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Laparoscopic retroperitoneal access to ovarian cysts fixed by severe pelvic adhesions: a case report
Left cystectomy or left adnexectomy can be difficult in cases of frozen pelvis, with an adnexa entirely covered with the sigmoid colon and stuck to the pelvic sidewall.
This video clearly demonstrates the advantages of the left retroperitoneal access to the adnexa, limiting the risks of injury of the ureter and the perforation of the sigmoid colon. The different steps of the operation are as follows: 1) Lysis of adhesions between the sigmoid colon and the left pelvic sidewall to visualize the tube. 2) Division of adhesions between the sigmoid colon and the uterus to visualize the left ovary. 3) Left retroperitoneal access to the ovary with a longitudinal incision of the peritoneum, laterally. 4) Division of the utero-ovarian pedicle. 5) Retroperitoneal dissection of the ureter to completely release the ovary from the ureter. 6) Lysis of the upper surface of the ovary from the sigmoid colon.
JB Dubuisson, J Dubuisson
Хирургические операции
3 года назад
5614 просмотров
297 лайков
0 комментариев
08:20
Laparoscopic retroperitoneal access to ovarian cysts fixed by severe pelvic adhesions: a case report
Left cystectomy or left adnexectomy can be difficult in cases of frozen pelvis, with an adnexa entirely covered with the sigmoid colon and stuck to the pelvic sidewall.
This video clearly demonstrates the advantages of the left retroperitoneal access to the adnexa, limiting the risks of injury of the ureter and the perforation of the sigmoid colon. The different steps of the operation are as follows: 1) Lysis of adhesions between the sigmoid colon and the left pelvic sidewall to visualize the tube. 2) Division of adhesions between the sigmoid colon and the uterus to visualize the left ovary. 3) Left retroperitoneal access to the ovary with a longitudinal incision of the peritoneum, laterally. 4) Division of the utero-ovarian pedicle. 5) Retroperitoneal dissection of the ureter to completely release the ovary from the ureter. 6) Lysis of the upper surface of the ovary from the sigmoid colon.
Adnexal masses: techniques, principles
When dealing with adnexal masses, it is fundamental to learn how to diagnose them, to exclude functional cysts, and to address benign and malignant conditions properly. Looking back on past history, the main factor is the patient’s age, considering that the risk of malignancy increases significantly after menopause. An appropriate selection of patients has helped in the reduction of occurrence of unexpected cancer managed by laparoscopy to 4-6/1000 women with adnexal masses. The operator should always follow surgical principles which include careful examination of the external surface of the tumor, peritoneal cytology, prevention of cyst rupture, prevention of contact between the cyst and the abdominal wall and frozen section examination in case of suspicious lesion. The dermoid cyst is the most common type of ovarian germ cell tumor and the recommended treatment is cystectomy following conventional principles: ovarian capsule incision, cyst wall dissection (making sure not to open it), selective coagulation of bleeders and ovarian closure according to the case. In the case of endometriotic cysts it is recommended to preserve as much ovarian tissue as possible and to preserve the vascularization in the ovarian hilus. Finally during cyst removal from the abdominal cavity, the use of plastic bags has been associated with the lowest rate of cyst spillage.
B Van Herendael
Лекции
7 лет назад
4723 просмотра
97 лайков
0 комментариев
29:56
Adnexal masses: techniques, principles
When dealing with adnexal masses, it is fundamental to learn how to diagnose them, to exclude functional cysts, and to address benign and malignant conditions properly. Looking back on past history, the main factor is the patient’s age, considering that the risk of malignancy increases significantly after menopause. An appropriate selection of patients has helped in the reduction of occurrence of unexpected cancer managed by laparoscopy to 4-6/1000 women with adnexal masses. The operator should always follow surgical principles which include careful examination of the external surface of the tumor, peritoneal cytology, prevention of cyst rupture, prevention of contact between the cyst and the abdominal wall and frozen section examination in case of suspicious lesion. The dermoid cyst is the most common type of ovarian germ cell tumor and the recommended treatment is cystectomy following conventional principles: ovarian capsule incision, cyst wall dissection (making sure not to open it), selective coagulation of bleeders and ovarian closure according to the case. In the case of endometriotic cysts it is recommended to preserve as much ovarian tissue as possible and to preserve the vascularization in the ovarian hilus. Finally during cyst removal from the abdominal cavity, the use of plastic bags has been associated with the lowest rate of cyst spillage.