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Complex Cloaca Repair
Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252 management, surgical intervention is warranted. This video describes an unusual clinical scenario involving spondylodiscitis, along with its evaluation and management. Surgical intervention has historically been performed with laparotomy, however in select presentations, a minimally invasive laparoscopic approach is warranted. The techniques for laparoscopic removal of sacral colpopexy mesh are demonstrated in the setting of spondylodiscitis. 412
Video Session 16 - Urogyn/Pelvic Floor Disorders/Vaginal Surgery (3:25 PM - 5:05 PM) 3:46 PM – GROUP A
The Laparoscopic Pectopexy (NPP): A New Approach for Apical Prolapse Repair Noe GK. Ob/Gyn, Comunal Clinic of Dormagen, Dormagen, NRW, Germany For prolapse repair we prefer the combination of different techniques according to the pelvic floor defects and the patients complains. In more than 90% we combine the pectopexy with additional vaginal or laparoscopic approaches. Laparoscopic colposuspension, vaginal colporraphy, laparoscopic midline or posterior facial repair. The long-term follow-up (21.8 months) showed a clear difference regarding de novo defecation disorders (0% in the pectopexy versus 19.5% in the sacropexy group). De novo SUI occurred in 4.8% vs 4.9%. Rectoceles incidence (9.5% vs 9.8%) was similar in both groups. No de novo lateral defect cystoceles were found after pectopexy but 12.5% after sacropexy. The apical relapse rates, 2.3% versus 9.8%, were not statistically significant. Laparoscopic pectopexy is a novel method of vaginal prolapse therapy that offers practical advantages compared to laparoscopic sacropexy. As laparoscopic pectopexy does not reduce the pelvic space and it results in a zero percentage of defecation disorders. 413
Video Session 16 - Urogyn/Pelvic Floor Disorders/Vaginal Surgery (3:25 PM - 5:05 PM) 3:57 PM – GROUP B
Laparoscopic Repair of Rectovesical Fistula Puntambekar SS, Jadhav SM, Gauba YR, Manchekar MM, Puntambekar SP. Galaxy Care Laparoscopy Institute, Pune, Maharashtra, India The objective is to demonstrate laparoscopic repair of Recto-vesical fistula in a hysterectomised patient. Detailed explanation and demonstration of each step of the surgery is shown using the video attached below. Our patient was operated case of Ca Ovary for which open hysterectomy was done 2 months back. she came to our institute with complaints of passing feces from the urine. Colonoscopy revealed 20mm recto-vesical fistula 10cms from the anal verge. Here we went through transcystic route by splitting the bladder in two halves, ureters were cannulated and excision and repair of Rectovesical fistula was done. Laparoscopic repair is a feasible and efficacious approach for the management of such an entity because of its increased magnification, better understanding of anatomy and ability to work in deep pelvis. 415
Video Session 16 - Urogyn/Pelvic Floor Disorders/Vaginal Surgery (3:25 PM - 5:05 PM) 4:04 PM – GROUP B
Technique for Apical Support at the Time of Laparoscopic Vaginal Cuff Closure Adajar AA,1 Juarez L,2 Takshk E,2 Jachtorowycz MJ,3 Nitti JS.4 1Illinois Institute of Gynecology & Advanced Pelvic Surgery, Chicago, Illinois;
2
S141 3
Ob/Gyn, Presence St. Joseph’s Hospital, Chicago, Illinois; Ob/Gyn, Presence St. Francis Hospital, Evanston, Illinois; 4Ob/Gyn, Rush University Medical Center, Chicago, Illinois Apical suspension performed at the time of benign hysterectomy is recommended to decrease the risk of pelvic organ prolapse. Incorporating native, level 1 uterosacral ligaments into vaginal cuff closure, when performed from a laparoscopic approach, has less risks of complications when compared to a vaginal approach. Benefits with the laparoscopic approach include direct visualization of the ureters, improved access to the para-vaginal space, as well as decreased estimated blood loss and decreased hospital duration. The laparoscopic approach also has been found to have superior apical support and total vaginal length. The following video demonstrates a laparoscopic technique to incorporate the uterosacral ligaments for apical support, when closing the vaginal cuff, when performing a benign hysterectomy. 416
Video Session 16 - Urogyn/Pelvic Floor Disorders/Vaginal Surgery (3:25 PM - 5:05 PM) 4:11 PM – GROUP B
Surgical Pearls in Vaginal Hysterectomy Leon MG, Chang-Jackson S-CR, Miller HJ. Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center at Houston/McGovern School of Medicine, Houston, Texas Vaginal hysterectomy remains the safest and most cost-effective route to remove the uterus with benign disease (1-4). The vaginal approach has also been proven to be a valid alternative for enlarged uteri (5). Despite this evidence, fewer than 20% of hysterectomies are performed using this method (6). This video demonstrates techniques on how to successfully perform this minimally invasive procedure. Innovative approaches to prevent and identify bladder injuries are provided, including intravesical instillation of methylene blue, a method that has not been well-described in the available literature on vaginal hysterectomy. By showing how to prepare the surgical field, place tissue clamps, perform morcellation of a large specimen, and remove the adnexa, this video illustrates how to perform a vaginal hysterectomy safely and efficiently. 417
Video Session 16 - Urogyn/Pelvic Floor Disorders/Vaginal Surgery (3:25 PM - 5:05 PM) 4:18 PM – GROUP B
Complex Cloaca Repair Eigg MH. Ob/Gyn, Rochester General Hospital, Rochester, New York This is a case presentation surgical video of a 59 year old female who formed a Cloaca after an ano-vaginal fistula repair and anal sphincteroplasty. The patient has Crohn’s disease and CREST syndrome that complicated her prior surgery and this presented reconstruction. The repair in this video uses bilateral Martius flaps. During this surgery only the bulbocavernosus fat pads are developed and utilized bilaterally. 418
Video Session 16 - Urogyn/Pelvic Floor Disorders/Vaginal Surgery (3:25 PM - 5:05 PM) 4:29 PM – GROUP C
Laparoscopic Excision of the ‘‘Wadded’’ Apical Vaginal Mesh Elkattah R, Mohling S, Furr R. Women’s Surgery Center, Chattanooga, Tennessee
Video Session 16 - Urogyn/Pelvic Floor Disorders/Vaginal Surgery (3:25 PM - 5:05 PM) 3:46 PM – GROUP A
The Laparoscopic Pectopexy (NPP): A New Approach for Apical Prolapse Repair Noe GK. Ob/Gyn, Comunal Clinic of Dormagen, Dormagen, NRW, Germany For prolapse repair we prefer the combination of different techniques according to the pelvic floor defects and the patients complains. In more than 90% we combine the pectopexy with additional vaginal or laparoscopic approaches. Laparoscopic colposuspension, vaginal colporraphy, laparoscopic midline or posterior facial repair. The long-term follow-up (21.8 months) showed a clear difference regarding de novo defecation disorders (0% in the pectopexy versus 19.5% in the sacropexy group). De novo SUI occurred in 4.8% vs 4.9%. Rectoceles incidence (9.5% vs 9.8%) was similar in both groups. No de novo lateral defect cystoceles were found after pectopexy but 12.5% after sacropexy. The apical relapse rates, 2.3% versus 9.8%, were not statistically significant. Laparoscopic pectopexy is a novel method of vaginal prolapse therapy that offers practical advantages compared to laparoscopic sacropexy. As laparoscopic pectopexy does not reduce the pelvic space and it results in a zero percentage of defecation disorders. 413
Video Session 16 - Urogyn/Pelvic Floor Disorders/Vaginal Surgery (3:25 PM - 5:05 PM) 3:57 PM – GROUP B
Laparoscopic Repair of Rectovesical Fistula Puntambekar SS, Jadhav SM, Gauba YR, Manchekar MM, Puntambekar SP. Galaxy Care Laparoscopy Institute, Pune, Maharashtra, India The objective is to demonstrate laparoscopic repair of Recto-vesical fistula in a hysterectomised patient. Detailed explanation and demonstration of each step of the surgery is shown using the video attached below. Our patient was operated case of Ca Ovary for which open hysterectomy was done 2 months back. she came to our institute with complaints of passing feces from the urine. Colonoscopy revealed 20mm recto-vesical fistula 10cms from the anal verge. Here we went through transcystic route by splitting the bladder in two halves, ureters were cannulated and excision and repair of Rectovesical fistula was done. Laparoscopic repair is a feasible and efficacious approach for the management of such an entity because of its increased magnification, better understanding of anatomy and ability to work in deep pelvis. 415
Video Session 16 - Urogyn/Pelvic Floor Disorders/Vaginal Surgery (3:25 PM - 5:05 PM) 4:04 PM – GROUP B
Technique for Apical Support at the Time of Laparoscopic Vaginal Cuff Closure Adajar AA,1 Juarez L,2 Takshk E,2 Jachtorowycz MJ,3 Nitti JS.4 1Illinois Institute of Gynecology & Advanced Pelvic Surgery, Chicago, Illinois;
2
S141 3
Ob/Gyn, Presence St. Joseph’s Hospital, Chicago, Illinois; Ob/Gyn, Presence St. Francis Hospital, Evanston, Illinois; 4Ob/Gyn, Rush University Medical Center, Chicago, Illinois Apical suspension performed at the time of benign hysterectomy is recommended to decrease the risk of pelvic organ prolapse. Incorporating native, level 1 uterosacral ligaments into vaginal cuff closure, when performed from a laparoscopic approach, has less risks of complications when compared to a vaginal approach. Benefits with the laparoscopic approach include direct visualization of the ureters, improved access to the para-vaginal space, as well as decreased estimated blood loss and decreased hospital duration. The laparoscopic approach also has been found to have superior apical support and total vaginal length. The following video demonstrates a laparoscopic technique to incorporate the uterosacral ligaments for apical support, when closing the vaginal cuff, when performing a benign hysterectomy. 416
Video Session 16 - Urogyn/Pelvic Floor Disorders/Vaginal Surgery (3:25 PM - 5:05 PM) 4:11 PM – GROUP B
Surgical Pearls in Vaginal Hysterectomy Leon MG, Chang-Jackson S-CR, Miller HJ. Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center at Houston/McGovern School of Medicine, Houston, Texas Vaginal hysterectomy remains the safest and most cost-effective route to remove the uterus with benign disease (1-4). The vaginal approach has also been proven to be a valid alternative for enlarged uteri (5). Despite this evidence, fewer than 20% of hysterectomies are performed using this method (6). This video demonstrates techniques on how to successfully perform this minimally invasive procedure. Innovative approaches to prevent and identify bladder injuries are provided, including intravesical instillation of methylene blue, a method that has not been well-described in the available literature on vaginal hysterectomy. By showing how to prepare the surgical field, place tissue clamps, perform morcellation of a large specimen, and remove the adnexa, this video illustrates how to perform a vaginal hysterectomy safely and efficiently. 417
Video Session 16 - Urogyn/Pelvic Floor Disorders/Vaginal Surgery (3:25 PM - 5:05 PM) 4:18 PM – GROUP B
Complex Cloaca Repair Eigg MH. Ob/Gyn, Rochester General Hospital, Rochester, New York This is a case presentation surgical video of a 59 year old female who formed a Cloaca after an ano-vaginal fistula repair and anal sphincteroplasty. The patient has Crohn’s disease and CREST syndrome that complicated her prior surgery and this presented reconstruction. The repair in this video uses bilateral Martius flaps. During this surgery only the bulbocavernosus fat pads are developed and utilized bilaterally. 418
Video Session 16 - Urogyn/Pelvic Floor Disorders/Vaginal Surgery (3:25 PM - 5:05 PM) 4:29 PM – GROUP C
Laparoscopic Excision of the ‘‘Wadded’’ Apical Vaginal Mesh Elkattah R, Mohling S, Furr R. Women’s Surgery Center, Chattanooga, Tennessee