Department of Gynecology, Northwest Women's and Children's Hospital (Shaanxi Provincial Maternity and Child Health Care Hospital), Xi'an, Shaanxi, China.
Department of Gynecology, Northwest Women's and Children's Hospital (Shaanxi Provincial Maternity and Child Health Care Hospital), Xi'an, Shaanxi, China.
Am J Obstet Gynecol. 2023 Jul;229(1):72-74. doi: 10.1016/j.ajog.2023.03.018. Epub 2023 Mar 17.
Uncontained power morcellation during laparoscopic myomectomy may spread tissue fragments or malignant cells into the abdominal cavity. Recently, various approaches to contained morcellation, have been adopted to retrieve the specimen. However, each of these methods has its own drawbacks. Intraabdominal bag-contained power morcellation adopts a complex isolation system, which prolongs the operation and increases medical costs. Contained manual morcellation via colpotomy or mini-laparotomy increases the trauma and the risk of infection. Contained manual morcellation via umbilical incision during single-port laparoscopic myomectomy may be the most minimally invasive and cosmetic approach. But the popularization of single-port laparoscopy is challenging because of technical difficulties and high costs. We have therefore, developed a surgical technique using 2 umbilical port-incisions (5 mm and 10 mm), which are merged into 1 large umbilical incision (25-30mm) for contained manual morcellation during specimen retrieval, and one 5mm incision in the lower left abdomen for an ancillary instrument. As demonstrated in the video, this technique significantly facilitates surgical manipulation using conventional laparoscopic instruments while still keeping the incisions minimal. It is also economical because the use of an expensive single-port platform and special surgical instruments is avoided. In conclusion, the merging of dual umbilical port-incisions for contained morcellation adds a minimally invasive, cosmetic, and economical option to laparoscopic specimen retrieval that would enrich a gynecologist's skill set, which is particularly relevant in a low-resource settings.
腹腔镜子宫肌瘤剔除术中不受控制的组织粉碎术可能会将组织碎片或恶性细胞扩散到腹腔中。最近，已经采用了各种方法来进行受控制的粉碎术，以获取标本。然而，这些方法各有其自身的缺点。腹腔内袋式动力粉碎术采用复杂的隔离系统，延长了手术时间并增加了医疗费用。经阴道切开术或小剖腹术进行的受控制的手动粉碎术增加了创伤和感染的风险。经脐部单孔腹腔镜子宫肌瘤剔除术中进行的受控制的手动粉碎术可能是最微创和美容的方法。但是，由于技术困难和成本高，单孔腹腔镜的普及具有挑战性。因此，我们开发了一种使用 2 个脐部切口（5mm 和 10mm）的手术技术，这些切口合并成 1 个大脐部切口（25-30mm），用于在标本取出时进行手动受控制的粉碎术，并且在左下腹部有 1 个 5mm 的切口用于辅助器械。如视频所示，这种技术使用常规腹腔镜器械显著方便了手术操作，同时仍保持切口最小化。它还具有经济性，因为避免了昂贵的单孔平台和特殊手术器械的使用。总之，双脐部切口合并用于受控制的粉碎术为腹腔镜标本取出增加了一种微创、美容和经济的选择，丰富了妇科医生的技能集，特别是在资源匮乏的环境中具有重要意义。
