BACKGROUND In the presence of a large uterus,total laparoscopic hysterectomy(TLH),always requires morcellation to allow removal of the tissues from the abdominal cavity.However,uncontained morcellation has been scruti...BACKGROUND In the presence of a large uterus,total laparoscopic hysterectomy(TLH),always requires morcellation to allow removal of the tissues from the abdominal cavity.However,uncontained morcellation has been scrutinized because of the possible spread of occult leiomyosarcoma.Therefore,in-bag extracorporeal morcellation has been developed.However,tissue containment and extraction are extremely challenging,especially when considering the increasing uterine size to be removed through minimally invasive surgery.CASE SUMMARY Herein,we describe a novel technique for extracorporeal intrauterine morcellation using the uterus outermost layer as a bag to achieve tissue extraction of very large uteri with suspected occult leiomyosarcoma after TLH.The study enrolled patients who were planned for TLH for large uteri(weight>500 g).TLH was performed following the procedure reported in our previous studies.The novel technique has been described step-by-step in a video,which representatively describes the preoperative imaging and morcellation procedure of three very large uteri weighing 1500 g,1700 g,and 3700 g,respectively.The procedures were performed without any complications.The patients had an uneventful postoperative course,and in all cases,the pathology was benign leiomyoma.CONCLUSION Extracorporeal intrauterine morcellation using the uterus outmost layer as a bag was found to be a feasible technique that allows a careful diagnosis and safe removal of suspected occult malignancies.The technique herein presented may be adopted in surgical practice,by adding it to the other available techniques of contained morcellation.It may represent a valid and feasible alternative,especially useful in cases of very large uteri exceeding the capacity of specimen retrieval bags.展开更多
目的探讨前瞻性研究STEP-W分类在经宫颈子宫肌瘤切除术（transcervical resection of myoma,TCRM）中的临床意义。方法 2014年5~12月于首都医科大学附属北京天坛医院行TCRM手术治疗34例子宫黏膜下肌瘤患者,对每位患者均采用STEP-W分类...目的探讨前瞻性研究STEP-W分类在经宫颈子宫肌瘤切除术（transcervical resection of myoma,TCRM）中的临床意义。方法 2014年5~12月于首都医科大学附属北京天坛医院行TCRM手术治疗34例子宫黏膜下肌瘤患者,对每位患者均采用STEP-W分类法和欧洲妇科内镜学会分类法（ESGE分类法）,评估手术难易程度,术中收集相关数据,统计两种分类方法与术后相关数据的关系。结果在手术时间、灌流量、完整切除率方面,STEP-W分类法与ESGE分类法差异无显著性（P〉0.05）。采用一致性和差异性检验研究样本中STEP-W分类法与ESGE分类法,差异具有显著性（P=0.040,ROC曲线下面积Az=0.747）。结论 STEP-W分类法不能替代ESGE分类法。展开更多
目的探究经阴道彩色多普勒超声(Transvaginal Color Doppler Sonography,TVCDS)在子宫内膜病变中的诊断与鉴别诊断价值?方法研究对象为2011年1月~2015年11月因阴道出血、白带过多或下腹疼痛,于我院行TVCDS的患者,共计2138人,年龄为19~61...目的探究经阴道彩色多普勒超声(Transvaginal Color Doppler Sonography,TVCDS)在子宫内膜病变中的诊断与鉴别诊断价值?方法研究对象为2011年1月~2015年11月因阴道出血、白带过多或下腹疼痛,于我院行TVCDS的患者,共计2138人,年龄为19~61岁,平均(41±3.41)岁。全部TVCDS检测阳性病例均行子宫内膜活检。本研究将TVCDS检查结果和子宫内膜活检所得病理诊断结果进行回顾性分析?结果 TVCDS诊断141例子宫内膜病变,其中子宫内膜癌诊断相符26例,误诊4例,漏诊2例;子宫内膜增生诊断相符24例,误诊3例,漏诊1例;子宫内膜息肉诊断相符53例,误诊8例,漏诊2例;子宫黏膜下肌瘤诊断相符20例,误诊3例,漏诊1例?TVCDS诊断子宫内膜病变的141例阳性病例中,正确诊断123例,误诊18例,漏诊6例,子宫内膜病变的总诊断符合率为87.23%。结论 TVCDS在诊断与鉴别诊断子宫内膜病变中有很高的运用价值?展开更多
文摘BACKGROUND In the presence of a large uterus,total laparoscopic hysterectomy(TLH),always requires morcellation to allow removal of the tissues from the abdominal cavity.However,uncontained morcellation has been scrutinized because of the possible spread of occult leiomyosarcoma.Therefore,in-bag extracorporeal morcellation has been developed.However,tissue containment and extraction are extremely challenging,especially when considering the increasing uterine size to be removed through minimally invasive surgery.CASE SUMMARY Herein,we describe a novel technique for extracorporeal intrauterine morcellation using the uterus outermost layer as a bag to achieve tissue extraction of very large uteri with suspected occult leiomyosarcoma after TLH.The study enrolled patients who were planned for TLH for large uteri(weight>500 g).TLH was performed following the procedure reported in our previous studies.The novel technique has been described step-by-step in a video,which representatively describes the preoperative imaging and morcellation procedure of three very large uteri weighing 1500 g,1700 g,and 3700 g,respectively.The procedures were performed without any complications.The patients had an uneventful postoperative course,and in all cases,the pathology was benign leiomyoma.CONCLUSION Extracorporeal intrauterine morcellation using the uterus outmost layer as a bag was found to be a feasible technique that allows a careful diagnosis and safe removal of suspected occult malignancies.The technique herein presented may be adopted in surgical practice,by adding it to the other available techniques of contained morcellation.It may represent a valid and feasible alternative,especially useful in cases of very large uteri exceeding the capacity of specimen retrieval bags.
