Journal of minimally invasive gynecology最新文献_第3页

Appendectomy in Chronic Pelvic Pain - The True Prevalence of Appendiceal Endometriosis: A Systematic Review and Meta-Analysis 慢性盆腔痛的阑尾切除术 - 阑尾子宫内膜异位症的真实发病率：系统回顾与元分析

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-11-01 DOI: 10.1016/j.jmig.2024.09.071

JR Kohn , M McHale

Study Objective

Through systematic review and meta-analysis, to determine the prevalence of histologically-proven endometriosis of the appendix in patients undergoing gynecologic surgery for chronic pelvic pain or suspected endometriosis.

Design

Systematic review and meta-analysis.

Setting

N/A.

Patients or Participants

Systematic review of MEDLINE, EMBASE, and Scopus from inception to April 2024, including cross-sectional or cohort studies and excluding case reports or case series. Studies must report the proportion of histologically-proven appendiceal endometriosis (AppE) among all appendectomies performed during gynecologic surgery for pelvic pain or suspected endometriosis.

Interventions

Comparison of findings between incidental appendectomy (removal of appendix without evidence of appendicitis or appendiceal pathology) vs visible appendectomy (removal of abnormal appearing appendix with suspected pathology). Random-effects meta-analysis was performed to determine the pooled prevalence.

Measurements and Main Results

29 studies were identified with 6,111 appendectomies performed during gynecologic surgery for pelvic pain or suspected endometriosis. Results appear in Figure 1. The pooled prevalence of histologically-proven endometriosis in the appendix (AppE) differed significantly between incidental appendectomy and appendectomy for an appendix with suspected pathology. Incidental appendectomy resulted in histologically-proven endometriosis in 8% of patients (95% confidence interval 6-11%). When only the abnormal appearing appendix was removed, the pooled prevalence of appendiceal endometriosis was 66% (95% confidence interval 34-88%).

Conclusion

Among those with “visible abnormalities”, the rate of histologically-proven endometriosis of the appendix was quite variable between studies – reinforcing the inconsistency between visual and histologic diagnosis of endometriosis. When appendectomy is performed routinely at the time of surgery for chronic pelvic pain or suspected endometriosis, the pooled prevalence of appendiceal endometriosis is 8%; as such, routine appendectomy should be considered for inclusion as a standard component of endometriosis excision surgery.

研究目的通过系统综述和荟萃分析，确定因慢性盆腔疼痛或疑似子宫内膜异位症而接受妇科手术的患者中经组织学证实的阑尾子宫内膜异位症的患病率.设计系统综述和荟萃分析.设置N/A.患者或参与者系统综述从开始到2024年4月的MEDLINE、EMBASE和Scopus，包括横断面或队列研究，不包括病例报告或病例系列。干预措施比较偶然阑尾切除术（切除无阑尾炎或阑尾病理证据的阑尾）与可见阑尾切除术（切除疑似病理的异常阑尾）的结果。进行随机效应荟萃分析以确定汇总的患病率。结果见图 1。经组织学证实的阑尾子宫内膜异位症（AppE）的汇总患病率在偶然阑尾切除术和因阑尾疑似病变而进行的阑尾切除术之间存在显著差异。意外阑尾切除术导致组织学证实子宫内膜异位症的患者占 8%（95% 置信区间为 6-11%）。结论在有 "可见异常 "的患者中，经组织学证实的阑尾子宫内膜异位症的发生率在不同的研究中存在很大差异--这加强了子宫内膜异位症的肉眼诊断和组织学诊断之间的不一致性。如果在慢性盆腔疼痛或疑似子宫内膜异位症的手术中常规进行阑尾切除术，阑尾子宫内膜异位症的总发病率为 8%；因此，应考虑将常规阑尾切除术作为子宫内膜异位症切除手术的标准组成部分。

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引用次数: 0

Video Endoscopic Inguinal Lymphadenectomy Via the Vulva Single Incision (VEIL-V) 视频内窥镜经外阴单切口腹股沟淋巴腺切除术（VEIL-V）

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-11-01 DOI: 10.1016/j.jmig.2024.09.048

C Liu , X Bi , Z Guan , X Lv , T Lei , X Ma

Study Objective

This study evaluates a novel, minimally invasive single-incision technique for vulvar surgery, aimed at improving safety and reducing complications.

Design

A 2cm incision on the standard vulvar incision line serves as the entry for single port endoscopic lymphadenectomy.

Setting

The procedure involves the patient in lithotomy position with the surgeon operating in between the legs.

Patients or Participants

Three patients with vulvar squamous cell carcinoma, FIGO stage Ib or lower, underwent the surgery post ethics approval, with no major contraindications.

Interventions

The surgery involves a single-port insertion through a 2cm incision, with subcutaneous separation by ultrasonic knife to create an anterior workspace AWS. Continue to expand AWS to the inguinal ligament, the outer edge to the medial anterior superior iliac spine, the inner edge is located 2cm from the inner side of the pubic symphysis, and down to the vertex of the femoral triangle. Remove the lymph nodes around the great saphenous vein, give top priority to the protection of the branches of the great saphenous vein. Expose the sartorius muscle, to make the femoral triangle clear, and completely remove the superficial inguinal lymph nodes. Incise the saphenous vein hiatus resect the lymph nodes between the femoral artery and vein, as well as deep inguinal lymph nodes.

Measurements and Main Results

The surgery duration was 60 minutes with a blood loss of about 10ml. Pathologically, the margins were clear of the tumor, and 13 inguinal lymph nodes were removed without finding metastases.

Conclusion

The single-incision method shortens the operative route and incision length. It ensures precise lymph node removal with enhanced endoscopic visibility, lowers lymphatic and vascular injury risks, and maintains skin integrity at the operative site.

研究目的这项研究评估了外阴手术的一种新型微创单切口技术，旨在提高安全性并减少并发症。设计在标准外阴切口线上切开一个 2 厘米的切口，作为单孔内窥镜淋巴腺切除术的入口。患者或参与者3名外阴鳞状细胞癌患者，FIGO分期Ib期或更低，在伦理批准后接受了手术，无重大禁忌症。干预措施手术包括通过2厘米切口进行单孔插入，用超声刀进行皮下分离，以创建前部工作区AWS。继续扩大 AWS 至腹股沟韧带，外缘至髂前上棘内侧，内缘位于耻骨联合内侧 2 厘米处，向下至股三角顶点。清除大隐静脉周围的淋巴结，优先保护大隐静脉分支。暴露腓肠肌，使股三角区清晰，彻底清除腹股沟浅淋巴结。切开大隐静脉裂孔，切除股动脉和静脉之间的淋巴结以及腹股沟深部淋巴结。结论单切口法缩短了手术路径和切口长度。结论单切口法缩短了手术路径和切口长度，确保了精确的淋巴结切除，提高了内窥镜的可视性，降低了淋巴和血管损伤的风险，并保持了手术部位皮肤的完整性。

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引用次数: 0

Introducing the International Deep Endometriosis Analysis Group Ultrasound Evaluation for Pre-Operative Planning 介绍国际深部子宫内膜异位症分析小组的术前规划超声评估

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-11-01 DOI: 10.1016/j.jmig.2024.09.080

A Chandler , P Akametalu , MV Vargas

Study Objective

To review the steps of the International Deep Endometriosis Analysis (IDEA) ultrasound protocol for integration in preoperative planning, identify findings that may be present on endometriosis ultrasound evaluation, and discuss the benefits of pre-operative mapping of endometriosis on ultrasound.

Design

Video presentation.

Setting

Endometriosis surgical center.

Patients or Participants

Patients with clinical signs and symptoms of endometriosis or adenomyosis.

Interventions

IDEA ultrasound evaluation for surgical planning.

Measurements and Main Results

N/A.

Conclusion

Transvaginal ultrasound can be used to understand the location and severity of endometriosis prior to surgery. This allows the surgeon to anticipate the stage of disease, individualize patient counseling, and assemble the appropriate multi-disciplinary team for a single well-planned surgery with optimal surgical outcomes.

研究目的回顾国际子宫内膜异位症深度分析（IDEA）超声检查方案纳入术前计划的步骤，确定子宫内膜异位症超声评估可能出现的结果，并讨论术前通过超声检查绘制子宫内膜异位症图的益处。患者或参与者有子宫内膜异位症或腺肌症临床症状和体征的患者。干预措施IDEA超声评估用于手术计划。这样，外科医生就可以预测疾病的阶段，为患者提供个性化的咨询，并组建适当的多学科团队，以进行一次精心策划的手术，获得最佳的手术效果。

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引用次数: 0

Laparoscopic Management of Cervico Vaginal Agenesis in Rudimentary Horn Uterus With Pelvic Kidney, Two Step Approach 两步法腹腔镜治疗带盆腔肾脏的粗隆角子宫颈阴道无阴道症

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-11-01 DOI: 10.1016/j.jmig.2024.09.051

H Pandit, A Tajane, A Shaikh

Study Objective

Developmental anomalies involving mullerian or paramesonephric ducts represents some of the most fascinating disorders in Obstetrics and Gynaecology.

Congenital absence of the uterine cervix and vagina in the presence of a functional endometrium is an extremely rare congenital anomaly. Women born with this anomaly present with collection of blood in the uterine cavity or hematometra, disabling pelvic pain and progressively worsening endometriosis

To present a two-step laparoscopic approach for the management of cervico-vaginal agenesis in rudimentary horn uterus with pelvic kidney in adolescent patients.

Design

A case report.

Setting

Pandit hospital and Laparoscopy centre, Ahmednagar, India.

Patients or Participants

A 15-year-old girl with primary amenorrhea and cyclical abdominal pain.

Interventions

MRI finding suggestive of right sided 5 × 3 × 2 cm rudimentary non communicating horn with vaginal agenesis.

Measurements and Main Results

Underwent a two-step laparoscopic procedure. The first step involved creating a vagina through meticulous dissection between the bladder and rectum, followed by the insertion of a specialized mold for vaginal dilation. Vaginoscopy was performed post-operatively to assess vaginal length and epithelialization. The second step involved mobilization of the right-sided uterine horn for central vagina anastomosis, utilizing various laparoscopic techniques including ligament dissection, broad ligament opening, ureterolysis, and careful fascial dissection.

The patient achieved significant vaginal length and proper epithelialization post-operatively. Menstrual regularity was achieved following the procedure, indicating successful functional restoration.

Conclusion

The two-step laparoscopic approach presented in this case offers a safe and effective method for managing cervico-vaginal agenesis in rudimentary horn uterus with pelvic kidney in adolescent patients. This approach minimizes morbidity and complications associated with traditional surgical techniques, providing a promising solution for this complex gynecological anomaly.

先天性子宫颈和阴道缺失且存在功能性子宫内膜是一种极为罕见的先天性畸形。目的：介绍一种两步腹腔镜方法，用于治疗青少年患者的宫颈阴道缺如伴有盆腔肾脏的未发育角子宫。背景印度艾哈迈德纳加尔的潘迪特医院和腹腔镜中心。患者或参与者15岁女孩，原发性闭经，周期性腹痛。干预措施MRI发现提示右侧5 × 3 × 2厘米的不沟通宫角发育不良伴阴道缺失。第一步是在膀胱和直肠之间进行细致的剥离，形成阴道，然后插入专用模具进行阴道扩张。术后进行阴道镜检查，以评估阴道长度和上皮化情况。第二步是利用各种腹腔镜技术，包括韧带剥离、阔韧带开口、输尿管溶解和仔细的筋膜剥离，移动右侧子宫角进行阴道中央吻合术。术后患者的阴道长度明显增加，上皮正常形成，术后月经规律，表明功能恢复成功。这种方法最大程度地降低了传统手术技术的发病率和并发症，为这种复杂的妇科畸形提供了一种可行的解决方案。

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引用次数: 0

The Adverse Impact of Endometrial Trauma on Pregnancy Outcomes; A Real-World Evidence Study 子宫内膜创伤对妊娠结局的不利影响；一项真实世界证据研究

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-11-01 DOI: 10.1016/j.jmig.2024.09.098

MG Munro , C Martin , IB Feldberg , O Kshirsagar , D Sobti , MP Bharadwaz , J Miller , R Wang

Study Objective

Evaluate pregnancy outcomes in women following uterine surgery, including hysteroscopic adhesiolysis.

Design

Retrospective study.

Setting

Database.

Patients or Participants

A 6.5-year United States 150-payor database comprising 120 million patients with commercial, Medicaid, or Medicare coverage.

Interventions

Pregnancy outcomes in women with hysteroscopic adhesiolysis, uterine surgery without adhesiolysis, or no documented uterine surgery.

Measurements and Main Results

The database was searched for individuals with continuous enrollment, identifying three cohorts with trailing data back to April 2017: A history of intrauterine adhesiolysis (HA), a uterine procedure, but no adhesiolysis (UP), and those without any history of uterine surgery (NoUP). All cohorts were followed until May 2023 (41 months) to identify those with a completed pregnancy. Propensity score matching was employed to make the baseline cohort composition similar. Preterm delivery, placenta accreta spectrum, placenta previa, and postpartum hemorrhage were all identified more frequently in those undergoing previous surgery as follows: Preterm Delivery: HA - 14.5%, UP - 10.1%, NoUP - 8.4%, p <0.05. Placenta Accreta Spectrum: HA - 4.6%, UP – 0.9%, NoUP – 0%, p <0.05. Placenta Previa: HA - 13.5%, UP - 10.1%, NoUP – 3.9%, p < 0.05. Postpartum Hemorrhage HA – 17.7%, UP – 25%, NoUP – 7.8% p < 0.05.

Conclusion

In this study, women identified with a history of hysteroscopic adhesiolysis experienced increased risks of preterm delivery, placenta accreta spectrum, placenta previa, and postpartum hemorrhage compared to those without a history of uterine surgery in the study interval. While the magnitude of the difference was less, those with uterine surgery absent adhesiolysis were also at increased risk. These data align with findings from other cohort studies and suggest that endometrial trauma is a risk factor for adverse pregnancy outcomes for both the women and the fetus, likely incurring the expenditure of considerable healthcare resources. Research and development of means by which such trauma could be minimized is needed.

研究目的评估子宫手术（包括宫腔镜粘连松解术）后妇女的妊娠结局.设计回顾性研究.设置数据库.患者或参与者6.5年的美国150家支付方数据库，包括1.2亿名商业、医疗补助或医疗保险患者。干预措施宫腔镜粘连溶解术、未进行粘连溶解术的子宫手术或未记录子宫手术的女性的妊娠结局.测量和主要结果对数据库中连续注册的个人进行搜索，确定了三个队列，其追踪数据可追溯至2017年4月：有宫腔内粘连溶解史（HA）、有子宫手术但无粘连溶解史（UP）和无任何子宫手术史（NoUP）。对所有组群进行随访，直至 2023 年 5 月（41 个月），以确定完成妊娠者。为了使基线队列组成相似，采用了倾向得分匹配法。早产、胎盘早剥、前置胎盘和产后出血在接受过手术的孕妇中发生率较高，具体情况如下：早产：HA - 14.5%，UP - 10.1%，NoUP - 8.4%，P <0.05。前置胎盘：HA - 4.6%，UP - 0.9%，NoUP - 0%，P <0.05。前置胎盘HA - 13.5%，UP - 10.1%，NoUP - 3.9%，P <0.05。产后出血 HA - 17.7%，UP - 25%，NoUP - 7.8% p <0.05.结论在这项研究中，与在研究区间内没有子宫手术史的妇女相比，有宫腔镜粘连溶解史的妇女发生早产、胎盘早剥谱系、前置胎盘和产后出血的风险更高。虽然差异的程度较小，但那些接受过子宫手术但没有进行过粘连分解术的产妇的风险也会增加。这些数据与其他队列研究的结果一致，表明子宫内膜创伤是导致妇女和胎儿不良妊娠结局的风险因素，很可能会耗费大量的医疗资源。有必要研究和开发可最大限度减少这种创伤的方法。

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引用次数: 0

International Societies 国际社团

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-11-01 DOI: 10.1016/S1553-4650(24)00780-5

引用次数: 0

Fowl Play Can Lead to Improved Surgical Skills: A Novel Simulation Model for Bladder Flap Creation, Colpotomy, and Vaginal Cuff Closure 鸡毛蒜皮的游戏也能提高手术技能：创建膀胱瓣、结肠切除术和阴道袖带闭合术的新型模拟模型

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-11-01 DOI: 10.1016/j.jmig.2024.09.111

M Murnane, KW Benabou, MW Griffith

Study Objective

The objective was to create a reproducible simulation model designed for trainees that incorporates 3 important laparoscopic hysterectomy surgical skills: the creation of the bladder flap, the creation of the colpotomy, and vaginal cuff closure.

Design

This simulation model utilizes a chicken drumstick with skin to represent the lower segment of the uterus and cervix. The model has 3 parts. The first part simulates the creation of the bladder flap. The drumstick is mounted to a uterine manipulator by inserting the manipulator through the joint of the drumstick and advancing the colpotomy cup over the joint. The skin of the drumstick serves to function as the bladder peritoneum and the goal is to laparoscopically incise the skin and bluntly dissect the skin down towards the joint. From there, after ensuring the skin is circumferentially dissected, the skin is then everted and folded down over the joint of the drumstick and over the colpotomy cup. The skin is secured down with a purse string suture. This is to facilitate the second part of the simulation, the creation of the colpotomy. For the third part, the vaginal cuff closure, the drumstick is removed from the manipulator and the joint of the chicken leg is then positioned towards the endoscope. The circumferential skin incision will mimic the vaginal cuff.

Setting

This model should be performed in a simulation lab that is capable of accommodating raw animal products.

Patients or Participants

No patients or participants are included.

Interventions

No treatment or intervention was employed.

Measurements and Main Results

There is no data to share.

Conclusion

We successfully created a simulation model that can be utilized by trainees to practice three key skills employed in a laparoscopic hysterectomy. This model successfully allows for the practice of bladder flap creation, colpotomy creation, and vaginal cuff closure. This simulation model is cost-effective and easily reproducible.

研究目的研究目的是为受训者设计一个可重复的模拟模型，其中包含 3 项重要的腹腔镜子宫切除手术技能：膀胱瓣的制作、结肠造口的制作和阴道袖带的闭合。模型由三部分组成。第一部分模拟制作膀胱瓣。鸡腿安装在子宫操作器上，将操作器从鸡腿的关节处插入，并在关节处推进结肠造口杯。鼓槌的皮肤起到膀胱腹膜的作用，目的是在腹腔镜下切开皮肤，并将皮肤向下钝性剥离至关节处。在确保周向剥离皮肤后，将皮肤向外翻出并向下折叠，覆盖鼓槌关节和结肠造口杯。用荷包线将皮肤向下固定。这是为了方便模拟的第二部分，即建立阴茎结肠造口。第三部分是阴道袖带闭合，从操作器上取下鸡腿，然后将鸡腿关节朝向内窥镜。设置该模型应在能够容纳生动物产品的模拟实验室中进行。患者或参与者未包括患者或参与者。干预措施未采用任何治疗或干预措施。测量和主要结果无数据可共享。结论我们成功创建了一个模拟模型，学员可利用该模型练习腹腔镜子宫切除术中使用的三种关键技能。该模型成功实现了膀胱瓣创建、结肠造口创建和阴道袖带闭合的练习。该模拟模型成本低廉，易于复制。

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引用次数: 0

ICG Guided Sentinel Lymph Node Mapping: Which Node to Harvest? ICG 引导下的前哨淋巴结造影：切除哪个淋巴结？

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-11-01 DOI: 10.1016/j.jmig.2024.09.052

F Heredia , JR Escalona , D Sanabria , J Landeros , M Arévalo , I Arévalo

Study Objective

To show an important issue concerning Sentinel Lymph node mapping strategy.

Design

A descriptive video highlighting the technical details to succesfuly harvest the correct sentinel node.

Setting

A tertiary private center.

Patients or Participants

two cases of endometrial cancer with Sentinel node mapping using NIR-ICG platform.

Interventions

Description of a possible pitfall while performing endoscopic surgery for endometrial cancer.

Measurements and Main Results

The selection of the correct node to harvest is commented and explaned in the two similar cases but with different decision.

Conclusion

Correct SLN mapping requires careful pathway tracking from the paracervix until the appearance of the first lymph node following the usual lymphatic courses.

Therefore, finding a highlighted lymph node does not result in an SLN.

Each highlighted pathway must be thoroughly explored to identify deeper and true SLNs.

The technique of SLN mapping demands careful exploration of ICG spread into lymphatic channels to guarantee a low false negative nodal status.

研究目的展示有关前哨淋巴结造影策略的一个重要问题。设计一段描述性视频，突出强调成功摘取正确前哨结的技术细节。干预措施描述内镜手术治疗子宫内膜癌时可能存在的误区。测量和主要结果对两例相似但决定不同的病例中选择正确切除的结节进行了评论和解释。因此，找到高亮淋巴结并不意味着找到了 SLN，必须彻底探查每一个高亮淋巴结的路径，以确定更深层的真正 SLN。

{"title":"ICG Guided Sentinel Lymph Node Mapping: Which Node to Harvest?","authors":"F Heredia , JR Escalona , D Sanabria , J Landeros , M Arévalo , I Arévalo","doi":"10.1016/j.jmig.2024.09.052","DOIUrl":"10.1016/j.jmig.2024.09.052","url":null,"abstract":"<div><h3>Study Objective</h3><div>To show an important issue concerning Sentinel Lymph node mapping strategy.</div></div><div><h3>Design</h3><div>A descriptive video highlighting the technical details to succesfuly harvest the correct sentinel node.</div></div><div><h3>Setting</h3><div>A tertiary private center.</div></div><div><h3>Patients or Participants</h3><div>two cases of endometrial cancer with Sentinel node mapping using NIR-ICG platform.</div></div><div><h3>Interventions</h3><div>Description of a possible pitfall while performing endoscopic surgery for endometrial cancer.</div></div><div><h3>Measurements and Main Results</h3><div>The selection of the correct node to harvest is commented and explaned in the two similar cases but with different decision.</div></div><div><h3>Conclusion</h3><div>Correct SLN mapping requires careful pathway tracking from the paracervix until the appearance of the first lymph node following the usual lymphatic courses.</div><div>Therefore, finding a highlighted lymph node does not result in an SLN.</div><div>Each highlighted pathway must be thoroughly explored to identify deeper and true SLNs.</div><div>The technique of SLN mapping demands careful exploration of ICG spread into lymphatic channels to guarantee a low false negative nodal status.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S11"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Fertility Preserving Laparoscopic Approach for Scar Ectopic Pregnancy Excision 保留生育能力的腹腔镜疤痕宫外孕切除术

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-11-01 DOI: 10.1016/j.jmig.2024.09.056

V Bhivsane, A Kendre

Study Objective

Surgical management of cesarean section scar ectopic pregnancy with temporary ligation of bilateral uterine artery at origin with shoelace knot technique.

Design

A stepwise video demonstration of procedure.

Setting

Surgery was done using 2D high-definition laparoscopy by qualified and experienced team.

Patients or Participants

A 30-year-old patient presented with 2-months amenorrhoea with vaginal bleeding and pain in lower abdomen. She had undergone two full term cesarean section. Patient was willing to preserve her fertility. Consent was obtained from patient for surgical management.

Interventions

Laparoscopic management of cesarean scar ectopic pregnancy with temporary ligation of bilateral uterine arteries at origin.

Measurements and Main Results

On USG, live cesarean scar ectopic pregnancy of 8 weeks gestation type IIa was diagnosed. Her B-HCG level was 26,400 IU/L. Surgical treatment was planned for her. In this video, we stepwise described our technique: 1) Adhesiolysis of omentum from anterior abdominal wall. 2) Retroperitoneum was opened. Temporary ligation of bilateral uterine arteries at origin was done with shoelace knot technique. 3) Uterus was densely adherent to anterior abdominal wall, dissected down. 4) Bladder dissection was done to expose scar. 5) Intramyometrial injection of vassopressin was given. 6) Complete evacuation of products of conception was done 7) Uterine scar repair was done with 1-0 vicryl. 8) Bilateral uterine arteries ligature was released. The surgery was uneventful with minimal blood loss.

Conclusion

Laparoscopic excision of cesarean scar ectopic pregnancy is a safe, effective, easily adaptable minimal invasive procedure for maintaining haemostasis, simultaneous repair of scar that lead to successful revision with minimal impact to subsequent fertility.

研究目的剖宫产瘢痕异位妊娠的手术治疗，采用鞋带结技术在原发部位临时结扎双侧子宫动脉.设计逐步视频演示手术过程.设置手术由经验丰富的合格团队使用二维高清腹腔镜完成.患者或参与者一名 30 岁的患者闭经 2 个月，伴有阴道出血和下腹疼痛。她曾接受过两次足月剖腹产手术。患者愿意保留生育能力。干预措施腹腔镜手术治疗剖宫产疤痕异位妊娠，在原发部位临时结扎双侧子宫动脉。她的 B-HCG 水平为 26,400 IU/L。计划对她进行手术治疗。在这段视频中，我们逐步介绍了我们的技术：1）从腹前壁粘连网膜。2) 打开腹膜后腔。用鞋带结技术暂时结扎双侧子宫动脉源头。3) 子宫与前腹壁紧密粘连，向下剥离。4) 剥离膀胱以暴露瘢痕。5) 子宫内注射加压素。6) 彻底排空受孕产物 7) 使用 1-0 vicryl 修复子宫疤痕。8) 解除双侧子宫动脉结扎。结论：腹腔镜下剖宫产疤痕异位妊娠切除术是一种安全、有效、易于适应的微创手术，可维持止血，同时修复疤痕，从而成功地进行翻修，对以后的生育影响极小。

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引用次数: 0

AAGL 2024 Cover AAGL 2024 封面

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-11-01 DOI: 10.1016/j.jmig.2024.10.027

引用次数: 0