Department of Obstetrics and Gynaecology, Epsom & St. Helier's University Hospitals NHS Trust, London, United Kingdom.
Department of Obstetrics and Gynaecology, Epsom & St. Helier's University Hospitals NHS Trust, London, United Kingdom.
J Minim Invasive Gynecol. 2019 Feb;26(2):358-359. doi: 10.1016/j.jmig.2018.04.012. Epub 2018 Apr 25.
To demonstrate a technique of performing laparoscopic resection of a post-cesarean section scar uterine cyst.
Technical video (Canadian Task Force classification III).
University Hospital.
A 38-year old woman.
Laparoscopic excision of a uterine cyst within a cesarean section scar.
A 38-year-old woman presented with secondary subfertility requesting removal of a cesarean section scar defect to prepare the uterine cavity for in vitro fertilization. Preoperative ultrasound demonstrated a 17.7 × 12.2 mm scar defect. At rigid hysteroscopy the anterior uterine wall cyst was observed and noted to be narrowing the uterine cavity. A laparoscopic approach was used to excise the uterine cyst. We carefully mobilized the bladder from its adhesions at the site of the previous cesarean section scar. The uterine cyst was located and margins of the defect identified. An ultrasonic-energy device was used to enucleate and excise the cyst. A uterine manipulator helped to identify the cervical canal and protect the posterior wall from inadvertent suture placement. The defect was closed with 1 vicryl interrupted sutures, being careful to incorporate the full thickness of the uterine wall to an able maximal opposition. An adhesion barrier was applied to the area. Transvaginal ultrasound scanning performed 6 weeks postoperatively demonstrated full healing with no residual defect.
Niches are recognized complications of cesarean sections resulting from incomplete healing of the scar and more likely in single-layer closures [1]. They can be associated with postmenstrual spotting, dysmenorrhea, chronic pain, subfertility, and poorer reproductive and obstetric outcomes [1-5]. Laparoscopic resection of niches is well established, showing symptomatic relief and an increase in residual myometrium [6]. Although cesarean section scar defects have been described as niches, we presented a further variety of defect that has not been previously described, a uterine cyst.
演示腹腔镜切除剖宫产术后子宫瘢痕囊肿的技术。
技术视频（加拿大任务组分类 III）。
大学医院。
一名 38 岁女性。
腹腔镜切除剖宫产瘢痕内的子宫囊肿。
一名 38 岁女性因继发性不孕就诊，要求切除剖宫产瘢痕缺损，为体外受精准备子宫腔。术前超声显示 17.7×12.2mm 的瘢痕缺损。在硬性宫腔镜检查中，观察到前壁子宫囊肿并发现其使子宫腔变窄。采用腹腔镜方法切除子宫囊肿。我们小心地将膀胱从其在先前剖宫产瘢痕处的粘连中分离出来。定位子宫囊肿并确定缺损边缘。使用超声能量装置进行核除和切除囊肿。子宫操纵器有助于识别宫颈管并防止后壁无意中放置缝线。用 1 根 vicryl 间断缝线关闭缺损，小心地将子宫壁的全层包含在内，以达到最大的对抗。在该区域应用粘连屏障。术后 6 周行经阴道超声扫描显示完全愈合，无残留缺损。
小窝是剖宫产术后的公认并发症，是由于瘢痕愈合不完全引起的，在单层缝合中更常见[1]。它们可能与经后点滴出血、痛经、慢性疼痛、不孕和较差的生殖和产科结局有关[1-5]。腹腔镜切除小窝已得到广泛应用，显示出症状缓解和残留子宫肌层增加[6]。虽然剖宫产瘢痕缺损已被描述为小窝，但我们提出了一种以前未描述过的进一步的缺损类型，即子宫囊肿。
