[Total pelviscopic removal of ovarian tumors in a bag bag posterior colpotomy].
Treatment of suspicious ovarian masses requires the oophorectomy in toto without opening the tumor or cyst wall. We describe a laparoscopic technique for the in-toto-removal of clinically suspicious ovarian tumours without puncture or morcellation of the tumour before it is entirely brought outside of the abdominal wall and without performing any abdominal incision longer than 25 mm: Oophorectomy is performed by means of bipolar coagulation and the CO2-laser. A nylon bag (Lapsac, Cook Inc.) is inserted into the abdomen and the ovary is enclosed in this bag by pulling the drawstring. The drawstring is held with a needleholder while the posterior vaginal fornix is opened. The needleholder drives the drawstring out of the pelvis through the vagina; this manoeuvre only takes a short amount of time, therefore preventing loss of CO2-gas and of visibility. By pulling the drawstring from outside the vagina the bag can be easily removed with its unmorcellated content. There is no danger of the intestines being damaged by a grasping forceps. Such a problem could occur in the event of extraction through a posterior culdotomy under impaired visibility due to loss of CO2-gas. Because the bag itself serves as a closing valve of the vaginal opening, there is a good visibility all the time.
Bratschi
H U
HU
Klinik Sonnenhof, Bern/Schweiz.
Heiz
B
B
D005260:Female; D006801:Humans; D020706:Laparoscopes; D053685:Laser Therapy / Q000295:instrumentation; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D010052:Ovariectomy / Q000295:instrumentation*; D010053:Ovary / Q000473:pathology; D013525:Surgical Instruments; D014621:Vagina / Q000601:surgery