Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Inova Fairfax Women's Hospital, Falls Church, VA, USA.
Division of Urogynecology, Department of Obstetrics and Gynecology, Walter Reed National Medical Center, Bethesda, MD, USA.
J Obstet Gynaecol Can. 2021 May;43(5):601-602. doi: 10.1016/j.jogc.2020.10.019. Epub 2020 Dec 15.
This video shows the surgical excision of a 20-cm peritoneal inclusion cyst with laparoscopic repair of pelvic floor defects caused by the mass effect of the cyst. A 44-year-old woman presented with bulge symptoms and a reducible posterior prolapse extending 4 cm beyond the introitus inconsistent with an enterocele/rectocele. Dynamic MRI revealed a 20-cm cystic mass surrounding the uterine fundus extending down the posterior wall of the vagina, anterior to the rectum. Robotic-assisted laparoscopy revealed stage-IV endometriosis and a large peritoneal inclusion cyst extending from the pelvic brim to the rectovaginal septum. The cyst was mobilized through retroperitoneal dissection. Redundant peritoneum was excised down to the perineal body, and the distended posterior vaginal wall was plicated laparoscopically. The peritoneum was closed in a purse-string fashion, obliterating any potential space. Resolution of the prolapse was confirmed along with restoration of normal anatomy. We managed a unique case of a large peritoneal inclusion cyst presenting as vaginal prolapse. To correct defects after cystectomy, laparoscopic repair was performed similarly to closing an enterocele. Repair of a high posterior defect can be performed laparoscopically when working abdominally to avoid vaginal incisions, allowing for excellent visualization and access.
这段视频展示了经腹腔镜切除 20 厘米大的腹膜包涵囊肿，并修复了由于囊肿的巨大影响导致的盆底缺陷。一名 44 岁女性因膨出症状和可复位的后脱垂而就诊，脱垂延伸超过阴道口 4 厘米，与肠膨出/直肠膨出不符。动态 MRI 显示一个 20 厘米大的囊性肿块环绕子宫底部，向下延伸至阴道后壁，位于直肠前方。机器人辅助腹腔镜检查发现 IV 期子宫内膜异位症和一个大的腹膜包涵囊肿，从骨盆边缘延伸至直肠阴道隔。通过腹膜后解剖将囊肿游离。切除多余的腹膜，直至会阴体，腹腔镜下折叠膨出的阴道后壁。将腹膜以荷包缝合的方式关闭，消除任何潜在的空间。脱垂得到了纠正，同时恢复了正常的解剖结构。我们成功治疗了一例罕见的大腹膜包涵囊肿表现为阴道脱垂的病例。为了在囊肿切除术后修复缺陷，采用与关闭肠膨出相同的方法进行腹腔镜修复。当在腹部进行手术时，可以进行高位后缺陷的修复，避免阴道切口，从而获得良好的可视化和操作空间。
