Pelosi M A, Pelosi M A, Eim J
Pelosi Women's Medical Center, Bayonne, NJ 07002, USA.
J Reprod Med. 2000 Jun;45(6):519-25.
In cases of uterine myomas of massive size, minimally invasive laparoscopic or laparoscopically assisted myomectomy techniques are not feasible alternatives to traditional laparotomy. This report introduces the use of hand-assisted laparoscopy, a novel approach that permits the insertion of the hand into the abdomen through a glove-sized incision while preserving the pneumoperitoneum, as an alternative to laparotomy for patients with massive myomas unsuitable for conventional laparoscopic myomectomy.
A 28-year-old nullipara requested minimally invasive myomectomy and fertility preservation for the treatment of a massively enlarged uterus reaching the level of the liver. Myomectomy was safely performed by hand-assisted laparoscopy using the Pneumo Sleeve System (Dexterity, Blue Bell, Pennsylvania), a 7.5-cm transverse suprapubic incision and a 1-cm umbilical laparoscopic incision. Surgery lasted 120 minutes, and the estimated blood loss was 250 mL. The total weight of the myomas was 3,120 g. The patient was discharged on the second postoperative day and had an uneventful recovery.
The successful outcome of this initial case suggests that hand-assisted laparoscopic myomectomy is a feasible and safe minimal-access option that could effectively replace routine laparotomy in patients with massive uterine enlargement.
对于巨大子宫肌瘤病例，微创腹腔镜或腹腔镜辅助肌瘤切除术技术并非传统剖腹手术的可行替代方案。本报告介绍了手辅助腹腔镜的应用，这是一种新颖的方法，可通过手套大小的切口将手插入腹腔，同时保持气腹状态，作为传统腹腔镜肌瘤切除术不适用的巨大肌瘤患者剖腹手术的替代方案。
一名28岁未生育女性因子宫极度增大至肝脏水平，要求进行微创肌瘤切除术并保留生育功能。使用气腹袖套系统（灵巧公司，宾夕法尼亚州蓝铃市）通过手辅助腹腔镜安全地实施了肌瘤切除术，经耻骨上7.5厘米横向切口和脐部1厘米腹腔镜切口。手术持续120分钟，估计失血量为250毫升。肌瘤总重量为3120克。患者术后第二天出院，恢复顺利。
该首例病例的成功结果表明，手辅助腹腔镜肌瘤切除术是一种可行且安全的微创选择，可有效替代子宫极度增大患者的常规剖腹手术。
