Single Port Access Total Laparoscopic Hysterectomy in Patient with Huge Myoma: Uterine Removal with Intraabominal Cutting Technique

Abstract

A 41-year-old woman with huge uterine myoma underwent SPA-TLH. Singel port channel system was consisted with The Alexis® wound retractor (Applied Medical, CA, USA) and 7½ surgical glove. Entering the abdominal cavity, the uterus was enlarged to 20 gestational weeks in size and globular in shape. After hysterectomy was completed in the abdomen, we used the cutting instrument, Lap-Blade (Red medical, Korea), for removal of huge uterus. We put Lap-Blade into the abdomen via single port channel, cut and sliced the huge mass in a spiral motion, and then divided into 5 pieces. This made it easy to remove from the vaginal cavity. It took 45 minutes for specimen removal. The total operation time was 115 minutes. The uterus weighed 1380 grams. Result: Intraabdominal cutting technique with endoscopic blade can reduce the time of specimen extraction. We believe this technique is feasible for SPA-TLH.