Urogynecology Unit, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece.
First Department of Obstetrics and Gynecology, Alexandra General Hospital, University of Athens, 80 Vas. Sofias Aven, 11528, Athens, Greece.
Int Urogynecol J. 2021 Aug;32(8):2287-2289. doi: 10.1007/s00192-021-04721-1. Epub 2021 Mar 11.
In this video we present the surgical management of a 58-year-old woman presenting with a large prolapsed myomatous uterus treated with vaginal hysterectomy (VH) and pelvic floor repair (PFR) (uterosacral ligament suspension and posterior colporraphy) under local anesthesia and conscious sedation.
The patient underwent VH and PFR by using an infiltration of a local anesthetic solution of lidocaine, ropivacaine and adrenaline in combination with intravenous (iv) conscious sedation. Debulking techniques, such as intramyometrial coring, uterine bisection, myomectomy and wedge resection, were used to facilitate VH. The final weight of the removed uterus was 870 g.
This video demonstrates that performing a surgically challenging VH under local anesthesia is feasible.
Vaginal uterine morcellation can be performed to debulk the enlarged uterus so that hysterectomy can be accomplished under local anesthesia. The use of local anesthesia may safely be offered as an alternative to patients undergoing a complex vaginal hysterectomy and reconstructive surgery.
在这个视频中，我们介绍了一位 58 岁女性的手术治疗方法，她患有大型脱垂子宫肌瘤，采用阴道子宫切除术 (VH) 和盆底修复术 (PFR) 进行治疗（子宫骶骨悬带和后阴道修补术），在局部麻醉和清醒镇静下进行。
患者采用利多卡因、罗哌卡因和肾上腺素的局部麻醉溶液浸润联合静脉（iv）清醒镇静进行 VH 和 PFR。采用子宫肌内核心、子宫二分法、子宫肌瘤切除术和楔形切除术等减瘤技术来辅助 VH。切除的子宫最终重量为 870g。
该视频表明，在局部麻醉下进行具有挑战性的 VH 是可行的。
可以进行阴道子宫碎块切除术来缩小增大的子宫，以便在局部麻醉下完成子宫切除术。对于接受复杂阴道子宫切除术和重建手术的患者，局部麻醉的使用可以作为一种安全的替代方法。
