膀胱吊り上げ法を使用し、腹腔鏡下に摘出しえた腟平滑筋腫の1例

抄録

  Vaginal leiomyomas are rare, and their etiology is unclear. Their symptoms and methods of surgical removal differ depending on the location and size. When adjacent to the vagina or urethra, they can be difficult to distinguish from paraurethral leiomyomas. Here, we report our experience using bladder suspension during laparoscopic removal of a vaginal leiomyoma.

  The patient was a 43-year-old woman, parity 2, who was examined for frequent urination and difficulty in urination. A 6-cm tumor was observed on the anterior vaginal wall. Eversion and extraction of the tumor outside the vagina were difficult, and therefore laparoscopic surgery was planned. To remove the vaginal wall tumor, which extended deep into the pelvis, a straight needle with nylon thread attached was used to pierce the bladder and suspended it by fixing it to the abdominal wall, which created adequate field of view and working space. Traction could not be applied because of the fragility of the myoma tissue, and the manipulations to detach the tumor were difficult due to indistinct boundaries with the vaginal wall and surrounding tissue. Nevertheless, complete enucleation was accomplished laparoscopically.

  The patient exhibited no postoperative complications, indicating that bladder suspension is a safe and useful method that could be applied to a variety of deep pelvic surgeries.