1. Data Analysis A retrospective medical records review was performed for the initial 100 patients who underwent Bosutinib Src inhibitor SPA-LAVH at Eun hospital. Between March 2010 and September 2011, 100 patients had undergone SPA-LAVH for nonmalignant gynecological diseases, including uterine leiomyoma (25 cases), adenomyosis (19 cases), adenomyosis coexisting leiomyoma (41 cases), preinvasive lesion of cervix coexisting adenomyosis or leiomyoma (7 cases), ovarian huge cyst (5 cases), endometrial hyperplasia (2 cases), and tuboovarian abscess (1 case). Past abdominopelvic surgery, body mass index (BMI), and the size of the uterus were not considered as exclusion criteria.
The following parameters were determined in the present observational study: age, parity, BMI, surgical history, indication for surgery, operative time (from incision to final umbilical closure), largest dimension of the uterus, weight of the extirpated uterus (as pathology report), hemoglobin change (from before surgery to postoperative day 1), and perioperative and postoperative complications. 2.2. Operation Procedures We used homemade, single-port, three-channel system using the Alexis wound retractor (Applied Medical, Rancho Santa Margarita, CA, USA), surgical glove, two 10mm trocars, and one 5mm trocar [7, 16, 17]. After partial eversion of the umbilicus, a curved semilunar skin incision was performed at the hidden lateral aspect of the umbilical crater. The incision was C-shaped and followed the natural curve of the inferior lateral aspect of the umbilical crater near the base.
After skin incision, a rectus fasciotomy and peritoneal incision were performed by direct cut-down technique. An approximately 1.5 2cm-sized skin incision was sufficient to install the three-channel, single-port system, because of the elasticity of the skin and the tissue beneath it, which can be dissected as long as required [16, 17]. As shown in Figure 1(a), the fascial edges were tagged with suture for traction prior to port system installation; this was useful for fascial closure at the end of the procedure. Figure 1 SPA-LAVH for adenomyosis with coexisting myoma (46-year-old woman). (a) Transumbilical single route for surgery using Alexis wound retractor. Distal ring was loaded within the intraperitoneal space and tightly turned inside out of the proximal ring, creating …
The Alexis wound retractor consists of a proximal ring, distal ring, and connecting retractable AV-951 sleeve. As shown in Figure 1(a), the distal ring was loaded within the intraperitoneal space and tightly turned inside out of the proximal ring (rolled up manner), creating an effective seal and a wider opening of the single-port incision by connecting retractable sleeve between the distal and proximal rings. Once fixed in the opening site, it laterally retracted the sides of the wound opening. This made the small incision as a wider and rounder opening.