Millochau J-C, Stochino-Loi E, Defortescu G, Darwish B, Roman H
Department of Gynecology and Obstetrics, Rouen University Hospital, France.
Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
J Gynecol Obstet Hum Reprod. 2017 Nov;46(9):691-692. doi: 10.1016/j.jogoh.2017.09.006. Epub 2017 Sep 28.
Resection of endometriosis nodules infiltrating the bladder is routinely performed by laparoscopy. However, laparoscopic resection may lead to inadvertent loss of healthy bladder tissue. Conversely, when bladder nodules are treated by cystoscopy alone, resection may be incomplete. A combined laparoscopic-cystoscopic approach allows safe and controlled resection. The video reports the procedure performed in a 33 year-old primipara who presented with a 40mm bladder nodule. The laparoscopic step is carried out by the gynecologist, who separates the bladder from the uterus and opens the vesico-vaginal space. Concomitantly, the urologist identifies and circumscribes the nodule's limits by cystoscopy. Then, the gynecologist identifies the circular incision previously performed, and completes the resection. The bladder defect is sutured. Early and mid-term postoperative outcomes were uneventful. In patients with large nodules of the bladder, combined laparoscopic-cystoscopic approach allows complete resection of endometriosis lesion, preserves healthy bladder tissue and avoids inadvertent injury of ureters.
浸润膀胱的子宫内膜异位结节通常通过腹腔镜手术切除。然而，腹腔镜切除可能会意外损伤健康的膀胱组织。相反，仅通过膀胱镜治疗膀胱结节时，切除可能不彻底。腹腔镜联合膀胱镜手术方法可实现安全可控的切除。该视频报道了一位33岁初产妇的手术过程，她有一个40毫米的膀胱结节。腹腔镜步骤由妇科医生进行，将膀胱与子宫分离并打开膀胱阴道间隙。与此同时，泌尿科医生通过膀胱镜识别并界定结节边界。然后，妇科医生找到先前做的环形切口并完成切除。膀胱缺损进行缝合。术后早期和中期结果均平稳。对于膀胱有大结节的患者，腹腔镜联合膀胱镜手术方法可完整切除子宫内膜异位病变，保留健康的膀胱组织并避免意外损伤输尿管。
