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Laparoscopic Management of Ectopic Pregnancy – Unusual Anatomic Location
S32
Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S1eS51
is performed under general anesthesia, previous to obstetric curettage, in patients with ultrasonografic diagnosis of first trimester pregnancy loss. This video shows various fenotypical malformations such as Anenchepaly, cleft lip, syndactily, Cystic Hygrama, Down Syndrome and Patau Syndrome, that were not detected by ultrasound. Transcervical Embryoscopy is a simple 10-minute procedure that facilitates obstetric curettage and gives useful information for genetic counseling specially in patients with recurrent pregnancy loss.
107
Video Session 4dReproductive Surgery (3:27 PM d 3:34 PM)
‘‘Extra Amniotic Band Syndrome’’ e Uterine Synechiae and Development of Early Pregnancy Schoot BC. OB/GYN, Catharina Hospital, Eindhoven, The Netherlands Study Objective: Curettage, uterine surgery or puerperal interventions, can cause synechiae. Synechiae vary in consistency (flimsy, intermediate or strong), position (cervical, fundal) and area engaged. Synechiae can disappear or remain during pregnancy. Flimsy and intermediate adhesions will stretch/break, whereas strong synechiae force the amniotic sac around it, creating an amniotic fold. Entrapment of the fetus can be seen by ultrasound. Severe deformation of the amniotic sac can influence fetal development. Those deformations show resemblance with abnormalities as seen in amniotic band syndrome No theories concerning amniotic band syndrome (ABS) can explain all features. We hypothesise that in case of development of the fetus between strong, multiple and conglomerated synechiae, occurring fetal deformities can mimic features as seen in ABS. Arguments and animations are demonstrated to support this hypothesis.
108
Video Session 4dReproductive Surgery (3:35 PM d 3:43 PM)
Different Approach in the Laparoscopic Treatment of Dermoid Cyst Rosales JA, Castillo LE, Gonzalez R, Alvarez A. Endoscopy Surgery, CDG Fertilidad, Veracruz, Mexico Study Objective: The objective was retrospectively reviewed the outcome of laparoscopic surgery for suspected ovarian dermoid cysts with rupture of the capsule occurred during the enocleation with the unique treatment abdominal cavity lavage. Patients and methods: A retrospective survey of 3 patients who had laparoscopic removal of a benign dermoid cyst, aged 31, 27, and 26 years old. Results: The 1 patient had abdominal pain and a unilateral left cyst with a diameter of 8 cm, the 2 patient had abnormal transvaginal bleeding and a unilateral right cyst with a diameter of 6 cm, and the 3 patient was diagnosed incidentally with unilateral right cyst with a diameter of 5 cm. The treatment was cystectomy and enucleation, in all cases there were the spillage of dermoid content and the treatment was the vigorous abdominal cavity lavage. Conclusion: With adequate abdominal cavity lavage the spillage of dermoid content during the enocleation reduce complications like chemical peritonitis.
109
two uterine cavities at the level of the isthmus and septal resection with ‘‘Versapoint’’ equipment was performed, leading to a normal uterine cavity. Laparoscopy revealed a single uterine body and postsurgical evolution was normal. Many anomalies like these could be initially diagnosed with imaging studies. Afterwards, laparoscopy and hysteroscopy are suggested for women in whom interventional therapy is likely to be undertaken. Though this case can’t be classified in the AFS (1988) classification system, it provides a reflection to consider the ‘‘Musset Theory’’ (Musset et al, 1968), where midline resorption begins at the isthmus and moves on caudally and cephalade.
Video Session 4dReproductive Surgery (3:44 PM d 3:50 PM)
A Septated Uterus with Double Cervix and Double Vagina Galva´n MA, Bustos HH, Ayala R, Valderrama JJ, Zavaleta RJ, Briones CH. Gynecology, Instituto Nacional de Perinatologı´a IER, Mexico, Distrito Federal, Mexico Study Objective: A 26 years old woman G1 A1 with fertility desire, and a sonohisterography revealing a septum with intercornual distance of 1.4 cm, underwent histeroscopic resection and diagnostic laparoscopy. The findings included a double vagina, double cervix and a longitudinal septum from fundus to isthmus. There was a communication between the
110
Video Session 4dReproductive Surgery (3:51 PM d 3:58 PM)
Laparoscopic Cervico-Isthmus Cerclage for Incompetent Cervix Stanford EJ, Saitis D. Gynecologic Specialties, University of Tennessee, Memphis, TN Study Objective: A history of reduced cervical length, advanced cervical dilation, prior early pregnancy loss, prior conization, or a history of multiple cervical dilations is associated with early delivery often before viability. Placement of a cervical cerclage is often done in an emergent setting leading to anxiety and poor outcomes if care is delayed. Studies show that placement of a cerclage is associated with a dramatic reduction of delivery at !32 weeks and improvement in neonatal survival. Despite these facts, only 75% of perinatologists recommend emergency cervical cerclage when indicated. This video demonstrates step-by-step placement of an abdominal cerclage laparoscopically in a 32 year obese female with cervical incompetence. Laparoscopic placement of an abdominal cervicoisthmus cerclage is shown in a systematic manner and the technique is discussed.
111
Video Session 4dReproductive Surgery (3:59 PM d 4:07 PM)
Laparoscopic Cerclage e Tips and Tricks from 17 Cases Einarsson JI. Division of Minimally Invasive Gynecologic Surgery, Brigham and Women’s Hospital, Boston, MA Study Objective: We present some tips and tricks for performing a laparoscopic cerclage. The main indications for an abdominal cerclage are a prior failed vaginal cerclage or a very short cervix in a patient with a history of cervical incompetence. Systematic reviews have found improved outcomes after abdominal cerclage as compared to vaginal cerclage. In the past 2 years, we have performed 17 cases and have learned some tips and tricks along the way the we would like to share with the audience. Included is a concurrent laparoscopic myomectomy and laparoscopic cerclage placement in pregnancy.
112
Video Session 4dReproductive Surgery (4:08 PM d 4:13 PM)
Laparoscopic Management of Ectopic Pregnancy e Unusual Anatomic Location Suzuki Y, Einarsson JI. Obstetrics and Gynecology, the Division of Minimally Invasive Gynecologic Surgery, Brigham and Women’s Hospital, Boston, MA Study Objective: The video contains two case reports of unusual site ectopic pregnancies. First, a 34-year-old G5 P1 with a cornual ectopic pregnancy was referred with a history of failed methotrexate treatment and ultrasound guided transabdominal potassium chloride injection. Laparoscopic management using an endoloop and cornual wedge resection is demonstrated. The second patient, a 26-year-old G5P2 was referred with a history of failed uterine artery embolization and methotrexate treatment for an ectopic pregnancy in a cesarean section scar. Laparoscopic management of this case is demonstrated.
Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S1eS51
is performed under general anesthesia, previous to obstetric curettage, in patients with ultrasonografic diagnosis of first trimester pregnancy loss. This video shows various fenotypical malformations such as Anenchepaly, cleft lip, syndactily, Cystic Hygrama, Down Syndrome and Patau Syndrome, that were not detected by ultrasound. Transcervical Embryoscopy is a simple 10-minute procedure that facilitates obstetric curettage and gives useful information for genetic counseling specially in patients with recurrent pregnancy loss.
107
Video Session 4dReproductive Surgery (3:27 PM d 3:34 PM)
‘‘Extra Amniotic Band Syndrome’’ e Uterine Synechiae and Development of Early Pregnancy Schoot BC. OB/GYN, Catharina Hospital, Eindhoven, The Netherlands Study Objective: Curettage, uterine surgery or puerperal interventions, can cause synechiae. Synechiae vary in consistency (flimsy, intermediate or strong), position (cervical, fundal) and area engaged. Synechiae can disappear or remain during pregnancy. Flimsy and intermediate adhesions will stretch/break, whereas strong synechiae force the amniotic sac around it, creating an amniotic fold. Entrapment of the fetus can be seen by ultrasound. Severe deformation of the amniotic sac can influence fetal development. Those deformations show resemblance with abnormalities as seen in amniotic band syndrome No theories concerning amniotic band syndrome (ABS) can explain all features. We hypothesise that in case of development of the fetus between strong, multiple and conglomerated synechiae, occurring fetal deformities can mimic features as seen in ABS. Arguments and animations are demonstrated to support this hypothesis.
108
Video Session 4dReproductive Surgery (3:35 PM d 3:43 PM)
Different Approach in the Laparoscopic Treatment of Dermoid Cyst Rosales JA, Castillo LE, Gonzalez R, Alvarez A. Endoscopy Surgery, CDG Fertilidad, Veracruz, Mexico Study Objective: The objective was retrospectively reviewed the outcome of laparoscopic surgery for suspected ovarian dermoid cysts with rupture of the capsule occurred during the enocleation with the unique treatment abdominal cavity lavage. Patients and methods: A retrospective survey of 3 patients who had laparoscopic removal of a benign dermoid cyst, aged 31, 27, and 26 years old. Results: The 1 patient had abdominal pain and a unilateral left cyst with a diameter of 8 cm, the 2 patient had abnormal transvaginal bleeding and a unilateral right cyst with a diameter of 6 cm, and the 3 patient was diagnosed incidentally with unilateral right cyst with a diameter of 5 cm. The treatment was cystectomy and enucleation, in all cases there were the spillage of dermoid content and the treatment was the vigorous abdominal cavity lavage. Conclusion: With adequate abdominal cavity lavage the spillage of dermoid content during the enocleation reduce complications like chemical peritonitis.
109
two uterine cavities at the level of the isthmus and septal resection with ‘‘Versapoint’’ equipment was performed, leading to a normal uterine cavity. Laparoscopy revealed a single uterine body and postsurgical evolution was normal. Many anomalies like these could be initially diagnosed with imaging studies. Afterwards, laparoscopy and hysteroscopy are suggested for women in whom interventional therapy is likely to be undertaken. Though this case can’t be classified in the AFS (1988) classification system, it provides a reflection to consider the ‘‘Musset Theory’’ (Musset et al, 1968), where midline resorption begins at the isthmus and moves on caudally and cephalade.
Video Session 4dReproductive Surgery (3:44 PM d 3:50 PM)
A Septated Uterus with Double Cervix and Double Vagina Galva´n MA, Bustos HH, Ayala R, Valderrama JJ, Zavaleta RJ, Briones CH. Gynecology, Instituto Nacional de Perinatologı´a IER, Mexico, Distrito Federal, Mexico Study Objective: A 26 years old woman G1 A1 with fertility desire, and a sonohisterography revealing a septum with intercornual distance of 1.4 cm, underwent histeroscopic resection and diagnostic laparoscopy. The findings included a double vagina, double cervix and a longitudinal septum from fundus to isthmus. There was a communication between the
110
Video Session 4dReproductive Surgery (3:51 PM d 3:58 PM)
Laparoscopic Cervico-Isthmus Cerclage for Incompetent Cervix Stanford EJ, Saitis D. Gynecologic Specialties, University of Tennessee, Memphis, TN Study Objective: A history of reduced cervical length, advanced cervical dilation, prior early pregnancy loss, prior conization, or a history of multiple cervical dilations is associated with early delivery often before viability. Placement of a cervical cerclage is often done in an emergent setting leading to anxiety and poor outcomes if care is delayed. Studies show that placement of a cerclage is associated with a dramatic reduction of delivery at !32 weeks and improvement in neonatal survival. Despite these facts, only 75% of perinatologists recommend emergency cervical cerclage when indicated. This video demonstrates step-by-step placement of an abdominal cerclage laparoscopically in a 32 year obese female with cervical incompetence. Laparoscopic placement of an abdominal cervicoisthmus cerclage is shown in a systematic manner and the technique is discussed.
111
Video Session 4dReproductive Surgery (3:59 PM d 4:07 PM)
Laparoscopic Cerclage e Tips and Tricks from 17 Cases Einarsson JI. Division of Minimally Invasive Gynecologic Surgery, Brigham and Women’s Hospital, Boston, MA Study Objective: We present some tips and tricks for performing a laparoscopic cerclage. The main indications for an abdominal cerclage are a prior failed vaginal cerclage or a very short cervix in a patient with a history of cervical incompetence. Systematic reviews have found improved outcomes after abdominal cerclage as compared to vaginal cerclage. In the past 2 years, we have performed 17 cases and have learned some tips and tricks along the way the we would like to share with the audience. Included is a concurrent laparoscopic myomectomy and laparoscopic cerclage placement in pregnancy.
112
Video Session 4dReproductive Surgery (4:08 PM d 4:13 PM)
Laparoscopic Management of Ectopic Pregnancy e Unusual Anatomic Location Suzuki Y, Einarsson JI. Obstetrics and Gynecology, the Division of Minimally Invasive Gynecologic Surgery, Brigham and Women’s Hospital, Boston, MA Study Objective: The video contains two case reports of unusual site ectopic pregnancies. First, a 34-year-old G5 P1 with a cornual ectopic pregnancy was referred with a history of failed methotrexate treatment and ultrasound guided transabdominal potassium chloride injection. Laparoscopic management using an endoloop and cornual wedge resection is demonstrated. The second patient, a 26-year-old G5P2 was referred with a history of failed uterine artery embolization and methotrexate treatment for an ectopic pregnancy in a cesarean section scar. Laparoscopic management of this case is demonstrated.