Minilaparoscopic hysterectomy: A case report = Minilaparoscopic hysterectomy: A case report

다국어 초록 (Multilingual Abstract)

A 46-year old, multiparous woman visited to our department due to hypermenorrhea. Pelvic examination revealed a 10 weeks size uterus with globular enlargement, and ultrasonography demonstrated suspicious adenomyosis. Minilaparoscopic hysterectomy was performed. We inserted 4 ports (one 5-mm and three 3.5-mm ports) in the same manner as conventional laparoscopy. The left paraumbilical 5-mm port was used for instruments including bipolar forceps, vessel sealing device, needle holder, and suction canula. The umbilical 3.5-mm port was used for 3.3-mm 30° laparoscope. Two 3.5-mm ports were inserted at the right and left iliac fossa, and were used for grasping forceps and 3-mm bipolar forceps. After identification of both ureters, both round and tubo-ovarian ligaments were transected using bipolar and ultrasonic device. Bladder was sharply dissected, and both uterine arteries were transected using bipolar diathermy and ultrasonic energy. The colpotomy incision was made using monopolar diathermy, and the entire uterus was freed laparoscopically. During the colpotomy, we used pipe-type uterine manipulator, and this manipulator was effective to maintain the pneumoperitoneum. Additionally, when the vaginal cuff was closed, suture material was introduced into the abdominal cavity through this manipulator. The resected specimen was vaginally retrieved. The vaginal cuff was closed laparoscopically with a continuous suture using 2-0 absorbable unidirectional barbed suture material. We inserted a drainage tube through 5-mm port site. Operation time was 95 minutes, and estimated blood loss was 50 mL. Pathologic examination confirmed the diagnosis of adenomyosis and leiomyoma. Through adequate combination of various instruments, we could safely perform hysterectomy. If future advancement in technology offers the similar conditions as for conventional laparoscopy, minilaparoscopic hysterectomy may be a substitute for conventional laparoscopic hysterectomy.