Video ArticleSingle-Port Total Laparoscopic Hysterectomy in a Patient With Deep Infiltrating Endometriosis
Abstract
Study Objective
To present the feasibility of single-port laparoscopic surgery at patients with deep infiltrating endometriosis.
Design
Step by step explanation of the surgery using videos (Canadian Task Force classification III-c).
Setting
Single-port laparoscopic surgery is an emerging technique and an option for improving the benefits of laparoscopic surgery. The goals of single-port laparoscopic surgery is to further enhance the cosmetic benefits of minimally invasive surgery and minimize the potential risk and morbidity associated with multiport surgery [1, 2]. This procedure is not without challenges, however, such as instrument crowding and clashing, ergonomic difficulties, loss of instrument triangulation, and the need for advanced laparoscopic skills [1, 2]. Despite these challenges, technical advances in optics and instrumentation have led to the widespread use of single-port laparoscopic surgery to treat such gynecologic disorders as endometriosis, uterine myomas, and cancers [2, 3].
Interventions
A 42-year-old woman was admitted to our clinic with a complaint of chronic pelvic pain dysmenorrhea and deep dyspareunia. Her medical history revealed a cesarean section delivery and a diagnosis of endometriosis. Despite treatment of her endometriosis with dienogest, there has been no decline at her complaints. Ultrasound examination performed at admission revealed a 6 × 6 cm right adnexal mass compatible with endometrioma, with a normal left ovary and uterus. Rectovaginal examination detected no endometriotic nodules. Although all treatment options were explained and discussed and laparoscopic excision of right ovarian endometrioma was recommended, the patient strongly desired removal of the uterus and the ovaries to avoid recurrence of endometriosis and related complaints. Thus, laparoscopic hysterectomy and bilateral salpingo-oophorectomy were planned. Under general anesthesia and endotracheal intubation, the patient was placed in low lithotomy position with the arms tucked. An orogastric tube and a Foley catheter were placed. Abdominal access was performed following an open Hasson technique with a 2.0- to 2.5-cm vertical umbilical incision and a 4-channel (with two 10-mm and two 5-mm channels) access port was placed into the peritoneal cavity. On pelvic examination, a 6 × 6-cm right ovarian endometrioma adherent to the pelvic sidewall was detected, along with severe adhesions on the left side between the left adnex and the pelvic sidewall. The uterus was normal. The adhesion on the left side was released using a Harmonic scalpel (Ethicon Endosurgery, Cinncinnati, OH). The pelvic sidewall peritoneum was opened, and the ureters were identified and isolated at the pelvic brim and followed toward the true pelvis. The internal iliac artery, uterine and obliterated umbilical artery, and infundibulopelvic ligament were dissected and identified. The paravesical, pararectal, and rectouterine spaces were opened. Deep infiltrating endometriosis implants on the right side located in the uterosacral ligment and pararectal space were dissected and excised. After restoration of pelvic anatomy, hysterectomy and bilateral salpingo-oophorectomy were performed. The vaginal cuff was closed with intracorporeal knots. The patient was discharged on postoperative day 1, and reported no problems at follow-up.
Conclusion
Single-port laparoscopic hysterectomy appears to be a safe and feasible option in patients with deep infiltrating endometriosis, especially when performed by well-experienced surgeons.
References (3)
- P.F. Escobar et al.
Laparoendoscopic single-site (LESS) surgery in patients with benign adnexal disease
Fertil Steril
(2010)
Cited by (2)
Effects of clamping force on carrying energy ability of a harmonic scalpel
2020, Procedia CIRPThe carrying energy of a harmonic scalpel determines biological tissue coagulation quality, and is related to the clamping force between the blade of a harmonic scalpel and the biological tissue. The objective of this study is to investigate the effect of clamping force on the carrying energy ability of a harmonic scalpel. First, the carrying energy model of a harmonic scalpel transducer is developed, which is regarded as a mass-spring-damper oscillator. Then, the characteristic parameters at various clamping forces are determined by a least-square parameter identification method, which represent the carrying energy ability of harmonic scalpel. Furthermore, the carrying energy ability relative to clamping force is evaluated by coagulating biological tissue in vitro. The results show that mass, force resistance and stiffness of mass-spring-damper oscillator increase with increasing clamping force, which reflects the increase of the harmonic scalpel carrying energy ability. This trends plateaus with the continuous increase of clamping force. Correspondingly, the coagulation depth of biological tissue increases with the increase of clamping force, and an optimal clamping force exists. The results of the histological investigations are in good agreement with carrying energy under different clamping force conditions.
Is there a role for single-port laparoscopy in the treatment of endometriosis?
2017, Minerva Ginecologica
The authors declare that they have no conflicts of interest.