You are here

Article Text

Article menu

Download PDFPDF

Video article
Retrograde hysterectomy approach in a patient with a frozen pelvis due to a suspected ovarian malignancy
  1. Xuhui Dong,
  2. Lei Yuan and
  3. Liangqing Yao
  1. Obstetrics and Gynecology Hospital of Fudan University, Shanghai, Shanghai, China
  1. Correspondence to Dr Liangqing Yao, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, Shanghai, China; yaoliangqing{at}163.com

https://doi.org/10.1136/ijgc-2022-003363

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Surgical treatment of gynecological disease with colorectal involvement is a challenge which requires complete surgical excision of lesions.1 Blind blunt dissection of the Douglas pouch might cause massive and rectal tissue damage.2 3 Traditional hysterectomy may cause rectal injury for those cases with severe adhesion in the Douglas pouch.4 Retrograde hysterectomy has usually been applied in laparoscopic assisted vaginal surgery. However, are case demonstrated retrograde laparoscopic hysterectomy for a patient with severe adhesion in the Douglas pouch.

    Method: A step-by-step video demonstration of the technique

    Result: A 53-year-old woman with a history of dysmenorrhea had abdominal distention for 2 months. PET-CT showed that the uptake of fluorodeoxyglucose in the surrounding peripheral rim of soft tissue masses was elevated. Laparoscopy showed severe adhesions in the pelvic cavity, which might be caused by malignant tumor and endometriosis. It is difficult to expose the Douglas pouch due to the dense adhesions with poorly defined margins posteriorly to the uterus. Therefore, the surgeon decided to open the Douglas pouch finally. After coagulating the ligaments, pushing the bladder, and incising the vaginal wall, the outline and margin of the lesion was exposed so that the lesion could be cut off safely. Omentectomy, appendicectomy, partial peritonectomy, pelvic and para-aortic lymph node resection were performed. The neoplasm in the right ovarian cyst was clear cell carcinoma, and the lesion on the surface of the rectum was endometriosis. The patient recovered well without any complications and defecated 3 days after surgery. She is still alive up to now.

    Conclusion: Our video showed that a flexible change in laparoscopic surgical procedures could overcome difficulty safely and quickly. Compared with the traditional type, retrograde hysterectomy can recognize the margin of a lesion, and is a safe alternative for patients with dense adhesion around the uterus.

    Video 1 Retrograde hysterectomy approach in a patient with a frozen pelvis due to a suspected ovarian malignancy

    Data availability statement

    All data relevant to the study are included in the article.

    Ethics statements

    Patient consent for publication

    Ethics approval

    This study involves human participants but the ethics committee of the Obstetrics and Gynecology Hospital of Fudan University exempted this study. Participants gave informed consent to participate in the study before taking part.

    References

    1. ↵
      2. Yoriki K ,
      3. Kusuki I ,
      4. Kawamata M , et al
      . Successful detection of rectal injury during laparoscopic surgery using a rectal probe in a patient with deep endometriosis. J Obstet Gynaecol Res 2021;47:425–9.doi:10.1111/jog.14535 pmid:http://www.ncbi.nlm.nih.gov/pubmed/33073414
      OpenUrlPubMed
    2. ↵
      2. Volpi E ,
      3. Bernardini L ,
      4. Angeloni M , et al
      . Retroperitoneal and retrograde total laparoscopic hysterectomy as a standard treatment in a community hospital. Eur J Obstet Gynecol Reprod Biol 2014;172:97–101.doi:10.1016/j.ejogrb.2013.10.013 pmid:http://www.ncbi.nlm.nih.gov/pubmed/24315354
      OpenUrlPubMed
    3. ↵
      2. Litta P ,
      3. Saccardi C ,
      4. Conte L , et al
      . Reverse hysterectomy: another technique for performing a laparoscopic hysterectomy. J Minim Invasive Gynecol 2013;20:631–6.doi:10.1016/j.jmig.2013.04.004 pmid:http://www.ncbi.nlm.nih.gov/pubmed/23688601
      OpenUrlPubMed
    4. ↵
      2. Cho F-N
      . A technique to deal with severe adhesions between the uterus and bladder or rectum in laparoscopic-assisted vaginal hysterectomy. J Minim Invasive Gynecol 2007;14:750–1.doi:10.1016/j.jmig.2007.07.003 pmid:http://www.ncbi.nlm.nih.gov/pubmed/17980338
      OpenUrlPubMed

    Footnotes

    • Contributors XD: data collection and video editing, reviewing the literature, drafting and revising the manuscript; LY: revision of the manuscript; LY: patient’s overall management, final approval of the version to be submitted and critical review of the manuscript. All authors read and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.