Sznurkowski Jacek J, Wnuk Jakub
Profesor Jacek Sznurkowski Podmiot Leczniczy, ul. Stefana Żeromskiego 23A, 81-246 Gdynia, Poland.
LuxMed Szpital Gdańsk S.A., ul. Wileńska 44, 80-215 Gdańsk, Poland.
Reports (MDPI). 2025 May 17;8(2):71. doi: 10.3390/reports8020071.
: Uterine fibroids affect up to 25% of women of reproductive age and can lead to significant symptoms or impact fertility, often requiring surgical management. While hysteroscopic myomectomy is suitable for intracavitary fibroids, and subserosal fibroids typically necessitate open or minimally invasive surgery (MIS). Laparoscopic approaches offer notable advantages, including reduced postoperative pain and faster recovery. However, MIS is frequently avoided in cases of very large fibroids due to technical difficulty and concerns about safe tissue extraction. Power morcellation, previously used for specimen removal, has fallen out of favor due to the risk of disseminating occult malignancies, especially in women over 35. Therefore, establishing the in such cases is essential. : A woman of reproductive age presented with a symptomatic uterine fibroid measuring approximately 4 kg (1500 cm). Laparoscopic myomectomy was performed using a modified trocar entry technique and contained tissue fragmentation, avoiding morcellation. The operation was completed successfully without complications. Postoperative recovery was uneventful, and the patient was discharged on postoperative day two. Histopathological examination confirmed a benign leiomyoma. : This case highlights the of an exceptionally large uterine fibroid without morcellation. Through careful patient selection, strategic trocar placement, and controlled tissue fragmentation, MIS can be safely performed in select high-volume cases. These findings support reconsidering the size limitations of laparoscopic myomectomy when conducted by experienced surgeons using appropriate techniques.
子宫肌瘤影响高达25%的育龄女性，可导致明显症状或影响生育能力，通常需要手术治疗。虽然宫腔镜子宫肌瘤切除术适用于腔内肌瘤，而浆膜下肌瘤通常需要开放手术或微创手术（MIS）。腹腔镜手术具有显著优势，包括术后疼痛减轻和恢复更快。然而，由于技术难度和对安全取出组织的担忧，对于非常大的肌瘤病例，MIS常常不被采用。以前用于取出标本的动力粉碎术，由于存在传播隐匿性恶性肿瘤的风险，特别是在35岁以上的女性中，已不再受欢迎。因此，在这种情况下确定[此处原文缺失关键信息]至关重要。：一名育龄女性因有症状的子宫肌瘤就诊，肌瘤大小约4千克（1500立方厘米）。采用改良的套管针穿刺技术进行腹腔镜子宫肌瘤切除术，术中包含组织破碎，避免了粉碎术。手术成功完成，无并发症。术后恢复顺利，患者在术后第二天出院。组织病理学检查证实为良性平滑肌瘤。：该病例突出了在不进行粉碎术的情况下处理异常大的子宫肌瘤的[此处原文缺失关键信息]。通过仔细的患者选择、策略性的套管针放置和可控的组织破碎，在特定的高容量病例中可以安全地进行MIS。这些发现支持在经验丰富的外科医生使用适当技术进行腹腔镜子宫肌瘤切除术时重新考虑其大小限制。
