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Laparoscopic Excision of Isolated Para-Aortic Lymph Node Recurrence
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Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S191–S227
umbilicus. Triangulation of instruments in single incision surgery can be a challenging task to master, but is paramount to the successful completion of surgeries using this approach. In this video, we demonstrate a single incision laparoscopic tubal ligation using just two instruments inserted at the umbilicus. For those surgeons who wish to gain a better understanding around the issues of triangulation and ultimately apply these principles to single incision surgery, this is an excellent procedure to begin with.
728 Robotic Stapler for Coincidental Appendectomy Riley KA, Benton AS, Harkins GJ. Obstetrics and Gynecology, Penn State Hershey Medical Center, Hershey, Pennsylvania Coincidental appendectomy has been shown to be beneficial in numerous patient populations such as patients with endometriosis and chronic pelvic pain. Previous reports have noted that laparoscopic surgical staplers used at the time of gynecologic surgery allow for simple, rapid removal of the appendix with decreased procedure time and no spillage of appendiceal contents into the peritoneal cavity. The use of a robotic stapler will provide the same benefits and eliminate the need of the surgeon to rely on conventional laparoscopy to complete the appendectomy. A robotic stapling device has recently become available. It is a reusable, wristed stapling instrument that delivers six rows of staples with transection down the middle of the staple lines. This stapler was used to complete coincidental appendectomies in patients undergoing primary gynecologic surgery. The objective of this video is to demonstrate a new surgical instrument.
729 Laparoscopic Sacrocolpopexy with the Endo360 Automatic Suturing Device Rosenblatt PL,1 Dessie SG,1 Loring M.2 1Obstetrics and Gynecology, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts; 2Obstetrics and Gynecology, Newton-Wellesley Hospital, Newton, Massachusetts Laparoscopic sacrocolpopexy is considered a challenging procedure in the field of pelvic reconstructive surgery. This video presents the procedure done with the aid of the Endo360. This is a reusable suturing device that employs a normally shaped, curved, tapered needle swedged to a variety of standard sutures. The patient is a 63 year old women with stage 2 vaginal vault prolapse who requested definitive surgical management.
730
Poster Video: Oncology
Laparoscopic Primary Debulking Surgery for Woman with Advanced Ovarian Cancer Choi JS, Bae J, Lee WM, Koh AR, Kim SH, Ok JH. Obstetrics and Gynecology, Hanyang Univeristy College of Medicine, Seoul, Korea A 48-year old Korean woman presented with lower abdominal discomfort for three months. The serum level of CA-125 and CA19-9 were 828.3 IU/mL and 25.2 IU/mL. PET-CT scan showed multiple hypermetabolic sites on the pelvic and para-aortic lymph node area. We performed laparoscopic primary debulking surgery including LAVH with BSO, pelvic and para-aortic lymphadenectomy up to the left renal vein level, omentectomy, appendectomy, and excision of multiple metastatic lesions. The removed metastatic lymph nodes is placed into endoscopic bag and retrieved through the opened vaginal vault. Final pathology showed stage IIIC serous cystadenocarcinoma and multiple pelvic and para-aortic lymph node metastases. She received 9 cycle paclitaxel and
carboplatin adjuvant chemotherapy. Now, she has no evidence of disease after treatment. 731 Robotic Radical Trachelectomy for Early Stage Cervical Cancer Gungor M, Ozbasli E, Kahraman K, Genim C. Obstetrics and Gynecology Department, Acibadem University, Faculty of Medicine, Istanbul, Turkey Background/Hypothesis: Robotic radical trachelectomy is a minimally invasive technique that can preserve fertility in patients with early stage cervical cancer Methods and Materials: The video shows a case of robotic radical trachelectomy that was performed to a 40-year old patient who has a preoperative diagnosis of stage IBI cervical cancer. Results: The operation time was 210 minutes. The bleeding was 200 cc. No intraoperative and postoperative complication was observed. The patient was discharged on postoperative day 3 with no problem. Conclusion: Robotic radical trachelectomy for early stage cervical cancer is a promising fertility- sparing technique. It requires refined skills from an oncologic surgeon who is also skilled in robotic surgery. 732 Laparoscopic Excision of Isolated Para-Aortic Lymph Node Recurrence Lee WM,1 Choi SS,1 Bae J,1 Koh AR,1 Ko JH,2 Ju W.3 1Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Republic of Korea; 2Department of Obstetrics and Gynecology, Kangwon National University Hospital, Chuncheon, Gangwon-do, Republic of Korea; 3Department of Obstetrics and Gynecology, Ewha Womans University School of Medicine, Seoul, Republic of Korea A 54-year-old Korean woman was referred to my department because PETCT scan showed a hypermetabolic spot on the aortocaval area. She underwent radical abdominal hysterectomy with bilateral salpingooophorectomy, appendectomy, and bilateral pelvic lymphadenectomy followed by concurrent chemo-radiation because of pelvic lymph node metastasis and parametrial involvement in other hospital a few years ago. We performed laparoscopic excision of para-aortic metastatic lymph nodes on Jul 16, 2013. The final histopathological report showed that aortocaval lymph node was metastatic squamous cell carcinoma which greatest size was 2.6cm with extranodal extension. Six of all retrocaval lymph node was metastatic squamous cell carcinoma. After surgery, she received adjuvant chemotherapy and she is healthy without evidence of disease recurrence. 733 Vagina Prolonging Liu X, Jiang H. Obstetrics and Gyncology Hospital of Fudan University, Shanghai, China The vagina cuff was then closed with a running locking suture. The peritoneum from the surface underneath the bladder was sewn to the surface of the rectum with 0 monocryl sutures. Ovarian transposition was also performed for patients with cervical cancer or vaginal apex cancer who were younger than 50 years. For type II endometrial cancer, such as clear cell cancer, omentectomy was performed.(A) The intraoperative situs after freeing the right cardinal ligament. The tissues marked are 1, right fossa paravesicalis; 2, right cardinal ligament; 3, right fossa pararectalis; 4, right superior vesical artery; 5 right obturator nerve; 6, right ureter. 734 Robotic Infrarenal Para-Aortic Lymph Node Dissection Santkovsky I, ElSahwi K. Ob/Gyn, Jersey Shore University Medical Center, Neptune Township, New Jersey
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S191–S227
umbilicus. Triangulation of instruments in single incision surgery can be a challenging task to master, but is paramount to the successful completion of surgeries using this approach. In this video, we demonstrate a single incision laparoscopic tubal ligation using just two instruments inserted at the umbilicus. For those surgeons who wish to gain a better understanding around the issues of triangulation and ultimately apply these principles to single incision surgery, this is an excellent procedure to begin with.
728 Robotic Stapler for Coincidental Appendectomy Riley KA, Benton AS, Harkins GJ. Obstetrics and Gynecology, Penn State Hershey Medical Center, Hershey, Pennsylvania Coincidental appendectomy has been shown to be beneficial in numerous patient populations such as patients with endometriosis and chronic pelvic pain. Previous reports have noted that laparoscopic surgical staplers used at the time of gynecologic surgery allow for simple, rapid removal of the appendix with decreased procedure time and no spillage of appendiceal contents into the peritoneal cavity. The use of a robotic stapler will provide the same benefits and eliminate the need of the surgeon to rely on conventional laparoscopy to complete the appendectomy. A robotic stapling device has recently become available. It is a reusable, wristed stapling instrument that delivers six rows of staples with transection down the middle of the staple lines. This stapler was used to complete coincidental appendectomies in patients undergoing primary gynecologic surgery. The objective of this video is to demonstrate a new surgical instrument.
729 Laparoscopic Sacrocolpopexy with the Endo360 Automatic Suturing Device Rosenblatt PL,1 Dessie SG,1 Loring M.2 1Obstetrics and Gynecology, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts; 2Obstetrics and Gynecology, Newton-Wellesley Hospital, Newton, Massachusetts Laparoscopic sacrocolpopexy is considered a challenging procedure in the field of pelvic reconstructive surgery. This video presents the procedure done with the aid of the Endo360. This is a reusable suturing device that employs a normally shaped, curved, tapered needle swedged to a variety of standard sutures. The patient is a 63 year old women with stage 2 vaginal vault prolapse who requested definitive surgical management.
730
Poster Video: Oncology
Laparoscopic Primary Debulking Surgery for Woman with Advanced Ovarian Cancer Choi JS, Bae J, Lee WM, Koh AR, Kim SH, Ok JH. Obstetrics and Gynecology, Hanyang Univeristy College of Medicine, Seoul, Korea A 48-year old Korean woman presented with lower abdominal discomfort for three months. The serum level of CA-125 and CA19-9 were 828.3 IU/mL and 25.2 IU/mL. PET-CT scan showed multiple hypermetabolic sites on the pelvic and para-aortic lymph node area. We performed laparoscopic primary debulking surgery including LAVH with BSO, pelvic and para-aortic lymphadenectomy up to the left renal vein level, omentectomy, appendectomy, and excision of multiple metastatic lesions. The removed metastatic lymph nodes is placed into endoscopic bag and retrieved through the opened vaginal vault. Final pathology showed stage IIIC serous cystadenocarcinoma and multiple pelvic and para-aortic lymph node metastases. She received 9 cycle paclitaxel and
carboplatin adjuvant chemotherapy. Now, she has no evidence of disease after treatment. 731 Robotic Radical Trachelectomy for Early Stage Cervical Cancer Gungor M, Ozbasli E, Kahraman K, Genim C. Obstetrics and Gynecology Department, Acibadem University, Faculty of Medicine, Istanbul, Turkey Background/Hypothesis: Robotic radical trachelectomy is a minimally invasive technique that can preserve fertility in patients with early stage cervical cancer Methods and Materials: The video shows a case of robotic radical trachelectomy that was performed to a 40-year old patient who has a preoperative diagnosis of stage IBI cervical cancer. Results: The operation time was 210 minutes. The bleeding was 200 cc. No intraoperative and postoperative complication was observed. The patient was discharged on postoperative day 3 with no problem. Conclusion: Robotic radical trachelectomy for early stage cervical cancer is a promising fertility- sparing technique. It requires refined skills from an oncologic surgeon who is also skilled in robotic surgery. 732 Laparoscopic Excision of Isolated Para-Aortic Lymph Node Recurrence Lee WM,1 Choi SS,1 Bae J,1 Koh AR,1 Ko JH,2 Ju W.3 1Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Republic of Korea; 2Department of Obstetrics and Gynecology, Kangwon National University Hospital, Chuncheon, Gangwon-do, Republic of Korea; 3Department of Obstetrics and Gynecology, Ewha Womans University School of Medicine, Seoul, Republic of Korea A 54-year-old Korean woman was referred to my department because PETCT scan showed a hypermetabolic spot on the aortocaval area. She underwent radical abdominal hysterectomy with bilateral salpingooophorectomy, appendectomy, and bilateral pelvic lymphadenectomy followed by concurrent chemo-radiation because of pelvic lymph node metastasis and parametrial involvement in other hospital a few years ago. We performed laparoscopic excision of para-aortic metastatic lymph nodes on Jul 16, 2013. The final histopathological report showed that aortocaval lymph node was metastatic squamous cell carcinoma which greatest size was 2.6cm with extranodal extension. Six of all retrocaval lymph node was metastatic squamous cell carcinoma. After surgery, she received adjuvant chemotherapy and she is healthy without evidence of disease recurrence. 733 Vagina Prolonging Liu X, Jiang H. Obstetrics and Gyncology Hospital of Fudan University, Shanghai, China The vagina cuff was then closed with a running locking suture. The peritoneum from the surface underneath the bladder was sewn to the surface of the rectum with 0 monocryl sutures. Ovarian transposition was also performed for patients with cervical cancer or vaginal apex cancer who were younger than 50 years. For type II endometrial cancer, such as clear cell cancer, omentectomy was performed.(A) The intraoperative situs after freeing the right cardinal ligament. The tissues marked are 1, right fossa paravesicalis; 2, right cardinal ligament; 3, right fossa pararectalis; 4, right superior vesical artery; 5 right obturator nerve; 6, right ureter. 734 Robotic Infrarenal Para-Aortic Lymph Node Dissection Santkovsky I, ElSahwi K. Ob/Gyn, Jersey Shore University Medical Center, Neptune Township, New Jersey