Efficient myometrial defect closure in a layer by layer fashion after robot-assisted laparoscopic adenomyomectomy: a novel technique
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
ObjectiveIn this video, we present our novel technique for myometrial defect closure following robot-assisted laparoscopicadenomyomectomy. MethodsA narrated video demonstration of our technique. Our patient was a 47-year-old single woman with severedysmenorrhea, who did not respond to medical therapy and wished to preserve her uterus. Surgery was performedafter thorough counseling and obtaining informed consent from the patient (Institutional Review Board number:KC17OESI0238; approval date: March 19, 2018). After removal of the adenomyotic tissue during surgical intervention,the myometrial defect was closed in three steps. First, the defect between the anterior and posterior innermostmyometrial layers was closed using a 2-0 Stratafix suture, CT-1 (circle taper) needle (Ethicon, Somerville, NJ, USA). Next, the two sides were approximated using a 2-0 PDS® (polydioxanone) Suture (Ethicon, Somerville, NJ, USA) andV-34 (TAPERCUT®) surgical needle (Ethicon, Somerville, NJ, USA). Finally, the serosa was sutured in a baseball fashionusing a 2-0 PDS suture, slim half-circle [SH] needle (Ethicon, Somerville, NJ, USA). ResultsThe patient had no postoperative complications, and her pain was greatly improved. The CA125 level decreased from434 U/mL to 45.99 U/mL, and the transvaginal ultrasound showed a reduction in posterior myometrial thickness from5.61 cm to 2.69 cm. ConclusionThis technique maintained the integrity of the endometrial cavity, posterior myometrial thickness, and uterine layeralignment. We believe that it is a feasible technique and may be a solution for adenomyosis in patients seeking forfertility preservation.
Abstract
ObjectiveIn this video, we present our novel technique for myometrial defect closure following robot-assisted laparoscopicadenomyomectomy. MethodsA narrated video demonstration of our technique. Our patient was a 47-year-old single woman with severedysmenorrhea, who did not respond to medical therapy and wished to preserve her uterus. Surgery was performedafter thorough counseling and obtaining informed consent from the patient (Institutional Review Board number:KC17OESI0238; approval date: March 19, 2018). After removal of the adenomyotic tissue during surgical intervention,the myometrial defect was closed in three steps. First, the defect between the anterior and posterior innermostmyometrial layers was closed using a 2-0 Stratafix suture, CT-1 (circle taper) needle (Ethicon, Somerville, NJ, USA). Next, the two sides were approximated using a 2-0 PDS® (polydioxanone) Suture (Ethicon, Somerville, NJ, USA) andV-34 (TAPERCUT®) surgical needle (Ethicon, Somerville, NJ, USA). Finally, the serosa was sutured in a baseball fashionusing a 2-0 PDS suture, slim half-circle [SH] needle (Ethicon, Somerville, NJ, USA). ResultsThe patient had no postoperative complications, and her pain was greatly improved. The CA125 level decreased from434 U/mL to 45.99 U/mL, and the transvaginal ultrasound showed a reduction in posterior myometrial thickness from5.61 cm to 2.69 cm. ConclusionThis technique maintained the integrity of the endometrial cavity, posterior myometrial thickness, and uterine layeralignment. We believe that it is a feasible technique and may be a solution for adenomyosis in patients seeking forfertility preservation.
참고문헌 (5)
- Donnez J, "Introduction: uterine adenomyosis, another enigmatic disease of our time", Fertil Steril, 109, pp.369~370 (2018)
- Struble J, "Adenomyosis : a clinical review of a challenging gynecologic condition", J Minim Invasive Gynecol, 23, pp.164~185 (2016)
- Leyendecker G, "Adenomyosis and reproduction", Best Pract Res Clin Obstet Gynaecol, 20, pp.523~546 (2006)
- Thain S, "Approaches to adenomyomectomy", Gynecol Minim Invasive Ther, 4, pp.49~54 (2015)
- Sinha R, "Robotic surgery in gynecology", J Minim Access Surg, 11, pp.50~59 (2015)