Akademik Veri Yönetim Sistemi
Journal of Gynecologic Surgery, cilt.32, sa.3, ss.207-210, 2016 (ESCI)
© 2016 Mary Ann Liebert, Inc.Background: Robotic hysterectomy for removal of large uteri is associated with several technical difficulties, such as removal of a large-sized uterus through the vagina. The aim of this case presentation and brief literature review is to describe the techniques and difficulties involved with the removal of a large uterus during a robot-assisted laparoscopic hysterectomy. Case: A 50-year-old woman presented with abnormal bleeding that was refractory to pharmacologic treatment. A vaginal examination showed that her uterus extended up to the umbilicus level. A review of the literature was performed to analyze uterine-removal techniques for large uteri via robotic hysterectomy. The hysterectomy procedure was performed carefully with some modifications, such as using a unidirectional method and performing posterior rotation of a uterine manipulator to provide a visual field. After the hysterectomy, the patient's uterine cervix was pulled through her vagina via a tenaculum. The posterior part of the uterus was pulled sequentially by placing a tenaculum on the posterior part of the uterus and gradually positioning it toward the uterine fundus. This method was a modified "roller paper" technique that is different from original description of the technique, because there was no cutting of the uterus in the original technique. The large uterus was then removed easily by the vaginal route. Results: The operation was completed successfully without perioperative complications. Conclusions: Although some techniques for removing large uteri - such as morcellation, uterus bivalving, T-shaped incision of the posterior vaginal cuff - a modified "roller paper" technique is safe, effective, and easy, and confers apparently no risk of tumoral dissemination. (J GYNECOL SURG 32:207)