359: A New Technique for Laparoscopic Stripping of Endometriomas: FloSeal Hemostatic Agent for Hemostasis of the Ovarian Wall

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Journal of Minimally Invasive Gynecology, Vol 14, No 6, November/December Supplement 2007

Study Objective: To retrospectively assess surgical parameters and short-term safety of the MiniArc Single Incision Sling System. Design: Chart review of 50 subjects implanted at 5 sites. Data is collected for the procedure and twelve week postoperative period. Setting: Procedures were performed at 5 medical centers, with chart review occurring by clinic staff at each of the 5 site respectively. Patients: Female subjects with stress urinary incontinence (SUI) mean age 58 (⫾16.8) years were implanted with MiniArc and included in this data collection. Procedure data for 40 subjects have been identified to date. Twelve week post-operative data collection is pending. Intervention: Subjects received the MiniArc Single Incision Sling System, a minimally invasive single incision sling, with mesh placed under the urethra and anchored in the obturator internus muscles at the level of the clitoris just lateral to the ischiopubic ramus. The polypropylene mesh is placed with a single 3mm diameter needle through a single 1.5cm vaginal incision at the mid-urethra. Measurements and Main Results: Mean procedure time was 6.4 (⫾2.2) min., with a mean estimated blood loss of 24.2 (⫾16.7) ml. There were no serious intra-operative complications. The majority of subjects (34/40) were discharged in 24 hours or less. Conclusion: Procedural chart review indicates that the MiniArc Single Incision Sling System is a safe, less-invasive option for patients requiring SUI intervention. 358 A Simplified Technique for Laparoscopic Total Hysterectomy: Report 100 Cases Mota M, Sesman M. Institute National of Perinatology, Mexico DF, Mexico Study Objective: To show a simplify technique for TLH in and Institute National of Health in Mexico City with reduction of the morbility of the surgery. Design: We performed 100 hundred cases of TLH with a simplify technique and the use of the Rumi System with the Koh Cup with no morbility. Setting: Institute National of Perynatology in Mexico City it is a teaching hospital with a Endoscopic Gynecologic Clinic. Patients: One hundred patients who need a LTH for bening gynecologic disease with uterus medium and large and mean wiegth of 500 gr same technique same equipment and instrumentation. Intervention: Total laparoscopic Hysterctomy with knotting the cuff in the vertical zone by laparoscopy and remove the cervix with the Rumi System and the Koh Cup. Measurements and Main Results: Of the 100 patients 100 % no had morbility the mean time of surgery was 60 minutes the mean bleeding was 30 cc the mean stay in hospital was 1 day, we use 5 ports 4 of 5 mm and 1 of 10

mm no infections in all cases, all the patients return to they activities in 8 days. Conclusion: We can assert that with this simple technique is useful to prevent morbility and we can asure that we cand do all the cases with confident and exactness. 359 A New Technique for Laparoscopic Stripping of Endometriomas: FloSeal Hemostatic Agent for Hemostasis of the Ovarian Wall Muzii L, Perniola G, Plotti F. Rome, Italy Study Objective: To evaluate the use of FloSeal, a twocomponent (collagen granules and thrombin) topical hemostatic agent for the control of minor bleeding of the ovarian wall at the end of the stripping procedure for endometriomas. Design: Case series. Setting: Tertiary care university hospital. Patients: Five consecutive patients submitted to laparoscopic excision of endometriomas. Intervention: After laparoscopic stripping of the endometrioma wall, FloSeal was applied on the ovarian parenchyma for hemostasis. Measurements and Main Results: At the end of the laparoscopic stripping procedure for ovarian cyst (diameter between 3 and 6 cm), the ovarian cortex was carefully everted and thoroughly rinsed in order to identify the precise localization of bleeding spots. The sites were covered with FloSeal under direct vision with a laparoscopic applicator. Gentle pressure on the ovary was applied for five minutes and subsequently bleeding sites were re-examined. Bleeding had completely ceased in all cases. Conclusion: This preliminary series suggests that FloSeal may be used instead of bipolar electric coagulation after excision of ovarian endometriomas. Since the latter has been identified as a cause of follicular damage, the possible benefit of FloSeal should be investigated in patients subjected to laparoscopic stripping. 360 TVT-O Inside-out: A Promising and Safer Route to Curing Genuine Stress Incontinence Nadkarni D. Hamilton. Ontario, Canada Study Objective: The TVT-O inside-out technique is a minimal access procedure that acts in a similar way as the TVT. However it’s predicted to be associated with fewer intraoperative complications. Little research data has been published on the TVT-O inside-out technique to cure stress incontinence. This study was prompted because we were observing good responses from the patients having undergone the procedure in our center. Design: It was designed as chart review comparing cure rates in 49 patients having received the TVT procedure versus 59 patient who underwent the TVT-O technique by