In this paper, http://www.selleckchem.com/products/Trichostatin-A.html we describe our clinical experience and techniques for LESS in this first case of a bilateral salpingo-oophorectomy for a 10cm ovarian fibroma, as well as outline our efforts in tackling the above-mentioned constraints imposed by single port surgery, and in doing so, hope to contribute to this exciting new area of laparoscopic surgery. To our knowledge, this is the first case report in the region about LESS techniques being applied in this clinical scenario. 2. Case Summary A 64-year-old Chinese lady first presented to our hospital with features of obstructive jaundice secondary to her underlying condition of choledocholithiasis, previously undiagnosed. Computed tomographic (CT) scan revealed a single adnexal mass of possibly ovarian origin.

A gynaecological consult was sought and a detailed pelvic ultrasound was performed which showed a well-defined 10cm solid mass posterior to and separate from the uterus, with low resistance vascularity on dopplers. The mass was highly mobile on clinical examination. The patient subsequently underwent an emergency laparoscopic cholecystectomy in view of her worsening jaundice and clinical status. A surveillance of the pelvis showed a large 10cm left ovarian mass, well circumscribed and mobile, with features of an ovarian fibroma. The rest of her pelvic organs were grossly normal. As the duration of the emergency cholecystectomy was long due to surgical difficulties, the decision was made to remove the ovarian mass in a separate operation to avoid prolonging anaesthetic exposure. The operation was scheduled three months after her cholecystectomy.

She remained asymptomatic, and the mass was constant in size. Open Hasson entry was performed and a 2cm umbilical incision was made and concealed completely within the umbilicus to gain initial entry into the peritoneal cavity. The incision was then extended by another 0.5cm via stretching of the skin. No other extraumbilical skin incisions were used. The entire umbilical scar measured 2.5cm, which was just large enough to accommodate the single port. Next, the single port (Covidien) with three access inlets was introduced, and carbon dioxide pneumoperitoneum was created (Figure 1). A 5mm rigid video laparoscope was deployed via one of the access port inlets (Figure 2), and other working instruments were introduced via the remaining two inlets (Figure 3).

During the procedure, the patient was placed in Trendelenburg position. The uterus was manipulated with a Hegar dilator and the working instruments used Batimastat were standard laparoscopic instruments. Figure 1 Creation of pneumoperitoneum. Figure 2 Mutliple port access. Figure 3 Instrumentation. Intra-abdominally, recreation of triangulation was done, which would be further elaborated in Section 3. Bilateral salpingo-oophorectomy was performed.