机器人辅助腹腔镜子宫腺肌瘤切除术：保留子宫的方法

IF 3.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology Pub Date : 2025-10-22 DOI:10.1016/j.jmig.2025.09.132

CP Diniz , CM Rowley , J Mourad

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引用次数: 0

摘要

研究目的介绍机器人辅助腹腔镜局灶性子宫肌瘤切除术的手术技术和可行性。设计案例系列报告。在门诊手术环境中执行的程序。患者或参与者2例患者表现为大量月经出血和痛经，这是术前影像学检查发现的局灶性血凝瘤/腺肌瘤所致。两人都需要保留子宫的手术治疗。干预措施：两例患者均行机器人辅助腹腔镜子宫肌瘤切除术。关键步骤包括确定受影响的区域，仔细切除周围健康的子宫肌层，并进行多层子宫重建。术中技术包括加压素注射止血和吲哚菁绿（ICG）的使用。在手术开始时，将ICG显著稀释并通过子宫操纵器注入小体积（5-10cc），使用近红外（Firefly）成像观察，以帮助描绘子宫内膜腔。采用延迟可吸收倒刺缝线多层重建子宫缺损。测量和主要结果评估手术参数、病理证实和短期临床结果。•病理证实在两个切除标本局灶性腺肌瘤。•估计失血量（EBL）分别为50和75 mL。•无术中或术后立即并发症。•两名患者均在12小时内出院。结论子宫切除术是子宫腺肌症的最终治疗方法，机器人辅助子宫肌瘤切除术是一种可行、安全、有效的保留子宫的替代方法，在适当选择的患者中可以获得良好的短期症状控制。这种方法可以通过ICG引导的腔划定、细致的子宫重建和输卵管通畅等技术进行精确切除，从而保留子宫结构，满足患者的偏好，并有可能保持他们期望的生育能力。

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Robotic-Assisted Laparoscopic Adenomyomectomy: A Uterus-Sparing Approach

Study Objective

To describe the surgical technique and demonstrate the feasibility of robotic-assisted laparoscopic excision of focal adenomyomas (adenomyomectomy) in patients desiring uterine preservation.

Design

Case Series Report.

Setting

Procedures performed in an ambulatory surgery setting.

Patients or Participants

Two patients presented with heavy menstrual bleeding and dysmenorrhea attributed to focal adenomyosis/adenomyoma identified on preoperative imaging. Both desired uterus-sparing surgical management.

Interventions

Both patients underwent robotic-assisted laparoscopic adenomyomectomy. Key steps included identification of the affected area, careful excision from surrounding healthy myometrium, and multi-layer uterine reconstruction. Intraoperative techniques included vasopressin injection for hemostasis and the use of indocyanine green (ICG). The ICG, diluted significantly and instilled in a small volume (5-10cc) via the uterine manipulator at the start of the procedure, was visualized using near-infrared (Firefly) imaging to help delineate the endometrial cavity during excision. Uterine defects were reconstructed in multiple layers using delayed absorbable barbed suture.

Measurements and Primary Results

Operative parameters, pathological confirmation, and short-term clinical outcomes were evaluated.

• Pathology confirmed focal adenomyoma in both resected specimens.

• Estimated blood loss (EBL) was 50 and 75 mL, respectively.

• There were no intraoperative or immediate postoperative complications.

• Both patients were discharged home within 12 hours.

Conclusion

While hysterectomy offers definitive treatment for adenomyosis, robotic-assisted adenomyomectomy represents a feasible, safe, and effective uterus-sparing alternative, achieving favorable short-term symptom control in appropriately selected patients. This approach allows for precise excision with techniques like ICG guidance for cavity delineation, meticulous uterine reconstruction, and confirmation of tubal patency, thereby preserving uterine structure, addressing patient preference, and potentially maintaining their desired fertility.

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来源期刊

Journal of minimally invasive gynecology 医学-妇产科学

CiteScore

5.00

自引率

7.30%

发文量

272

审稿时长

37 days

期刊介绍： The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.