PMC6036857_01
CT scan of the monstrous uterus myomatosus of a 47-year-old nulliparous patient.
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Before surgery, we performed imaging diagnostics by means of computed tomography (CT) of the abdomen (Figure 1).
Positions of the 3 trocars on the left side of the patient.
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As such, we inserted 6 trocars including 3 on the left: one trocar in the lower, one in the middle, and one in the upper abdomen, allowing access to the left narrow space (Figure 2).
The camera was introduced via the trocar in the upper abdomen.
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Surgery was initiated at the patient's left side, using the upper left trocar to introduce the camera (Figure 3) and the other two left-located trocars to introduce forceps and coagulator or scissors.
The surgical team switched their position from the left to the right side of the patient which allowed a better access and view of the right side. (a) Start on the left side. (b) Change to the right side.
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Next, the surgeon and his team switched sides positioning to the right side of the patient, thus accessing the narrow space on the right side in between the right uterine wall and right abdominal wall (Figure 4).
At the patient's right side, the uterus was exposed and the right adnexa, parametria, and blood vessels were prepared and abscised. Then, we resected the corpus uteri and peritonealized the cervix with a purse-string suture (Figure 6).
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CT scan, multinodal, intraligamentary, and parametric myomas were found on the right side. Consequently, further exposure and protection of the ureter was done by visualizing followed by preparing or abscising the right adnexa, parametria, and blood vessels (Figure 5).