Naval Suyash, Naval Rucha, Naval Sudarshan, Rane Jayshree
Naval Multispeciality Hospital, Jalgaon, India.
Naval Multispeciality Hospital, Jalgaon, India.
J Minim Invasive Gynecol. 2017 Feb;24(2):193. doi: 10.1016/j.jmig.2016.07.012. Epub 2016 Jul 20.
To demonstrate key steps in performing safe laparoscopic multiple myomectomy.
Video focuses on stepwise description of all major steps of the surgical technique.
Twenty-seven-year-old woman. Informed consent was taken from the subject, and the institutional review board approved this research.
Laparoscopic multiple myomectomy with morcellation in bag.
About one-third of women with fibroids present with symptoms severe enough to warrant treatment. We demonstrate a case of a 27-year-old woman with complaints of secondary infertility and menorrhagia. On examination the uterus was enlarged up to 24 weeks size. Ultrasonography mapping located 7 myomas ranging in size from of 3 to 10 cm and classified as International Federation of Gynecology and Obstetrics classes 2, 3, 4, 5, 6, and 7. Generally, laparotomy or laparoscopy and mini-laparotomy is performed for such cases of multiple myomas. However, the total laparoscopic approach can confer benefits if performed following safe steps and within good time. The following were the key steps of surgery: (1) Higher port position using Lee Huang point for primary port, (2) intermittent vasopressin use for each myomectomy, (3) cold technique of myomectomy, (4) myoma lace creation, (5) multiple layer suturing using double-ended barbed sutures, (6) myoma garland creation, and (7) morcellation in a stomach-shaped bag.
The intermittent use of vasopressin is effective in reducing blood loss. Suturing using barbed sutures is less time consuming. Creating lace of myomas by passing a thread through each myoma, prevents losing them in the abdominal cavity and creating garland of myomas by tying two free ends of the lace helps in easier bagging. Morcellation in bag prevents dissemination of bits of myoma and visceral injury. These steps help in performing laparoscopic multiple myomectomy safely. However, this technique should be reserved for selected cases and should be performed by surgical teams with the required expertise and experience.
展示安全实施腹腔镜多发性子宫肌瘤切除术的关键步骤。
视频聚焦于手术技术所有主要步骤的逐步描述。
一名27岁女性。已获得该受试者的知情同意，且机构审查委员会批准了本研究。
采用袋内粉碎术的腹腔镜多发性子宫肌瘤切除术。
约三分之一的子宫肌瘤女性患者症状严重到足以需要治疗。我们展示了一名27岁女性病例，其主诉为继发性不孕和月经过多。检查发现子宫增大至24周大小。超声检查定位出7个肌瘤，大小从3厘米至10厘米不等，国际妇产科联合会分类为2、3、4、5、6和7级。一般来说，对于此类多发性肌瘤病例会进行剖腹手术或腹腔镜及迷你剖腹手术。然而，如果按照安全步骤并在合适时间内进行，全腹腔镜手术方法可带来益处。以下是手术的关键步骤：（1）使用李黄点作为主操作孔的较高位置；（2）每次子宫肌瘤切除术中间歇性使用血管加压素；（3）子宫肌瘤切除的冷技术；（4）创建肌瘤花边；（5）使用双头倒刺缝线进行多层缝合；（6）创建肌瘤花环；（7）在胃形袋内进行粉碎术。
间歇性使用血管加压素可有效减少失血。使用倒刺缝线缝合耗时较少。通过将线穿过每个肌瘤创建肌瘤花边可防止其在腹腔内丢失，通过系紧花边的两个自由端创建肌瘤花环有助于更轻松地装入袋中。袋内粉碎术可防止肌瘤碎片播散和内脏损伤。这些步骤有助于安全地实施腹腔镜多发性子宫肌瘤切除术。然而，该技术应仅用于特定病例，且应由具备所需专业知识和经验的手术团队进行操作。
