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Laparoscopic Bilateral Ovarian Transposition With Preservation of Tubes in Women With Medulloblastoma
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253 minimally invasive approach. Laparoscopic assistance may also be necessary secondary to lack of tactile feedback with robotic surgery. 545
Video Posters – Reproductive Issues
Tips for Laparoscopic Single Incision Abdominal Cerclage Placement Guan X, Walsh T, Hernandez A, Osial P, Xu D. Baylor College of Medicine, Houston, Texas This video demonstrates a laparoscopic single incision abdominal cerclage placement in a patient with cervical incompetence. Single-incision surgery is initially more challenging due to the poor ergonomics, but with practice this technique is feasible for a provider with experience in laparoscopic surgery. This video aims to teach techniques for performing a laparoscopic single-incision cerclage. This video reviews how single-site suturing and knot tying can be performed with minimal difficulty. 546 Fimbrioplasty and Neosalpingostomy: Treating Infertility Tubal Factor Hernandez Nieto CA, Paez Lobeira LC. Gynecology and Obstetrics, Tec Salud - ITESM, San Pedro Garza Garcıa, Nuevo Leon, Mexico Tubal factor infertility, as example, hidrosalpynx, is best treated by salpingectomy and IVF. This may not be feasible for some patients; for these ones, tubal surgery may be offered. The advantages of tubal surgery are that it is a one-time, minimally invasive outpatient procedure, and patients may attempt conception every month without further intervention and may conceive more than once. A good prognosis is associated with patients who have no more than limited filmy adnexal adhesions, mildly dilated tubes (\3 cm) with thin and pliable walls, and a lush endosalpinx with preservation of the mucosal fonds. Laparoscopic neosalpingostomy and fimbrioplasty are carried out by opening a hydrosalpinx or increasing the opening for fimbrial phimosis, respectively., with good pregnancy outcomes, and low ectopic pregnancy rates after surgery. Patients with poor-prognosis hydrosalpinges are better served by salpingectomy followed by IVF. 547 Laparoscopic Ovarian Transposition Kakar F,1 English D,2 Menderes G,2 Azodi M.2 1Ob/Gyn, Danbury Hospital, Danbury, Connecticut; 2Ob/Gyn, Yale New Haven, New Haven, Connecticut Patient is a 34-year-old G1P0010 with diagnosis of cervical cancer. Although her last PAP in 2012 was normal, her most recent showed LSIL. Subsequent colposcopy and biopsy revealed CINIII. LEEP procedure in 12/2014, revealed a poorly differentiated carcinoma of the cervix in the background of CINIII, and Lymphovascular Space Invasion (LVSI). Therefore, the need for radical hysterectomy, possible adjuvant therapy, and fertility sparing options were discussed. Robotic assisted type III radical hysterectomy with upper vaginectomy, bilateral salpingectomy with preservation of both ovaries, bilateral pelvic and periaortic lymph node dissection was performed. Chemoradiaiton was recommended by tumor board, given LVSI and deep stromal invasion on pathology. Given patient’s desire for future fertility, laparoscopic ovarian transposition of the left and cortical stripping of the right ovary was performed. Radiation verification films were obtained, which verified the new location of the ovary to be outside of the high intensity radiation zone. 548 Herlyn Werner Wunderlich Syndrome: Varying Presentations Raju R, Abuzeid OM, Bolonduro O, Akinpeloye A, Ashraf M, Abuzeid MI. Ob/Gyn, Hurley Medical Center, Flint, Michigan Herlyn Werner Wunderlich Syndrome is a rare congenital anomaly. We present two cases of HWW Syndrome with varying presentations. Case 1
S153
presented with severe dysmenorrhea and a significant left hematometra with Stage II endometriosis resulting in early diagnosis at the age of 14. Case 2 was asymptomatic and diagnosed incidentally on an ultrasound performed during an annual exam with minimal endometriosis which resulted in a delayed diagnosis at the age of 23. This difference in presentation can be secondary to the fused uteri in Case 2 resulting in more of hematocolpos and less of hematometra. HWW syndrome can thus have varying presentations ranging from severe dysmenorrhea to an asymptomatic incidental finding. 549 Laparoscopic Bilateral Ovarian Transposition With Preservation of Tubes in Women With Medulloblastoma Kart C, Guven S, Guvendag g€uven E. Obstetrcs & Gynaecology, Blacksea Technical University, Trabzon, Turkey 26-year-old women, unmarried. mormal ovarian reserve, AMH:2.7 operated cranial medulloblastoma. vertebral and cranial radiotherapy planned. to preeserve ovarian reserve laparoscopic ovarian transposition planned in order to preserve future fertility. both tubes also preserved and ovaries were put at lateral edge of colon almost 10 cm away from vertebral column. 550 Laparoscopic Management of a Rudimentary Horn Pregnancy Shiber LJ, Biscette S. Minimally Invasive Gynecologic Surgery, University of Louisville Hospital, Louisville, Kentucky Rudimentary horn pregnancy is rare, occurring in 1 in 76,000 to 1 in 140,000 pregnancies. Radiologic diagnosis is often difficult. When suspected in an asymptomatic patient, laparoscopic resection of the gravid horn can be accomplished safely. This surgical film provides a general outline of mullerian anomalies, specifically those categorized as unicornuate, and reviews the limited literature regarding diagnosis and management of rudimentary uterine horn pregnancy. A patient case is then discussed and a detailed presentation of the laparoscopic approach to resection of a pregnant rudimentary horn is provided, using surgical footage. Surgical techniques, including identification of surrounding anatomy and attention to hemostasis are highlighted. 551
Video Posters – Robotics
Overcoming the Obstacles of Visualization in Robotically-Assisted Abdominal Cerclage Using Indocyanine Green Zeybek B, Borahay M, Kilic GS. Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas The aim of this video is to present a case of a robotically-assisted abdominal cerclage and use of indocyanine green dye for overcoming the obstacles of visualization during the procedure. 552 Robotic Single-Incision Myomectomy Guan X, Harry C, Walsh T, Osial P. Baylor College of Medicine, Houston, Texas We present a case of robotic-single incision myomectomy. Robotic singlesite site surgery does have minor limitations compared to multi-port robotic surgery. While it continues to have the benefits of excellent 3D visualization, most of the robotic-single site instruments do not yet have the ability to articulate and there is decreased range of motion at the accessory port which requires minor changes to surgical technique. Our video demonstrates that this technology is capable of performing a myomectomy despite the current robotic instrument restrictions. Tips are provided help successfully approach and perform a successful roboticsingle site myomectomy.
Video Posters – Reproductive Issues
Tips for Laparoscopic Single Incision Abdominal Cerclage Placement Guan X, Walsh T, Hernandez A, Osial P, Xu D. Baylor College of Medicine, Houston, Texas This video demonstrates a laparoscopic single incision abdominal cerclage placement in a patient with cervical incompetence. Single-incision surgery is initially more challenging due to the poor ergonomics, but with practice this technique is feasible for a provider with experience in laparoscopic surgery. This video aims to teach techniques for performing a laparoscopic single-incision cerclage. This video reviews how single-site suturing and knot tying can be performed with minimal difficulty. 546 Fimbrioplasty and Neosalpingostomy: Treating Infertility Tubal Factor Hernandez Nieto CA, Paez Lobeira LC. Gynecology and Obstetrics, Tec Salud - ITESM, San Pedro Garza Garcıa, Nuevo Leon, Mexico Tubal factor infertility, as example, hidrosalpynx, is best treated by salpingectomy and IVF. This may not be feasible for some patients; for these ones, tubal surgery may be offered. The advantages of tubal surgery are that it is a one-time, minimally invasive outpatient procedure, and patients may attempt conception every month without further intervention and may conceive more than once. A good prognosis is associated with patients who have no more than limited filmy adnexal adhesions, mildly dilated tubes (\3 cm) with thin and pliable walls, and a lush endosalpinx with preservation of the mucosal fonds. Laparoscopic neosalpingostomy and fimbrioplasty are carried out by opening a hydrosalpinx or increasing the opening for fimbrial phimosis, respectively., with good pregnancy outcomes, and low ectopic pregnancy rates after surgery. Patients with poor-prognosis hydrosalpinges are better served by salpingectomy followed by IVF. 547 Laparoscopic Ovarian Transposition Kakar F,1 English D,2 Menderes G,2 Azodi M.2 1Ob/Gyn, Danbury Hospital, Danbury, Connecticut; 2Ob/Gyn, Yale New Haven, New Haven, Connecticut Patient is a 34-year-old G1P0010 with diagnosis of cervical cancer. Although her last PAP in 2012 was normal, her most recent showed LSIL. Subsequent colposcopy and biopsy revealed CINIII. LEEP procedure in 12/2014, revealed a poorly differentiated carcinoma of the cervix in the background of CINIII, and Lymphovascular Space Invasion (LVSI). Therefore, the need for radical hysterectomy, possible adjuvant therapy, and fertility sparing options were discussed. Robotic assisted type III radical hysterectomy with upper vaginectomy, bilateral salpingectomy with preservation of both ovaries, bilateral pelvic and periaortic lymph node dissection was performed. Chemoradiaiton was recommended by tumor board, given LVSI and deep stromal invasion on pathology. Given patient’s desire for future fertility, laparoscopic ovarian transposition of the left and cortical stripping of the right ovary was performed. Radiation verification films were obtained, which verified the new location of the ovary to be outside of the high intensity radiation zone. 548 Herlyn Werner Wunderlich Syndrome: Varying Presentations Raju R, Abuzeid OM, Bolonduro O, Akinpeloye A, Ashraf M, Abuzeid MI. Ob/Gyn, Hurley Medical Center, Flint, Michigan Herlyn Werner Wunderlich Syndrome is a rare congenital anomaly. We present two cases of HWW Syndrome with varying presentations. Case 1
S153
presented with severe dysmenorrhea and a significant left hematometra with Stage II endometriosis resulting in early diagnosis at the age of 14. Case 2 was asymptomatic and diagnosed incidentally on an ultrasound performed during an annual exam with minimal endometriosis which resulted in a delayed diagnosis at the age of 23. This difference in presentation can be secondary to the fused uteri in Case 2 resulting in more of hematocolpos and less of hematometra. HWW syndrome can thus have varying presentations ranging from severe dysmenorrhea to an asymptomatic incidental finding. 549 Laparoscopic Bilateral Ovarian Transposition With Preservation of Tubes in Women With Medulloblastoma Kart C, Guven S, Guvendag g€uven E. Obstetrcs & Gynaecology, Blacksea Technical University, Trabzon, Turkey 26-year-old women, unmarried. mormal ovarian reserve, AMH:2.7 operated cranial medulloblastoma. vertebral and cranial radiotherapy planned. to preeserve ovarian reserve laparoscopic ovarian transposition planned in order to preserve future fertility. both tubes also preserved and ovaries were put at lateral edge of colon almost 10 cm away from vertebral column. 550 Laparoscopic Management of a Rudimentary Horn Pregnancy Shiber LJ, Biscette S. Minimally Invasive Gynecologic Surgery, University of Louisville Hospital, Louisville, Kentucky Rudimentary horn pregnancy is rare, occurring in 1 in 76,000 to 1 in 140,000 pregnancies. Radiologic diagnosis is often difficult. When suspected in an asymptomatic patient, laparoscopic resection of the gravid horn can be accomplished safely. This surgical film provides a general outline of mullerian anomalies, specifically those categorized as unicornuate, and reviews the limited literature regarding diagnosis and management of rudimentary uterine horn pregnancy. A patient case is then discussed and a detailed presentation of the laparoscopic approach to resection of a pregnant rudimentary horn is provided, using surgical footage. Surgical techniques, including identification of surrounding anatomy and attention to hemostasis are highlighted. 551
Video Posters – Robotics
Overcoming the Obstacles of Visualization in Robotically-Assisted Abdominal Cerclage Using Indocyanine Green Zeybek B, Borahay M, Kilic GS. Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas The aim of this video is to present a case of a robotically-assisted abdominal cerclage and use of indocyanine green dye for overcoming the obstacles of visualization during the procedure. 552 Robotic Single-Incision Myomectomy Guan X, Harry C, Walsh T, Osial P. Baylor College of Medicine, Houston, Texas We present a case of robotic-single incision myomectomy. Robotic singlesite site surgery does have minor limitations compared to multi-port robotic surgery. While it continues to have the benefits of excellent 3D visualization, most of the robotic-single site instruments do not yet have the ability to articulate and there is decreased range of motion at the accessory port which requires minor changes to surgical technique. Our video demonstrates that this technology is capable of performing a myomectomy despite the current robotic instrument restrictions. Tips are provided help successfully approach and perform a successful roboticsingle site myomectomy.