Overcoming extensive abdominal adhesions: Utilizing mini-wound techniques for successful laparoscopic staging in cancer surgery

Objective

Using an ultra-mini-wound technique to dissect the adhesion surrounding the umbilicus port site aiding laparoscopic staging surgery for treating a woman with an early-stage endometrioid endometrial cancer (E-EC) who had widespread and extensive abdominal adhesions secondary to the previous complicated cesarean section (C/S) and bladder rupture.

Case Report

A 70-year-old woman with a history of a previous C/S and complicating bladder rupture treated with the Boari flap repair, leaving a longitudinal depressed scar over the abdomen from the umbilicus site to pubic hair area in her 30s was scheduled for laparoscopic staging surgery due to early-stage E-EC. We performed an ultra-mini midline incision (3-cm) crossing the umbilicus to manually dissect the adhesion surrounding the umbilicus and inserted the main trocar port to establish the workplace for further laparoscopic staging surgery. Additionally, malposition of the right ureter (passing through the dome of the abdominal cavity) secondary to previous Boari flap repair for ruptured urinary bladder was clearly identified. Surgery was completed and uneventful. The patient was discharged on the day 4 with a total length of hospital stay of four days. She is living well and freeing of disease and sequelae.

Conclusion

An ultra-mini wound assisted laparoscopic surgery can be successfully applied in women with an extensive and widespread abdominal adhesion without increasing adverse events or prolonging length of hospital stay.