Restricted accessCase reportFirst published online 2013-06
Transvaginal Natural Orifice Specimen Extraction with Wound Retractor in Management of Large Ovarian Fibroma with Extensive Calcification by Laparoendoscopic Single-Site Surgery
Background: With advancements in surgical technique and equipment, successful laparoscopic management has been reported in selected cases of ovarian fibroma. However, management of large ovarian fibroma with extensive calcification by laparoendoscopic single-site surgery (LESS) has never been described. Case: A 24-year-old nulligravida was referred because of a pelvic mass with suspicion of large subserosal myoma. In addition to extensive calcification in the central portion of the tumor, three-dimensional computerized tomographic angiography showed aneurysm-like dilatation of the ascending branch of the left uterine artery that anastomosed with the left ovarian artery. Left ovarian tumor with prominent vascularization was successfully excised by LESS. For natural orifice specimen extraction (NOSE), a wound retractor was transvaginally placed through posterior colpotomy. Then, the solid ovarian tumor was extracted by fragmentation using a scissors and cold knife under laparoscopic monitoring. Results: The patient's postoperative course was uneventful. Pathologic diagnosis was ovarian fibroma with extensive calcification. Conclusions: Transvaginal NOSE could be potentially useful to extract bulky specimens in gynecologic LESS surgery. (J GYNECOL SURG 29:151)
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