case_images: PMC4808536_01
case_images: Transvaginal color Doppler ultrasonography showing a pedunculated myoma connected to the uterine body. The blood flow was interrupted at the base of the myoma pedicle (arrow), suggesting the occurrence of torsion.
case_images: CRIOG2016-7831270.001.jpg
case_images: PMC4808536_01_CRIOG2016-7831270.001.jpg
case_images: fig1
case_images: On transvaginal ultrasonography, a solid pedunculated mass measuring 55 x 41 mm was identified (Figure 1). Further evaluation by color Doppler ultrasonography showed that the blood flow was interrupted at the base of the pedicle of this mass (Figure 1, arrow), suggesting the presence of torsion.
case_images: Sagittal T2-weighted MRI showing a torted pedicle of the subserosal myoma (arrow).
case_images: CRIOG2016-7831270.002.jpg
case_images: PMC4808536_01_CRIOG2016-7831270.002.jpg
case_images: fig2
case_images: Sagittal T2-weighted MRI (Figure 2) confirmed this finding by showing a subserosal myoma with a torted pedicle (Figure 2, arrow).
case_images: Gasless laparoendoscopic single-site myomectomy was performed through an Alexis wound retractor (small size, Applied Medical, Rancho Santa Margarita, CA) attached via a 2.5 cm midline umbilical skin incision with the surgical view secured by abdominal-wall lifting with an intra-abdominal fan retractor system (Mizuho Co., Tokyo, Japan).
case_images: CRIOG2016-7831270.003.jpg
case_images: PMC4808536_01_CRIOG2016-7831270.003.jpg
case_images: fig3
case_images: A single-port laparoscopic view showing the necrotized subserosal myoma with torsion at its pedicle in the cul-de-sac (arrow).
case_images: CRIOG2016-7831270.004.jpg
case_images: PMC4808536_01_CRIOG2016-7831270.004.jpg
case_images: fig4
case_images: Under laparoscopic vision using a rigid 5 mm, 30-degree EndoEYE laparoscope (Olympus, Tokyo, Japan), a necrotized subserosal myoma with torsion at its pedicle was identified in the pouch of Douglas (Figure 4, arrow).
case_images: Extracorporeal extraction of excised myoma was performed through the umbilical incision by in-bag manual morcellation using a number 11 surgical blade.
case_images: CRIOG2016-7831270.005.jpg
case_images: PMC4808536_01_CRIOG2016-7831270.005.jpg
case_images: fig5
case_images: For efficient retrieval, another smaller Alexis wound retractor (X-small size, Applied Medical) was placed inside the retriever bag to maximize the size of the opening as well as fixing unevenness in the circumference (Figure 5).
case_images: The cosmetic outcome of the wound, which was concealed in the umbilicus after gasless laparoendoscopic single-site myomectomy.
case_images: CRIOG2016-7831270.006.jpg
case_images: PMC4808536_01_CRIOG2016-7831270.006.jpg
case_images: fig6
case_images: After the surgical procedure was completed, the wound retractor was removed and the umbilical wound was closed (Figure 6).