PMC4808536_01
Transvaginal color Doppler ultrasonography showing a pedunculated myoma connected to the uterine body. The blood flow was interrupted at the base of the myoma pedicle (arrow), suggesting the occurrence of torsion.
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On transvaginal ultrasonography, a solid pedunculated mass measuring 55 x 41 mm was identified (Figure 1). Further evaluation by color Doppler ultrasonography showed that the blood flow was interrupted at the base of the pedicle of this mass (Figure 1, arrow), suggesting the presence of torsion.
Sagittal T2-weighted MRI showing a torted pedicle of the subserosal myoma (arrow).
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Sagittal T2-weighted MRI (Figure 2) confirmed this finding by showing a subserosal myoma with a torted pedicle (Figure 2, arrow).
Gasless laparoendoscopic single-site myomectomy was performed through an Alexis wound retractor (small size, Applied Medical, Rancho Santa Margarita, CA) attached via a 2.5 cm midline umbilical skin incision with the surgical view secured by abdominal-wall lifting with an intra-abdominal fan retractor system (Mizuho Co., Tokyo, Japan).
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A single-port laparoscopic view showing the necrotized subserosal myoma with torsion at its pedicle in the cul-de-sac (arrow).
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Under laparoscopic vision using a rigid 5 mm, 30-degree EndoEYE laparoscope (Olympus, Tokyo, Japan), a necrotized subserosal myoma with torsion at its pedicle was identified in the pouch of Douglas (Figure 4, arrow).
Extracorporeal extraction of excised myoma was performed through the umbilical incision by in-bag manual morcellation using a number 11 surgical blade.
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For efficient retrieval, another smaller Alexis wound retractor (X-small size, Applied Medical) was placed inside the retriever bag to maximize the size of the opening as well as fixing unevenness in the circumference (Figure 5).
The cosmetic outcome of the wound, which was concealed in the umbilicus after gasless laparoendoscopic single-site myomectomy.
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After the surgical procedure was completed, the wound retractor was removed and the umbilical wound was closed (Figure 6).