Donat Lindsay Clark, Menderes Gulden, Tower Amanda M, Azodi Masoud
Department of Obstetrics and Gynecology, Bridgeport Hospital, Yale New Haven Health System, Bridgeport, Connecticut.
Department of Obstetrics and Gynecology, Bridgeport Hospital, Yale New Haven Health System, Bridgeport, Connecticut.
J Minim Invasive Gynecol. 2015 May-Jun;22(4):543. doi: 10.1016/j.jmig.2015.02.003. Epub 2015 Feb 11.
To show and describe a unique method for improved vascular control when performing a robotic myomectomy.
A video showing skeletonization of the uterine vessels and uterine artery occlusion to maximize vascular control and minimize blood loss during robotic-assisted myomectomy (Canadian Task Force classification III).
Myomectomy is a procedure often reserved for the treatment of symptomatic leiomyomas in women who desire fertility preservation. Although traditionally performed via laparotomy, laparoscopic and robotic-assisted approaches are increasing in popularity. One of the limitations of myomectomy is the potential for increased blood loss and surgical morbidity. Although studies suggest a decrease in blood loss with a robotic approach, the risk of requiring a blood transfusion remains.
In this video, we show a technique for maximizing vascular control during myomectomy in a Jehovah's Witness. In addition to subserosal injection with a dilute solution of vasopressin, we used vascular clips and bulldog clamps to temporarily occlude the uterine arteries. The uterine vessels were skeletonized at the level of the cervix to provide access for placing the vascular clips. Additionally, a peritoneal window was created in the mesosalpinx, and bulldog clamps were available to transiently occlude the utero-ovarian vessels in case of increased blood loss.
Temporary occlusion of the uterine vessels can be used during robotic-assisted myomectomy to provide improved vascular control. We were able to use this technique during robotic-assisted myomectomy in a Jehovah's Witness patient. This approach can be considered for selected patients by experienced laparoscopic surgeons to lower blood loss and potentially decrease the need for transfusion.
展示并描述一种在进行机器人子宫肌瘤切除术时改善血管控制的独特方法。
一段视频，展示子宫血管骨骼化及子宫动脉闭塞，以在机器人辅助子宫肌瘤切除术中最大化血管控制并减少失血（加拿大工作组分类III级）。
子宫肌瘤切除术通常用于治疗有生育需求的有症状子宫肌瘤女性。虽然传统上通过剖腹手术进行，但腹腔镜和机器人辅助方法越来越受欢迎。子宫肌瘤切除术的局限性之一是可能增加失血和手术并发症。尽管研究表明机器人手术方法可减少失血，但仍存在输血风险。
在本视频中，我们展示了一种在耶和华见证会患者的子宫肌瘤切除术中最大化血管控制的技术。除了用稀释的血管加压素溶液进行浆膜下注射外，我们还使用血管夹和牛头夹临时闭塞子宫动脉。在宫颈水平对子宫血管进行骨骼化处理，以便放置血管夹。此外，在输卵管系膜中创建一个腹膜窗口，如有失血增加情况，可用牛头夹临时闭塞子宫卵巢血管。
在机器人辅助子宫肌瘤切除术中可使用子宫血管临时闭塞来改善血管控制。我们能够在一名耶和华见证会患者的机器人辅助子宫肌瘤切除术中使用该技术。经验丰富的腹腔镜外科医生可为选定患者考虑这种方法，以减少失血并可能减少输血需求。
