Department of Obstetrics and Gynecology and Women's Health, University of Louisville Hospital, Louisville, Kentucky (all authors).
Department of Obstetrics and Gynecology and Women's Health, University of Louisville Hospital, Louisville, Kentucky (all authors).
J Minim Invasive Gynecol. 2021 Apr;28(4):748-749. doi: 10.1016/j.jmig.2020.06.019. Epub 2020 Jun 28.
To demonstrate improved techniques and safety measures for total laparoscopic hysterectomy for a severely enlarged uterus.
Technical video of the surgery, which demonstrates various techniques for improved visualization, hemostasis, and manipulation for total laparoscopic hysterectomy for a 7400 g uterus.
Academic tertiary care hospital, University of Louisville Hospital, Louisville, Kentucky.
A 44-year-old woman, gravida 0, presented with a severely enlarged myoma uterus, class III obesity with a body mass index of 40.4 kg/m, and hypertension seeking minimally invasive hysterectomy. Magnetic resonance imaging demonstrated a uterus measuring 26 × 26 × 17 cm with multiple myomas. The patient was counseled in detail regarding minimally invasive surgery. She underwent total laparoscopic hysterectomy, bilateral salpingectomy, right oophorectomy, and cystoscopy. The total operative time was 4 hours 12 minutes, and the estimated blood loss was 700 mL. Pre- and postoperative hemoglobin was 13.3 g/dL and 11.3 g/dL, respectively. A 4-cm minilaparotomy incision was created as an extension of the umbilical port, and the specimen was extracted by scalpel morcellation using the extracorporeal C-incision tissue extraction technique. The patient was discharged home on postoperative day 1 and recovered without any complications.
There is an increasing trend in performing laparoscopic hysterectomy for large uteri, which has a lower incidence of overall complications than laparotomy [1,2]. In addition, a cost analysis has demonstrated the superiority of laparoscopic hysterectomy for myomatous uterus accounting for the rare incidence of leiomyosarcoma [3]. Our video demonstrates improved hemostasis and visualization techniques through the use of high-cephalad camera and assistant ports, generous traditional bipolar desiccation, blunt retraction with suction irrigator in the midline umbilical port, and surgical bed rotation. We also describe in detail the scalpel morcellation technique. To date, we believe this is the largest uterine size removed laparoscopically that has been reported in the literature. In the hands of an experienced surgeon and with the demonstrated techniques, a laparoscopic approach to hysterectomy of a very enlarged uterus is safe and feasible.
展示用于严重增大子宫的全腹腔镜子宫切除术的改良技术和安全措施。
手术技术的视频，展示了用于改善可视化、止血和操作的各种技术，用于 7400 克子宫的全腹腔镜子宫切除术。
学术三级保健医院，路易斯维尔大学医院，肯塔基州路易斯维尔。
一名 44 岁的妇女，零产次，患有严重增大的子宫肌瘤子宫，三级肥胖，体重指数为 40.4kg/m，伴有高血压，寻求微创手术性子宫切除术。磁共振成像显示子宫大小为 26×26×17cm，有多发性肌瘤。详细向患者咨询了微创手术。她接受了全腹腔镜子宫切除术、双侧输卵管切除术、右侧卵巢切除术和膀胱镜检查。总手术时间为 4 小时 12 分钟，估计失血量为 700ml。术前和术后血红蛋白分别为 13.3g/dL 和 11.3g/dL。在脐部端口的延长线上创建一个 4cm 的小腹腔镜切口，并使用体外 C 形切口组织提取技术通过手术刀切碎来提取标本。患者术后第 1 天出院，无任何并发症恢复。
对于大子宫，行腹腔镜子宫切除术的趋势日益增加，其总体并发症发生率低于剖腹手术[1,2]。此外，成本分析表明，腹腔镜子宫切除术在子宫肌瘤子宫中具有优势，因为罕见的平滑肌肉瘤[3]发病率。我们的视频通过使用高颅顶摄像头和辅助端口、慷慨的传统双极干燥、在中线脐部端口使用吸引冲洗器进行钝性牵引以及手术床旋转，展示了改良的止血和可视化技术。我们还详细描述了手术刀切碎技术。到目前为止，我们认为这是文献中报道的最大子宫大小的腹腔镜切除。在有经验的外科医生手中，采用所展示的技术，腹腔镜治疗非常增大的子宫的方法是安全可行的。
