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1450 Laparoscopic Cornual Resection of Heterotopic Cornual Pregnancy
S108
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
complications. Uterine artery embolization reduced more than 50% of the uterine volume. These strategies facilitated the access to the pelvis and promoted excellent laparoscopic view to completely treat myomatosis and deep endometriosis.
pregnancy. The myometrial lesion showed connection to the endometrial cavity. The site of removal was closed with interrupted polyglactin endosutures. The postoperative course was uneventful and the final pathologic report was an adenomyomatous polyp. Because the myometrial lesion showed connection to the endometrial cavity, hysteroscopic examination was performed after recovery, demonstrated a polypoid mass and a uterine septum. Hysteroscopic polypectomy was performed and the pathological diagnosis was also an adenomyomatous polyp. Conclusion: To our knowledge, this is the first report of an adenomyomatous polyp growing through the myometrial layer, into the pelvic cavity. Further study and a larger number of cases are needed to elucidate the mechanism which lies beneath the penetrating growth pattern of the adenomyomatous polyp into the myometrium.
Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION N 1450 Laparoscopic Cornual Resection of Heterotopic Cornual Pregnancy Jiang L,* Chan-Tiopaianco M, Horng HC, Chen YJ, Wang PH. Obstetrics and Gynecology, Taipei Veteran General Hospital, Taipei, Taiwan *Corresponding author. Video Objective: Laparoscopic heterotopic cornual pregnancy resection. Setting: A 41 y/o woman, with history of G3P0E1(status post right salpingectomy)SA1 got pregnancy via IVF with frozen embryo transferred. Four embryos were transferred. However, at about gestational age 6 weeks, two intrauterine gestational sac and one right cornual gestational sac were found. All the fetus had heart beats. Thin uterine wall at right cornus about 0.53cm in size was also noticed. To preserve normal intrauterine pregnancy, surgical intervention was suggested, and the patient received laparoscopic cornual resection surgery. Interventions: During operation, to prevent fetus injury, we didn’t use uterine manipulator or pitressin injection. We also avoided electrical energy device to decrease thermal effect to fetus. Because of the rich blood flow of uterus, we hoped to decreased the surgical time, and barbed suture was used. Multiple suture layers for uterus was applied. We also used vaginal ultrasound during operation to check the uterine condition. After checking bleeders, adhesion barrier was used. For postoperative medication, progesterone was prescribed for tocolysis. We checked ultrasound after the surgery, and only one fetus with fetal heart beat was noticed. Conclusion: Laparoscopic heterotypic cornual pregnancy resection is feasible with the advantages of decreased hospital stay, less wound pain, and less use of analgesics. Further obstetrics outcome is reassuring in current studies. Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION O 1402 Hemoperitoneum Caused by Ectopic Location of an Adenomyomatous Polyp Moon HS,* Koo JS, Nam GI. Obstetrics & Gynecology, Good Moonhwa Hospital, Busan, Korea, Republic of (South) *Corresponding author. Video Objective: To demonstrate an unusual case of hemoperitoneum caused by adenomyomatous polyps growing through the myometrial layer, into the pelvic cavity. Setting: An academic teaching hospital. Interventions: A 46-year-old woman was referred for postcoital abdominal pain for 3 days. Physical examination revealed both direct and rebound tenderness of the whole abdomen. Her vital signs were stable. The hemoglobin level was 12.7g/dL, CA-125 elevated to 80.3 U/ml (reference range, 0-35 U/ml) and serum b-hCG level below 1.2mIU/ml. Transvaginal ultrasound demonstrated free fluid in cul-de-sac. The initial clinical diagnosis was hemoperitoneum and she underwent operative laparoscopy. Approximately 500cc of blood and clots were pooled in the abdomino-pelvic cavity. A brown-colored soft lesion with an irregular surface was noted in the right cornua which was suspected to be a ruptured interstitial pregnancy. Removed tissue specimen was sent for frozen biopsy, of which result was endometrial tissue not related to
Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION P 1787 A Case of Female Genital Tuberculosis with Superimposed Tubo-Ovarian Abscess in a Developed Nation Fowler ML,* O’Rourke-Suchoff D, Steer J, Noel NL, Hendessi P. Boston Medical Center, Boston, MA *Corresponding author. Video Objective: To describe the surgical techniques in a case of female genital tuberculosis (TB) with superimposed tubo-ovarian abscess (TOA) in a developed country. Setting: A 22-year-old G0 who was born in Vietnam presented to the emergency room with pelvic pain and known bilateral hydrosalpinx. She was treated for pelvic inflammatory disease, and a TB test was sent and later returned as positive. Her initial chest x-ray was read as normal. When she returned for follow up, a CT scan was planned to evaluate the extent of pulmonary and possible pelvic disease. However, before this could be done, she became febrile, requiring hospitalization with concern for TB or TOA. Interventions: Once pulmonary and peritoneal TB were suspected based on imaging, diagnosis of TB was attempted via sputum culture and endometrial biopsy. However, there was significant concern that the patient had a tubo-ovarian abscess given the high fevers, dilated tubes, and delay in urogenital TB diagnosis confirmation. This led to the patient being taken to the operating room for diagnostic laparoscopy and drainage of the tube. This video shows the techniques used to evaluate pelvic organs when acute infection is suspected. Ultimately, the endometrial biopsy returned positive for culture of Mycobacterium tuberculosis, confirming the diagnosis of female genital tuberculosis. Conclusion: This patient was diagnosed genital TB with superimposed bacterial infection, leading to the pyosalpinx. Female genital TB can cause a diagnostic challenge, and surgery may be required to achieve a diagnosis. Pre-operative planning and careful surgical technique is essential when faced with dense adhesions. Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION Q 2932 Total Laparoscopic Hysterectomy: 5 Step Approach for Uteri Larger than 500 Grams Katebi Kashi P,* Hamilton CA. OB/GYN, Inova FairFax Hospital, Falls Church, VA *Corresponding author. Video Objective: To demonstrate a five step approach facilitating successful completion of Total Laparoscopic Hysterectomy (TLH) in patients with uteri larger than 500 grams.
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
complications. Uterine artery embolization reduced more than 50% of the uterine volume. These strategies facilitated the access to the pelvis and promoted excellent laparoscopic view to completely treat myomatosis and deep endometriosis.
pregnancy. The myometrial lesion showed connection to the endometrial cavity. The site of removal was closed with interrupted polyglactin endosutures. The postoperative course was uneventful and the final pathologic report was an adenomyomatous polyp. Because the myometrial lesion showed connection to the endometrial cavity, hysteroscopic examination was performed after recovery, demonstrated a polypoid mass and a uterine septum. Hysteroscopic polypectomy was performed and the pathological diagnosis was also an adenomyomatous polyp. Conclusion: To our knowledge, this is the first report of an adenomyomatous polyp growing through the myometrial layer, into the pelvic cavity. Further study and a larger number of cases are needed to elucidate the mechanism which lies beneath the penetrating growth pattern of the adenomyomatous polyp into the myometrium.
Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION N 1450 Laparoscopic Cornual Resection of Heterotopic Cornual Pregnancy Jiang L,* Chan-Tiopaianco M, Horng HC, Chen YJ, Wang PH. Obstetrics and Gynecology, Taipei Veteran General Hospital, Taipei, Taiwan *Corresponding author. Video Objective: Laparoscopic heterotopic cornual pregnancy resection. Setting: A 41 y/o woman, with history of G3P0E1(status post right salpingectomy)SA1 got pregnancy via IVF with frozen embryo transferred. Four embryos were transferred. However, at about gestational age 6 weeks, two intrauterine gestational sac and one right cornual gestational sac were found. All the fetus had heart beats. Thin uterine wall at right cornus about 0.53cm in size was also noticed. To preserve normal intrauterine pregnancy, surgical intervention was suggested, and the patient received laparoscopic cornual resection surgery. Interventions: During operation, to prevent fetus injury, we didn’t use uterine manipulator or pitressin injection. We also avoided electrical energy device to decrease thermal effect to fetus. Because of the rich blood flow of uterus, we hoped to decreased the surgical time, and barbed suture was used. Multiple suture layers for uterus was applied. We also used vaginal ultrasound during operation to check the uterine condition. After checking bleeders, adhesion barrier was used. For postoperative medication, progesterone was prescribed for tocolysis. We checked ultrasound after the surgery, and only one fetus with fetal heart beat was noticed. Conclusion: Laparoscopic heterotypic cornual pregnancy resection is feasible with the advantages of decreased hospital stay, less wound pain, and less use of analgesics. Further obstetrics outcome is reassuring in current studies. Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION O 1402 Hemoperitoneum Caused by Ectopic Location of an Adenomyomatous Polyp Moon HS,* Koo JS, Nam GI. Obstetrics & Gynecology, Good Moonhwa Hospital, Busan, Korea, Republic of (South) *Corresponding author. Video Objective: To demonstrate an unusual case of hemoperitoneum caused by adenomyomatous polyps growing through the myometrial layer, into the pelvic cavity. Setting: An academic teaching hospital. Interventions: A 46-year-old woman was referred for postcoital abdominal pain for 3 days. Physical examination revealed both direct and rebound tenderness of the whole abdomen. Her vital signs were stable. The hemoglobin level was 12.7g/dL, CA-125 elevated to 80.3 U/ml (reference range, 0-35 U/ml) and serum b-hCG level below 1.2mIU/ml. Transvaginal ultrasound demonstrated free fluid in cul-de-sac. The initial clinical diagnosis was hemoperitoneum and she underwent operative laparoscopy. Approximately 500cc of blood and clots were pooled in the abdomino-pelvic cavity. A brown-colored soft lesion with an irregular surface was noted in the right cornua which was suspected to be a ruptured interstitial pregnancy. Removed tissue specimen was sent for frozen biopsy, of which result was endometrial tissue not related to
Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION P 1787 A Case of Female Genital Tuberculosis with Superimposed Tubo-Ovarian Abscess in a Developed Nation Fowler ML,* O’Rourke-Suchoff D, Steer J, Noel NL, Hendessi P. Boston Medical Center, Boston, MA *Corresponding author. Video Objective: To describe the surgical techniques in a case of female genital tuberculosis (TB) with superimposed tubo-ovarian abscess (TOA) in a developed country. Setting: A 22-year-old G0 who was born in Vietnam presented to the emergency room with pelvic pain and known bilateral hydrosalpinx. She was treated for pelvic inflammatory disease, and a TB test was sent and later returned as positive. Her initial chest x-ray was read as normal. When she returned for follow up, a CT scan was planned to evaluate the extent of pulmonary and possible pelvic disease. However, before this could be done, she became febrile, requiring hospitalization with concern for TB or TOA. Interventions: Once pulmonary and peritoneal TB were suspected based on imaging, diagnosis of TB was attempted via sputum culture and endometrial biopsy. However, there was significant concern that the patient had a tubo-ovarian abscess given the high fevers, dilated tubes, and delay in urogenital TB diagnosis confirmation. This led to the patient being taken to the operating room for diagnostic laparoscopy and drainage of the tube. This video shows the techniques used to evaluate pelvic organs when acute infection is suspected. Ultimately, the endometrial biopsy returned positive for culture of Mycobacterium tuberculosis, confirming the diagnosis of female genital tuberculosis. Conclusion: This patient was diagnosed genital TB with superimposed bacterial infection, leading to the pyosalpinx. Female genital TB can cause a diagnostic challenge, and surgery may be required to achieve a diagnosis. Pre-operative planning and careful surgical technique is essential when faced with dense adhesions. Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION Q 2932 Total Laparoscopic Hysterectomy: 5 Step Approach for Uteri Larger than 500 Grams Katebi Kashi P,* Hamilton CA. OB/GYN, Inova FairFax Hospital, Falls Church, VA *Corresponding author. Video Objective: To demonstrate a five step approach facilitating successful completion of Total Laparoscopic Hysterectomy (TLH) in patients with uteri larger than 500 grams.