Department of Obstetrics and Gynecology, Hurley Medical Center, Michigan State University College of Human Medicine, Flint, Michigan.
Department of Obstetrics and Gynecology, Hurley Medical Center, Michigan State University College of Human Medicine, Flint, Michigan.
J Minim Invasive Gynecol. 2018 Jan;25(1):26-27. doi: 10.1016/j.jmig.2017.06.011. Epub 2017 Jun 21.
To demonstrate a modified technique of temporary suspension of the ovary to the fascia of the anterior abdominal wall after operative laparoscopy for advanced stage-endometriosis to reduce postoperative adhesion formation.
Video illustrating this modified technique of ovarian suspension (Canadian Task Force classification III).
A previous study described a technique of temporary suspension of the ovary to the abdominal wall using nylon suture [1]. Here we demonstrate a modification of this technique involving underwent temporary suspension of the right ovary, using dissolvable 3-0 plain catgut suture, after operative laparoscopy for advanced-stage endometriosis (American Society for Reproductive Medicine stage III classification).
This patient underwent right ovariolysis for stage III endometriosis. A CO laser was used to evaporate spots of endometriosis on the surface of the ovary, ovarian fossa, and the wall of a small endometrioma. A 3-0 plain catgut suture was placed in the right ovarian ligament, and the needle was cut and removed from the peritoneal cavity. The ends of the sutures were brought out of the peritoneal cavity through a 3-mm skin incision using an Endo Close device (Medtronic, Minneapolis, Minnesota). The suture was tied over the fascia while allowing CO gas out of the peritoneal cavity, to ensure that the suture remained under tension and the ovary was well suspended without touching the abdominal wall. The suture was used to elevate the ovary away from the ovarian fossa, to avoid recurrence of adhesions between it and the ovary. Postoperatively the patient did well and was discharged home on oral pain medication on the same day of surgery. No postoperative complications related to the suspension procedure were reported. The patient had an uneventful recovery.
This modified approach of temporary ovarian suspension to the fascia of the anterior abdominal wall appears to be simple, safe, and easy to learn.
展示一种改良的手术方法，即在腹腔镜手术治疗晚期子宫内膜异位症后，将卵巢临时悬挂于前腹壁筋膜上，以减少术后粘连形成。
视频演示改良的卵巢悬挂技术（加拿大任务组分类 III 级）。
之前的研究描述了一种使用尼龙缝线将卵巢临时悬挂于腹壁的技术[1]。在这里，我们展示了一种改良技术，即在腹腔镜手术治疗晚期子宫内膜异位症（美国生殖医学学会 III 期分类）后，使用可吸收 3-0 普通肠线临时悬挂右侧卵巢。
该患者因 III 期子宫内膜异位症行右侧卵巢松解术。CO2 激光用于蒸发卵巢表面、卵巢窝和小子宫内膜瘤壁上的子宫内膜异位症病灶。在右侧卵巢韧带处放置 3-0 普通肠线，将针从腹腔内剪断并取出。将缝线的两端通过一个 3mm 的皮肤切口用 Endo Close 装置（美敦力，明尼苏达州明尼阿波利斯）带出腹腔。在缝线穿过筋膜时打结，同时让 CO2 气体从腹腔内逸出，以确保缝线保持张力，卵巢被很好地悬挂起来，而不会触及腹壁。缝线用于将卵巢从卵巢窝提起，以避免其与卵巢之间再次发生粘连。术后患者恢复良好，当天即出院，口服止痛药。未报告与悬挂程序相关的术后并发症。患者恢复顺利。
这种改良的临时卵巢悬挂在前腹壁筋膜的方法似乎简单、安全且易于学习。
