Maher P, Wood C, Hill D
Department of Obstetrics/Gynecology, Endosurgery Unit, Mercy Hospital for Women, 126 Clarendon Street, East Melbourne 3002, Australia.
J Am Assoc Gynecol Laparosc. 1995 Feb;2(2):199-202. doi: 10.1016/s1074-3804(05)80017-9.
Twenty-one patients with stage 3 or 4 endometriosis in the pouch of Douglas had combined laparovaginal surgery using the Maher abdominal wall elevator. Opening the pouch of Douglas at the beginning of the operation allowed the combined surgery. Instruments were introduced through both the vagina and accessory laparoscopic incision. And a finger was placed in the vagina to palpate and detect abnormal tissue and assist in blunt dissection. The extent of pathologic tissue in the pouch of Douglas was easily identified. This approach allowed flexibility in maximizing the optimum route, vaginal or laparoscopic, to remove the uterus, and facilitated rectal surgery. The alternatives of laparoscopic and laparotomy surgery have limitations compared with combined laparovaginal surgery, particularly deep in the pelvic cavity.
21例Douglas陷凹处有3期或4期子宫内膜异位症的患者接受了使用Maher腹壁提升器的腹腔镜阴道联合手术。手术开始时打开Douglas陷凹可进行联合手术。器械通过阴道和辅助腹腔镜切口置入。并将一根手指放入阴道内以触诊和检测异常组织并协助钝性分离。Douglas陷凹处病理组织的范围很容易确定。这种方法在最大限度地选择最佳途径（经阴道或腹腔镜）切除子宫方面具有灵活性，并便于直肠手术。与腹腔镜阴道联合手术相比，单纯腹腔镜手术和开腹手术有局限性，尤其是在盆腔深部。
