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. 2016:2016:7831270.
doi: 10.1155/2016/7831270. Epub 2016 Mar 13.

Torsion of a Subserosal Myoma Managed by Gasless Laparoendoscopic Single-Site Myomectomy with In-Bag Manual Extraction

Akihiro Takeda  1 , Hiromi Nakamura  1
Affiliations

Torsion of a Subserosal Myoma Managed by Gasless Laparoendoscopic Single-Site Myomectomy with In-Bag Manual Extraction

Akihiro Takeda et al. Case Rep Obstet Gynecol. 2016.

Abstract

Acute torsion of a subserosal myoma is a rare surgical emergency that is infrequently diagnosed preoperatively. Furthermore, laparoendoscopic single-site (LESS) myomectomy with in-bag tissue extraction for the management of this disorder has not yet been described. A 43-year-old, gravida 1, para 1 woman was referred to our department due to a solid pelvic mass associated with persistent abdominal pain. A pedunculated subserosal myoma with torsion was strongly suspected based on ultrasonography and magnetic resonance imaging. Emergency LESS surgery showed that the subserosal myoma arising from the posterior uterine wall torted at its pedicle in the cul-de-sac. The twisted myoma node was excised by coagulation and cut using a LigaSure Atlas, followed by in-bag manual morcellation and extraction through an umbilical wound. The present case report emphasizes that LESS myomectomy with in-bag tissue extraction is a feasible minimally invasive surgical option for the management of subserosal myoma with torsion after a precise imaging-based diagnostic evaluation.

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Figures

Figure 1
Figure 1
Transvaginal color Doppler ultrasonography showing a pedunculated myoma connected to the uterine body. The blood flow was interrupted at the base of the myoma pedicle (arrow), suggesting the occurrence of torsion.
Figure 2
Figure 2
Sagittal T2-weighted MRI showing a torted pedicle of the subserosal myoma (arrow).
Figure 3
Figure 3
Gasless laparoendoscopic single-site myomectomy was performed through an Alexis wound retractor (small size, Applied Medical, Rancho Santa Margarita, CA) attached via a 2.5 cm midline umbilical skin incision with the surgical view secured by abdominal-wall lifting with an intra-abdominal fan retractor system (Mizuho Co., Tokyo, Japan).
Figure 4
Figure 4
A single-port laparoscopic view showing the necrotized subserosal myoma with torsion at its pedicle in the cul-de-sac (arrow).
Figure 5
Figure 5
Extracorporeal extraction of excised myoma was performed through the umbilical incision by in-bag manual morcellation using a number 11 surgical blade.
Figure 6
Figure 6
The cosmetic outcome of the wound, which was concealed in the umbilicus after gasless laparoendoscopic single-site myomectomy.
See this image and copyright information in PMC

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