Abstract:
OBJECTIVE:Laparoscopic uterine artery ligation may be performed during myomectomy or other uterine invasive procedures to reduce the amount of blood loss during surgery. In this video, the authors describe 3 different laparoscopic techniques to approach the uterine artery. DESIGN:Step-by-step video demonstration of 3 different surgical techniques. SETTING:Private hospital in Curitiba, Paraná, Brazil. INTERVENTIONS:The main steps of uterine artery ligation are described in detail as well as different laparoscopic variants to this procedure. ANTERIOR APPROACH:The impression of the uterine vessels can usually be seen anteriorly and laterally to the uterine cervix. After identification of the path of the uterine arteries, the peritoneum of the anterior cul-de-sac is opened over the vessels and the uterine artery is carefully dissected next to the lateral border of the uterine cervix. This dissection must be performed with extreme caution because the uterine veins are very close to the artery. Venous bleeding at this point of the dissection can be very difficult to control without ligating the vessels. After circumferential dissection of the artery, temporary occlusion is conducted using 2-0 polyester suture. POSTERIOR APPROACH, LATERAL TO THE INFUNDIBULOPELVIC LIGAMENT:For ligation of the uterine artery posteriorly to the uterus and laterally to the pelvic infundibulum, opening of the peritoneum of the broad ligament should start immediately below the round ligament, parallel and medial to the external iliac vessels toward the base of the pelvic infundibulum. The avascular space is dissected by blunt dissection (traction and countertraction), identifying the lateral (external iliac vessels) and medial (pelvic infundibulum and the ureter attached to the peritoneum of the ovarian fossa) landmarks. The external iliac artery is dissected cranially to find the bifurcation of the common iliac artery and the internal iliac artery. The first medial branch of the anterior division of the internal iliac usually is the uterine artery. After circumferential dissection of the uterine artery, it may be ligated according to the same technique described above. MEDIAL APPROACH:For the medial approach, the peritoneum should be opened medial to the infundibulopelvic ligament. The assistant grasps the infundibulopelvic ligament, creating a peritoneal tent. Immediately after broad ligament opening, anatomic landmarks are identified. First, the ureter is identified and medialized. For the identification of vascular anatomy, movement of the obliterated umbilical artery is made active, which reduces the risk of error to ligate the uterine artery. After circumferential dissection of the artery, it may be ligated according to the same technique described above. CONCLUSION:Laparoscopic uterine artery ligation may be performed during laparoscopic myomectomy to reduce intraoperative blood loss. According to the position of the myomas within the uterus as well as the uterine volume, the surgeon may choose among 1 of the above-mentioned techniques to perform. This technique could also be applied to other types of invasive uterine procedures to reduce blood loss. Standardization of these techniques could help to reduce the laparoscopic learning curve.
journal_name
J Minim Invasive Gynecoljournal_title
Journal of minimally invasive gynecologyauthors
Carranco RC,Vigeras A,Ribeiro R,Zomer MT,Kondo Wdoi
10.1016/j.jmig.2019.08.026subject
Has Abstractpub_date
2020-01-01 00:00:00pages
811-812issue
4eissn
1553-4650issn
1553-4669pii
S1553-4650(19)30404-2journal_volume
27pub_type
杂志文章abstract::Arteriovenous malformation (AVM) of the uterus is a rare cause of menorrhagia and may at times lead to life-threatening hemorrhage. The clinical findings may not always be reliable in the diagnosis of uterine AVM, and a high index of suspicion is important because, unlike many other causes of menorrhagia, curettage ma...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.jmig.2011.07.007
更新日期:2011-11-01 00:00:00
abstract:STUDY OBJECTIVE:To estimate pulmonary complications and diaphragm recurrence after resection of diaphragm metastases by minimally invasive surgery (MIS) for epithelial ovarian cancer (EOC). DESIGN:Retrospective analysis (Canadian Task Force classification III). SETTING:Mayo Clinic in Scottsdale, Arizona, from January...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2018.12.003
更新日期:2019-01-01 00:00:00
abstract:STUDY OBJECTIVE:To compare the effectiveness of and patient satisfaction with different routes of misoprostol administration for short-term cervical priming before operative hysteroscopy. DESIGN:Randomized blinded trial (Canadian Task Force classification I). SETTING:University hospital. PATIENTS:One hundred and twe...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jmig.2016.12.024
更新日期:2017-01-01 00:00:00
abstract:STUDY OBJECTIVE:To show how pudendal neurolysis can be managed safely with a laparoscopic approach. DESIGN:Stepwise demonstration of the technique with narrated video footage. SETTING:The pudendal nerve is formed from spinal roots at levels S2, S3, and S4. It passes through the pelvis parallel to the pudendal vein an...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2020.11.003
更新日期:2020-11-18 00:00:00
abstract::At laparoscopic-assisted vaginal hysterectomy with a novel "paper roll" vaginal morcellation technique, large uteri (> or = 500 g) can be removed via the vagina with safety, speed, and ease. The technique provides protection for the bladder and rectum, and large uteri can be removed in 1 piece, allowing the pathologis...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2010.02.005
更新日期:2010-05-01 00:00:00
abstract:STUDY OBJECTIVE:To describe the feasibility of performing Essure hysteroscopic sterilization immediately after NovaSure global endometrial ablation (GEA). DESIGN:Descriptive feasibility study (Canadian Task Force classification III). SETTING:Midwestern United States academic medical center. PATIENTS:Twenty-five wome...
journal_title:Journal of minimally invasive gynecology
pub_type: 临床试验,杂志文章
doi:10.1016/j.jmig.2007.01.014
更新日期:2007-07-01 00:00:00
abstract::A panel of experts in the field of endometriosis expressed their opinions on management options in a 35-year-old patient desiring pregnancy with a history of previous surgery for endometrioma and bowel obstruction symptoms. Many questions that this paradigmatic patient may pose to the clinician are addressed, and vari...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2015.01.021
更新日期:2015-05-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the feasibility and surgical outcome of a novel technique of endoscopic inguinal lymphadenectomy to treat vulvar cancer. DESIGN:Retrospective analysis performed by a single center over 2 years (Canadian Task Force classification II-2). SETTING:Major university teaching hospital. PATIENTS:...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2011.06.011
更新日期:2011-09-01 00:00:00
abstract::Although the use of vaginal mesh kits in treatment of pelvic organ prolapse (POP) has decreased the number of surgical failures, mesh exposure can occur. When conservative management fails, removing the exposed material is associated with the risk of recurrence of POP and could be challenging. We report a successful o...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2012.10.007
更新日期:2013-03-01 00:00:00
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journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2009.03.010
更新日期:2009-07-01 00:00:00
abstract::Lymphatic complications are a common occurrence after staging surgery for early-stage ovarian cancer (eEOC). We investigated whether the introduction of minimally invasive surgery influences the risk of developing lymphoceles and lymphorrhea in patients undergoing staging for eEOC. For this purpose, data of consecutiv...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.jmig.2017.03.014
更新日期:2017-01-01 00:00:00
abstract:STUDY OBJECTIVE:To study the effect of robotic surgery on the surgical approach to endometrial cancer in a gynecologic oncology center over a short time. DESIGN:Prospective analysis of patients with early-stage endometrial cancer who underwent robotic surgery. SETTING:Teaching hospital. PATIENTS:Eighty patients who ...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2009.03.013
更新日期:2009-07-01 00:00:00
abstract:STUDY OBJECTIVE:To assess the safety and efficacy of cold loop hysteroscopic myomectomy in a large series of cases. DESIGN:Retrospective study (Canadian Task Force Classification III). SETTING:Arbor Vitae Center for Endoscopic Gynecology, Rome, Italy. PATIENTS:A total of 1215 patients with 1 or more G1-G2 submucous ...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2015.03.004
更新日期:2015-07-01 00:00:00
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journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2019.08.014
更新日期:2020-01-01 00:00:00
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journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.jmig.2015.10.014
更新日期:2016-03-01 00:00:00
abstract::A MEDLINE search was conducted using the keywords "laparoscopy ovarian cancer," "laparoscopy and borderline ovarian tumors," "advanced stage ovarian cancer," "laparoscopic cytoreduction ovarian cancer," "laparoscopy intraperitoneal catheter," "port-site metastases," and "carbon dioxide pneumoperitoneum." The publicati...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.jmig.2009.01.007
更新日期:2009-05-01 00:00:00
abstract:STUDY OBJECTIVE:To describe a technique for hysteroscopic removal of retained products of conception (RPOC) implanted over an area of adenomyosis. DESIGN:A case report (Canadian Task Force classification III). SETTING:RPOC is an unfortunate complication that may occur after the resolution of a normal pregnancy; it is...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2017.09.010
更新日期:2018-01-01 00:00:00
abstract:STUDY OBJECTIVE:To assess the feasibility and safety of a McCall culdoplasty at the time of total laparoscopic hysterectomy and to evaluate the differences in the total vaginal length, vaginal apex during Valsalva, and sexual function 12 months after McCall culdoplasty compared with standard cuff closure. DESIGN:A pil...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jmig.2017.10.036
更新日期:2018-01-01 00:00:00
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journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jmig.2006.05.014
更新日期:2006-09-01 00:00:00
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journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2015.10.017
更新日期:2016-03-01 00:00:00
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journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2016.07.008
更新日期:2017-01-01 00:00:00
abstract:STUDY OBJECTIVE:To assess features of power morcellators (blade diameter, circular vs oscillating cutting, blade rotation speed, experience level) regarding their effect on the amount of tissue spill. In addition, the amount of tissue spill after the initial two-thirds and final one-third of the morcellated specimen wa...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2015.09.014
更新日期:2016-01-01 00:00:00
abstract::The objective of this retrospective study was to evaluate the feasibility, safety, and efficacy of a new laparoscopic technique for the treatment of uterovaginal prolapse using a transcervical access port to minimize the laparoscopic incision. From February 2008 through August 2010, symptomatic pelvic organ prolapse i...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2012.06.009
更新日期:2012-11-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the feasibility of total laparoscopic hysterectomy (TLH) using the Hohl instrument in an initial cohort of patients. DESIGN:Retrospective cohort analysis (Canadian Task Force classification II-3). SETTING:Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germ...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2005.04.006
更新日期:2005-09-01 00:00:00
abstract::Herein is described the case of a 28-year-old woman in whom uterine artery embolization (UAE) was performed to treat intramural ectopic pregnancy. The intramural ectopic pregnancy was diagnosed at magnetic resonance imaging, which showed a gestational sac surrounded completely by myometrium. The UAE procedure was unco...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2012.10.005
更新日期:2013-03-01 00:00:00
abstract:STUDY OBJECTIVE:Although all ectopic pregnancies are associated with risk of hemorrhage, cornual pregnancies are feared for catastrophic hemorrhage and uncontrollable bleeding. The maternal mortality rate can be as high as 2.5%, which is 7 times higher than the mortality rate for ectopic pregnancies in general. Differe...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2017.04.005
更新日期:2017-01-01 00:00:00
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journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2016.05.014
更新日期:2016-01-01 00:00:00
abstract:STUDY OBJECTIVE:The aim of this study was to evaluate the surgical and oncologic outcomes of robotic hysterectomy with or without or less pelvic and aortic lymphadenectomy in severely obese patients (body mass index [BMI] ≥ 40 kg/m(2)) with endometrial cancer. MATERIAL AND METHODS:Between August 2010 and November 2014...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jmig.2015.08.887
更新日期:2016-01-01 00:00:00
abstract:STUDY OBJECTIVE:To report the combined hysteroscopic and laparoscopic treatment of a complete septate uterus with unilateral cervical aplasia (class U2bC3V0/ESHRE/ESGE classification) and isolated mullerian remnants. DESIGN:Step-by-step presentation of the surgical treatment (Canadian Task Force classification 4). SE...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2015.09.006
更新日期:2016-01-01 00:00:00
abstract:STUDY OBJECTIVE:To compare the cost-effectiveness of ultrasound (US)-guided aspiration and ethanol sclerotherapy versus laparoscopic surgery for benign-appearing ovarian endometrioma. DESIGN:Prospective, cohort pilot study. SETTING:Multiple centers, Spain. PATIENTS:Forty patients with suspected ovarian endometrioma ...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jmig.2019.08.036
更新日期:2020-01-01 00:00:00