Objective of the study: For pregnant women with ovarian cysts, it's important that pregnant uterus is gently
treated in laparoscopic cystectomy. Especially the cases incarcerated in recto-uterine
pouch are difficult to do laparoscopic ovarian cystectomy. Such cases are suitable
for vaginal ovarian cystectomy, but it has severe complication, rectal injury. As
a reliable method of transvaginal access, we introduce a new culdotomy procedure and
repoted two pregnant cases.
Methods and procedures: New culdotomy procedure uses a technique for the creation of space in the cul-de-sac,
transvaginal ultrasound, and a newly developed umbrella Hakko needle. The umbrella
Hakko needle consists of a 19-gauge, 30-cm long, metal needle with an overcoat.
Results: In both cases, culdotomy was performed successfully. There were no severe operative
complications, rectal injury. Also, there were no blood transfusion, no severe hemoglobin
drop, and no postoperative complications.Pregnancy course of both case were no problem,
normal vaginal delivery.
Conclusions based on the results: Ultrasound-guided culdotomy of vaginal ovarian cystectomy for pregnant women incarcerated
ovarian dermoid cysts in retro-uterine pouch is useful, minimally invasive surgery.
It has potential applicability in transvaginal NOTES for pregnant women.
