. We used 2 horizontal loop mattress sutures acting as a pulley to distribute the force evenly throughout the suture strand, leading to a significantly stronger and more secure hold and reducing risk of avulsion [8]. The technique starts with a careful dissection of the peritoneum from the sacral promontory to the cervix. Two permanent sutures are used, taking bites at the anterior longitudinal ligament, the uterosacral, a loop mattress in the midline at the cervix, the uterosacral on the way back, and finally at the sacral promontory. Damage to the uterine vessels is minimized by maintaining a central uterine position. The stitch is tied with caudal pressure on the uterus, applied via the uterine manipulator, approximating the cervix to the sacral promontory. The peritoneum is closed with dissolvable sutures, burying the Ethibond to prevent exposure and bowel obstruction.Conclusion
Post-procedure, the uterus was well supported with a vaginal length of 15 cm. 相似文献10.
Benjamin D. Beran Marie Shockley Katrin Arnolds Michael L. Sprague Stephen E. Zimberg Andreas Tzakis Tommaso Falcone 《Journal of minimally invasive gynecology》2018,25(2):329
Study Objective
Uterine transplantation has proven feasible since the first live birth reported in 2014. To enable attachment of the uterus in the recipient, long vascular pedicles of the uterine and internal iliac vessels were obtained during donor hysterectomy, which required a prolonged laparotomy to the living donors. To assist further attempts at uterine transplantation, our video serves to review literature reports of internal iliac vein anatomy and demonstrate a laparoscopic dissection of cadaver pelvic vascular anatomy.Design
Observational (Canadian Task Force Classification III).Setting
Academic anatomic laboratory. Institutional Review Board ruled that approval was not required for this study.Intervention
Literature review and laparoscopic dissection of cadaveric pelvic vasculature, focusing on the internal iliac vein.Measurements and Main Results
Although the internal iliac artery tends to have minimal anatomic variation, its counterpart, the internal iliac vein, shows much variation in published studies 1, 2. Relative to the internal iliac artery, the vein can lie medially or laterally. Normal anatomy is defined as some by meeting 2 criteria: bilateral common iliac vein formed by ipsilateral external and internal iliac vein at a low position and bilateral common iliac vein joining to form a right-sided inferior vena cava [2]. Reports show 79.1% of people have normal internal iliac vein anatomy by these criteria [2]. The cadaver dissection revealed internal iliac vein anatomy meeting criteria for normal anatomy.Conclusion
Understanding the complexity and variations of internal iliac vein anatomy can assist future trials of uterine transplantation. 相似文献11.
Filipa Osório João Alves João Pereira Marta Magro Sónia Barata Adalgisa Guerra António Setúbal 《Journal of minimally invasive gynecology》2018,25(2):330-333
Study Objective
To describe our surgical approach in a rare case of deep infiltrating endometriosis of the obturator internus muscle with obturator nerve involvement.Design
A step-by-step surgical explanation using video and literature review (Canadian Task Force Classification III).Setting
Endometriosis can be pelvic or rarely extrapelvic and is classically defined as the presence of endometrial glands and stroma outside the uterine cavity 1, 2. Pain along the sensitive area of the obturator nerve, thigh adduction weakness and difficulty in ambulation are extremely rare presenting symptoms 2, 3, 4.Patient
We report a case of a 32-year-old patient who presented with cyclic leg pain in the inner right thigh radiating to the knee caused by a cystic endometriotic mass in the obturator internus muscle with nerve retraction. The patient provided informed consent to use the surgical video. Institutional review board approval was obtained.Interventions
Pelvic magnetic resonance imaging was performed and confirmed a nodular lesion of about 2.3?cm with high signal on T1WI and T2WI and without fat suppression on T2FS inside the right obturator internus muscle, suggesting an endometriotic lesion (Fig. 1). Surgical removal of the mass was performed using the laparoscopic approach. A normal pelvic cavity was found, and the retroperitoneal space was dissected. A mass located within the right obturator internus muscle, below the right iliac external vein, behind the corona mortis vein, and lateral to the right obturator nerve was identified. The whole region was inflamed, and the nerve was partially involved. Dissection was performed carefully with rupture of the tumor, releasing a chocolatelike fluid (Fig. 2), and the cyst was removed. Pathology examination was consistent with endometriosis. Patient improvement was observed, with pain relief and improved ability for right limb mobilization. No recurrence of endometriosis was found at the follow-up visit 6 months later.Measurements and Main Results
The obturator nerve is responsible for motor and sensitive innervation of the joins and internal muscles of thigh and knee as well as the innervation of skin in the internal thigh. Pain along the sensitive area of the obturator nerve at the time of menstruation, thigh adduction weakness, difficulty ambulating, or paresthesia can be presenting symptoms with the involvement of the obturator nerve [5]. Besides paresthesia, our patient presented all the symptoms. The suspected diagnosis of obturator internus muscle endometriosis with retraction of the obturator nerve was confirmed by laparoscopic surgery and pathological examination of the excised tissue. To our knowledge, only 4 cases of endometriosis involving the obturator nerve have been described (according to MEDLINE searched in January 2017) 5, 6, 7, 8. The laparoscopic approach provided an excellent access to the retroperitoneal space, allowing fine dissection of the obturator nerve and the surrounding structures with complete removal of the cystic mass.Conclusion
We report a rare case of endometriosis with a single mass located inside the right obturator internus muscle with neuronal involvement of the obturator nerve. The fundamental role of laparoscopy was clearly demonstrated for the diagnosis and treatment of our patient. 相似文献12.
Huseyin Kiyak Lale Susan Wetherilt Kerem Doga Seckin Ibrahim Polat Pınar Kadirogullari Tolga Karacan 《Journal of minimally invasive gynecology》2018,25(4):582
Study Objective
Laparoscopic excision of a scar pregnancy and isthmocele repair with a barbed suture.Design
A step-by-step explanation of the laparoscopic excision technique of a scar pregnancy and isthmocele repair.Setting
Cesarean scar pregnancy occurs as a result of attachment of the products of conception to the uterine scar 1, 2, 3. In the present case, a 34-year-old, gravida 4, para 1 patient with a history of 1 miscarriage and 1 ectopic pregnancy was diagnosed with type 2 cesarean scar pregnancy at 7 weeks of gestation. Dilation and curretage was performed at the 8th week of gestation to terminate the pregnancy. On ultrasonography performed 1 month later, placental material underlying the isthmocele was observed. Her beta human chorionic gonadotropin level was 13 836 mIU/mL. She was followed up for 1.5 months until the beta human chorionic gonadotropin levels were negative. However, the mass underneath the scar had grown larger, measuring up to 5?×?6?cm. Laparoscopy was performed because the patient reported vaginal spotting and pelvic pain. The incision was sutured with a synthetic absorbable unidirectional barbed suture (Stratafix Knotless Tissue Control Device; Ethicon Inc., Somerville, NJ). No residual scar defect was visible on follow-up ultrasonography 1 week and 1 month after surgery.Conclusion
Barbed sutures ease the repair of uterine scar defects and can provide ideal reapproximation of thick myometrial tissue. Laparoscopic treatment of a scar pregnancy and isthmocele repair are effective and safe modes of treatment. 相似文献13.
Stacey A. Scheib 《Journal of minimally invasive gynecology》2018,25(2):326-327
Study Objective
To demonstrate a laparoendoscopic single-site (LESS) surgical approach to salpingectomy.Design
A technical video showing step-by-step a LESS surgical approach to salpingectomy (Canadian Task Force classification level III). Institutional review board approval was not required for this study.Setting
Of all gynecologic cancer types, ovarian cancer has the highest mortality rate and is the fifth leading cause of cancer deaths among women 1, 2. The leading theory of epithelial ovarian carcinogenesis indicates that serous, endometrioid, and clear cell ovarian carcinomas originated from the fallopian tube and endometrium and not directly from the ovary itself 1, 2, 3, 4, 5, 6, 7, 8, 9, 10. This has led to the use of prophylactic salpingectomy as a theoretical form of ovarian cancer risk reduction at the time of hysterectomy or as a means of tubal sterilization. Prophylactic salpingectomy does not appear to increase the risk of complications and appears to be safe [2]. Ovarian function does not seem to be compromised by salpingectomy based on serum markers or response rates with in vitro fertilization 11, 12, 13, 14, 15, 16. A LESS approach may reduce the morbidity associated with the placement of multiple ports and can improve cosmetic outcomes. Prophylactic LESS bilateral salpingo-oohorectomy was shown to be feasible and safe for high-risk patients for ovarian cancer [17].Interventions
Laparoscopic salpingectomy at the time of hysterectomy or as a means of tubal sterilization using the LESS technique.Conclusion
This is a simple and reproducible technique for preventing major complications associated with LESS salpingectomy. This approach permits easier specimen retrieval because of the large solitary incision that is made. There is a significant improvement in cosmetic satisfaction when compared with a traditional laparoscopic approach in the setting of prophylactic risk reduction surgery [18]. 相似文献14.
Gökhan Demirayak Cihan Comba İsa Aykut Özdemir 《Journal of minimally invasive gynecology》2018,25(5):776
Study Objective
To demonstrate the feasibility of sentinel lymph node (SLN) biopsy using a laparoendoscopic single-site (LESS) approach in endometrial cancer (EC).Design
A step-by-step video demonstration of the surgical procedure (Canadian Task Force Classification III).Setting
The satisfaction of patients who undergo LESS hysterectomy is greater than that reported by patients who undergo multiport laparoscopic hysterectomy, owing to better cosmesis and reduced postoperative analgesic requirements [1]. SLN biopsy is associated with significantly lower estimated blood loss, shorter operation time, and less morbidity compared with systematic lymphadenectomy [2]. LESS surgery can be more feasible and safer with the use of SLN biopsy compared with complete lymphadenectomy in patients with early-stage EC.Interventions
This 69-year-old woman with grade 2 endometrioid EC underwent SLN mapping followed by LESS SLN biopsy, total hysterectomy, and bilateral salpingo-oophorectomy. Before the umbilical incision was made, 1.25?mg/mL of indocyanine green was injected into the cervical stroma at the 3 o'clock and 9 o'clock positions to both deep and superficial levels. A 10-mm 30° standard-length optical camera for near-infrared fluorescence imaging was used. The total operative time was 75 minutes, and the estimated blood loss was 20?mL. SLNs were detected bilaterally between proximal parts of the external iliac arteries and veins. After SLN resection, total hysterectomy and bilateral salpingo-oophorectomy were performed. No postoperative complications occurred. The patient was discharged at 30 hours after surgery. In the final pathology, stage 1A G2 EC was detected.Conclusion
LESS SLN biopsy and TLH-BSO is a feasible procedure and sentinel lymph node concept may increase the use of LESS in EC. 相似文献15.
Study Objective
To demonstrate vaginal salpingectomy techniques in the presence of ovarian conservation.Design
Technical video demonstrating 2 methods of Fallopian tube removal with illustrations (Canadian Task Force classification III).Setting
The prevalence of salpingectomy at the time of hysterectomy has increased significantly since 1998 [1]. One reason for the increased rate of salpingectomy is the relationship of serous ovarian carcinomas to fimbrial serous tubal intraepithelial carcinomas [2]. A Swedish population-based study reported that salpingectomy is an effective measure to reduce ovarian cancer risk in the general population [3]. Prophylactic salpingectomy and delayed oophorectomy may be an acceptable alternative in some BRCA mutation carriers [4]. A retrospective cohort study of 425 vaginal hysterectomies showed that 88% of patients were able to successfully undergo concomitant salpingectomy [5]. Mayo Clinic Institutional Review Board approval was not required for this video article.Intervention
Two methods of salpingectomy are demonstrated differing in the final disposition of the proximal Fallopian tube (segment). The 2 different methods are shown to increase clarity and understanding of the technique.Conclusion
Salpingectomy without concomitant removal of the ovaries at vaginal hysterectomy is a feasible and beneficial procedure. 相似文献16.
Study Objective
To describe a technique for hysteroscopic removal of retained products of conception (RPOC) implanted over an area of adenomyosis.Design
A case report (Canadian Task Force classification III).Setting
RPOC is an unfortunate complication that may occur after the resolution of a normal pregnancy; it is more common after early pregnancy termination or spontaneous miscarriage [1]. Immediate consequences of RPOC include persistent vaginal bleeding, abdominal pain, pelvic infection, fever, and dilated cervix. Moreover, known long-term complications include the formation of intrauterine adhesions (IUAs) with the potential creation of Asherman syndrome resulting in adverse reproductive outcomes caused by subfertility, chronic pelvic pain, menstrual disturbances, and severe pregnancy complications such as abnormal placentation including the placenta accreta spectrum 2, 3. A recently published American Association of Gynecologic Laparoscopists practice report on IUAs suggests that the surgical approach used to treat intrauterine pathology could have an impact with greater risk for IUA formation when blind versus procedures under direct visualization are performed [4].Interventions
A 35-year-old patient who presented with persistent bleeding for over 5 weeks. The patient has a long history of dysmenorrhea and heavy menstrual bleeding. Magnetic resonance imaging revealed the presence of adenomyosis. She had an unfortunate spontaneous abortion at 8 weeks of gestation. On physical examination, she was found to have a dilated uterine cervix with persistent vaginal bleeding; there were no signs of infection. Pelvic ultrasound revealed an intrauterine hyperechogenic vascularized area of 2?×?2, 8?×?2?cm implanted over a focal area of adenomyosis, which is consistent with the presence of RPOC. With the aim of minimizing possible acute complications such as bleeding, infection, and uterine perforation, a hysteroscopic approach was taken to avoid performing a blind dilation and curettage. A secondary benefit of a hysteroscopic approach is a lower incidence of long-term complications such as IUAs and the consequent Asherman syndrome. We describe a hysteroscopic technique in which the use of electrosurgery is limited to minimize thermal damage of the endometrium, highlighting important tips and tricks of the procedure.Conclusion
Hysteroscopic removal of RPOC is a feasible and safe management option of this complication of pregnancy. We strongly suggest avoiding performing blind procedures such as dilation and curettage and favor the adoption of this modality that allows the removal of retained products of conception under direct visualization. 相似文献17.
Study Objective
To show various techniques to perform laparoscopic anterior discoid resection of rectosigmoid endometriotic nodules.Design
A step-by-step explanation of the techniques using video with narration (educational video).Setting
Segmental bowel resection and reanastomosis are treatment options for larger rectosigmoid endometriotic nodules. However, laparoscopic anterior discoid resection of rectosigmoid endometriotic nodules is feasible and potentially less morbid in the appropriate candidate. Detailed knowledge of the avascular planes of the pelvis, particularly the pararectal and rectovaginal spaces, is crucial when approaching these nodules, which may initially present within an obliterated posterior cul-de-sac. Resection begins with determination of the nodule size followed by enucleation of the nodule itself. A 2-layer closure with barbed suture is then performed using a rectal probe as a template. Our institution previously demonstrated that barbed suture is safe to use in bowel repair and did not result in major complications [1]. An air leak test assesses the integrity of the repair and may be completed with air insufflation or with a methylene blue or povidone-iodine enema. With larger nodules, a V-shaped closure may be necessary. The patients provided consent to use images and videos of the procedure. Institutional review board approval was not required for this procedure.Interventions
Laparoscopic anterior discoid resection of a rectosigmoid endometriotic nodule.Conclusion
Laparoscopic anterior discoid resection avoids the need for segmental bowel resection and reanastomosis. Barbed suture is a safe option for 2-layer bowel closure [1]. 相似文献18.
19.
Emilie Faller Jean Jacques Baldauf François Becmeur Anne Lehn Cherif Youssef Akladios Lise Lecointre 《Journal of minimally invasive gynecology》2018,25(5):769-770
Study Objective
To demonstrate a technique of laparoscopic management of a rudimentary horn in a 12-year-old girl.Design
A step-by-step explanation of the surgery using a video (instructive video) approved by the local institutional review board.Setting
A university hospital (University Hospital of Strasbourg, Strasbourg, France).Patient
A 12-year-old girl with a uterine rudimentary horn.Intervention
We describe a case of a 12-year-old girl who had no medical history. She had her first menstruation at 11 years old with major left pelvic pain occurring each month. Ultrasonography showed a duplication of the uterus with a liquid collection on the left side; this type of malformation is called an accessory and cavitated uterine mass. Medical treatment was initiated with progestin. Magnetic resonance imaging showed a left noncommunicating rudimentary horn with a unicornuate uterus. No other malformation was present, particularly in the kidneys. A primary vaginal endoscopy was performed showing a single cervix without vaginal malformation. It was decided to perform a laparoscopic excision of the left rudimentary horn. We placed a 10-mm optical port into the umbilicus and 3 accessory 5-mm trocars. Evaluation of the abdominal cavity showed 2 normal adnexas with normal ovaries. We decided to start with a left salpingectomy using the Ligasure device (Medtronic, Minneapolis, MN), staying close to the tube to preserve ovarian vascularization. The remnant fimbria must be removed to avoid cancerization. Then, the vesicouterine septum was divided until we reached the cervix to dissect the bladder from the rudimentary horn. The broad ligament was fenestrated in order to push the left ureter laterally .The utero-ovarian pedicle was transected with the Ligasure device; the left ovary was preserved and vascularized by the left infundibulopelvic ligament. We then dissected the left uterine artery. The posterior peritoneum was opened. The resection of the rudimentary horn was performed by means of a monopolar hook. The dissection was performed slowly with selective coagulation until we reached the cavity of the horn, with old blood flowing out. The entire cavity was removed, and we confirmed the absence of communication with the other part of the uterus. Uterine reconstruction was performed with inverted separated stiches of a 2-0 braided suture, and, finally, an antiadhesion barrier was placed.Conclusions
Laparoscopic management of a uterine rudimentary horn is feasible with satisfactory uterine reconstruction. This is not the first case of this surgery performed by laparoscopy. A similar case has been published in 2015 [1], and recently another video [2] has been published describing 2 other cases. 相似文献20.
Stefano Restaino Carlo Ronsini Angelo Finelli Alessandro Santarelli Giovanni Scambia Francesco Fanfani 《Journal of minimally invasive gynecology》2018,25(6):954