An effective method using laparoscopy in treatment of upper vaginal leiomyoma.

OBJECTIVE: To introduce an effective approach using laparoscopy in the treatment of upper vaginal leiomyoma. DESIGN: Step-by-step video explanation of the surgical procedure with still pictures and surgical video clips to demonstrate the detailed technique, approved by the Shengjing Hospital of China Medical University. SETTING: Hospital. PATIENT(S): A 34-year-old woman diagnosed with 5-cm upper vaginal leiomyoma, who had sexual discomfort for 5 years. INTERVENTION(S): Using laparoscopy in the treatment of upper vaginal leiomyoma consists of five steps: first lysing the pelvic adhesion; exploring the pelvic cavity and locating the vaginal leiomyoma through gynecologic examination by the assistant; recognizing the position between leiomyoma and ureter and carefully dissociating ureter while avoiding injury; completely enucleating and resecting the vaginal leiomyoma using laparoscopy; and exploring the ureter, rectum, and uterine artery to make sure there was no injury. MAIN OUTCOME MEASURE(S): Value and feasibility of using laparoscopy in treatment of upper vaginal leiomyoma. RESULT(S): The vaginal leiomyoma was removed successfully using laparoscopic operation and the operative time was 95 minutes. In the follow-up period, the patient did not report any symptoms, and she became pregnant at the time of the 20th month after operation and underwent a vaginal delivery at full-term. CONCLUSION(S): For upper vaginal leiomyoma treatment, laparoscopic operation could present a clear visual field to avoid injury of bladder, ureter, rectum, and uterine artery. Laparoscopic operation is safe and feasible in treatment of upper vaginal leiomyoma.

Laparoscopic myomectomy using self-made retrieval bag to contain tissue extraction.

OBJECTIVE: To introduce an effective approach using a self-made retrieval bag during laparoscopic myomectomy to contain tissue extraction. DESIGN: Step-by-step video explanation of the surgical procedure with still pictures and surgical video clips to demonstrate the detailed technique, approved by the Shengjing Hospital of China Medical University. SETTING: University hospital. PATIENT(S): A 32-year-old woman diagnosed with a uterine myoma (diameter, 6 cm). She had endured 5 years of intermittent lower abdominal pain and 2 years of infertility. INTERVENTION(S): A self-made retrieval bag during laparoscopic myomectomy was used (consists of four steps) to contain tissue extraction. 1. Self-made retrieval bag using a sterile medical bag. 2. Inspect the pelvic cavity, evaluate and determine the location and number of myomas. 3. Resect the myoma. 4. Morcellate the myoma into pieces inside the retrieval bag using laparoscopic power morcellation. MAIN OUTCOME MEASURE(S): Value and feasibility of using a self-made retrieval bag in laparoscopic myomectomy. RESULT(S): The myoma was successfully and completely resected by laparoscopy using a self-made retrieval bag to contain tissue extraction. Operative time was 93 minutes. In the follow-up period, the patient did not report any symptom of iatrogenic parasitic myoma. The woman had a pregnancy at month 26 after operation and underwent a cesarean section. This resulted in a full-term baby. CONCLUSION(S): Our surgical approach demonstrated a number of noteworthy advantages. The use of retrieval bag to contain tissue extraction during laparoscopic morcellation can avoid the risk of iatrogenic parasitic myoma. The retrieval bag is self-made using a sterile packing bag, which is cost free and also reduces operative expenses.

An Effective Method Combining Various Endoscopes in the Treatment of Intravesical Migrated Intrauterine Device.

OBJECTIVE: To introduce an effective method combining various endoscopes in the treatment of intravesical migrated intrauterine device (IUD). DESIGN: A step-by-step explanation of the surgery using video, approved by the Shengjing Hospital of China Medical University. SETTING: Shengjing Hospital of China Medical University. INTERVENTIONS: A 39-year-old young woman, in whom an IUD was inserted 2 months prior, presented with frequent urination after IUD insertion. Cystoscope and pelvic computed tomography were performed, and the results showed an IUD in the bladder. The migrated IUD was found partly in the uterus and partly in the bladder by hysteroscope and cystoscope. Management of the migrated IUD consists of 4 steps: (1) lysing the adhesion between the bladder and uterus, (2) suturing the bladder and taking the IUD part out of the bladder, (3) removing the IUD part in the uterus, and (4) suturing the bladder again to reinforce it and suturing the uterus. CONCLUSION: The migrated IUD in the bladder was successfully and completely extracted by the method combining various endoscopes; operative time was 56 minutes. In the follow-up period the patient did not report any symptoms of frequency urination. This surgical process has the following characteristics: Preoperative examination should be performed to clarify the ectopic site of the IUD, various endoscopes should be combined for diagnosis and treatment, and endoscopic surgery is an effective treatment method for migrated IUD.

An effective "water injection"-assisted method for excision of ovarian endometrioma by laparoscopy.

OBJECTIVE: To introduce an effective approach for excision of ovarian endometrioma by "water injection"-assisted laparoscopy treatment. DESIGN: Step-by-step video explanation of the surgical procedure with still pictures and surgical video clips to demonstrate the detailed technique, approved by the Shengjing Hospital of China Medical University. SETTING: Hospital. PATIENTS: A 26-year-old young woman diagnosed with a 6 cm in diameter right ovarian cyst, who endured 5 years of dysmenorrhea. INTERVENTIONS: The "water injection"-assisted laparoscopic excision of ovarian endometrioma consists of five steps: rupture the ovarian endometrial cyst and remove the "chocolate fluid;" inject the "water" (diluted vasopressin solution) into the interface between endometrioma and ovarian parenchyma; stop injecting until the solution overflow; separate the endometrioma away from the ovarian parenchyma; and suture the ovary. MAIN OUTCOME MEASURES: Value and feasibility of "water injection"-assisted laparoscopic excision of ovarian endometrioma. RESULTS: The "water injection"-assisted laparoscopic excision of ovarian endometrioma was feasible and effective. In the follow-up period, the patient did not report any symptom of dysmenorrhea; and the sex hormone and antimüllerian hormone tests reached to normal levels. CONCLUSION: Our surgical approach demonstrated several noteworthy advantages. After "water injection", the endometrioma and ovarian parenchyma was easily distinguished and separated. The approach avoided normal ovarian tissue destruction during endometrioma separation. The utilization of diluted vasopressin solution might decrease bleeding of ovarian wound. Considering its simplicity of realization, our surgical approach should be promoted to more reproductive-age patients.