2023 Volume 50 Issue 2 Pages 143-148
There are limited reports on the use of laparoscopic ultrasonography in gynecological surgery. We describe a case in which intraoperative laparoscopic ultrasonography was used to identify and treat a rare paraurethral tumor. A 39-year-old woman with four previous pregnancies and one delivery had frequent urination for approximately 1 year prior to her visit to our department. Transvaginal ultrasonography and MRI showed a well-defined mass of approximately 5 cm in diameter just below the urethra in the anterior vaginal wall. The patient had frequent urination, and the tumor seemed to have increased in size. Hence, we decided to remove it. Our preoperative diagnosis was a vaginal leiomyoma in the anterior vaginal wall, which was to be removed with laparoscopic assistance due to its proximity to the bladder and urethra. Laparoscopically, the anterior vaginal wall and bladder were dissected from the vaginal wall to near the urethra. However, there was no continuity between the tumor and vaginal wall. Furthermore, intraoperative laparoscopic ultrasonography revealed that the tumor was in the dissected peri-bladder tissue. We determined that this was a paraurethral tumor, not a vaginal tumor, and switched to a transvaginal approach that allowed periurethral manipulation, which led to the removal of the tumor. Histopathological examination revealed a leiomyoma with no malignant findings. Intraoperative laparoscopic ultrasonography allowed us to diagnose the pararectal tumor. Hence, laparoscopic ultrasonography is useful for observing the intra-abdominal cavity and identifying tumors in the vaginal, paraurethral, and periurethral areas, which are considered to be relatively rare.
