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New surgical technique of laparoscopic resection of adenomyosis under real-time intraoperative ultrasound elastography guidance: A case report.

ABSTRACT: Detecting adenomyosis in the myometrium is a challenge since it is infiltrative with ill-defined margins and can be often confused with uterine fibroids. However, recent advances, such as ultrasound elastography, have enabled its detection in the myometrium, thereby facilitating its accurate diagnosis. We report our experience of performing complete laparoscopic resection of adenomyosis under real-time ultrasound elastography guidance in a 32-year-old woman who underwent laparoscopic adenomyomectomy following severe dysmenorrhea and heavy menstrual bleeding. Real-time ultrasound elastography was also utilized intraoperatively to detect residual adenomyosis. Complete adenomyosis resection and uterine reconstruction were achieved. Follow-up magnetic resonance imaging was conducted to confirm successful uterine reconstruction. The patient recovered rapidly with no complications. Intraoperative elastography-guided laparoscopic adenomyomectomy was feasible and effective in completely removing adenomyotic lesions.

SUBMITTER: Ota Y

PROVIDER: S-EPMC7408330 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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New surgical technique of laparoscopic resection of adenomyosis under real-time intraoperative ultrasound elastography guidance: A case report.

Ota Yoshiaki Y Ota Kuniaki K Takahashi Toshifumi T Suzuki Soichiro S Sano Rikiya R Shiota Mitsuru M

Heliyon 20200804 8

Detecting adenomyosis in the myometrium is a challenge since it is infiltrative with ill-defined margins and can be often confused with uterine fibroids. However, recent advances, such as ultrasound elastography, have enabled its detection in the myometrium, thereby facilitating its accurate diagnosis. We report our experience of performing complete laparoscopic resection of adenomyosis under real-time ultrasound elastography guidance in a 32-year-old woman who underwent laparoscopic adenomyomec ...[more]

PMID: 32793836

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Project description:Rupture of the Achilles tendon is a common injury seen in patients of varying ages and activity levels. There are many considerations for treatment of these injuries, with both operative and nonoperative management providing satisfactory outcomes in the literature. The decision to proceed with surgical intervention should be individualized for each patient, including the patient’s age, future athletic goals, and comorbidities. Recently, a minimally invasive percutaneous approach to repair the Achilles tendon has been proposed as an equivalent alternative to the traditional open repair, while avoiding wound complications associated with larger incisions. However, many surgeons have been hesitant to adopt these approaches due to poor visualization, concern that suture capture in the tendon is not as robust, and the potential for iatrogenic sural nerve injury. The purpose of this Technical Note is to describe a technique using high-resolution ultrasound guidance intraoperatively during minimally invasive repair of the Achilles tendon. This technique minimizes the drawbacks of poor visualization associated with percutaneous repair, while providing the benefit of a minimally invasive approach. Technique Video Video 1 Detailed description of our preferred technique using ultrasound guidance during Achilles tendon repair with the Percutaneous Achilles Repair System (PARS) system. The ultrasound probe is placed over the posterior aspect of the ankle, overlying the Achilles tendon. The patient is in the prone position on the operating table. In the long axis view, the longitudinal fibers of the Achilles tendon and paratenon can be visualized. Moving distally, the Achilles tendon can be visualized as it inserts onto the calcaneus. Moving from distal to proximal, the Achilles tendon can be seen fanning out from a cord-like structure to more of a ribbon-like structure as it extends into the gastrocnemius and soleus. In the short-axis view, the “broom-end” appearance of the tendon can be appreciated. Moving lateral to the tendon, the sural vein and nerve can be visualized and avoided during the PARS repair. The sural nerve can be identified by its location and the classic honeycomb appearance, in contrast to the accompanying sural vein, which is hypoechoic in nature and compressible. While using the ultrasound intraoperatively, the surgeon can ensure the PARS needles are passed through the jig into the bulk of the Achilles tendon. This can be visualized on both the short- and long-axis views after each suture pass and can help decrease risk of suture cutout due to poor suture placement. Use of the ultrasound intraoperatively also allows the surgeon to identify the location of the sural nerve, and avoid it during the procedure and with each needle pass. After each needle pass is confirmed on ultrasound to have proper position, the remainder of the repair proceeds as normal.

Dataset Information

New surgical technique of laparoscopic resection of adenomyosis under real-time intraoperative ultrasound elastography guidance: A case report.

Publications

New surgical technique of laparoscopic resection of adenomyosis under real-time intraoperative ultrasound elastography guidance: A case report.

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