Laparoscopic Myomectomy in the 2nd Trimester of Pregnancy

Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97 intact and tension-free anastomosis of the ureter and the bladder. If the involved segment is small, we perform simple reimplantation of the ureter to the bladder. However, if the defect is larger, we need to perform a psoas hitch and sometimes a Boari flap in accordance with how much length of the ureter needs to be compensated for. In rare cases where there is a great deal of loss of ureteral length, we interpose a graft of the ileum. The harvest defect of the ileum in reconstructed with functional end-to-end anastomosis. Conclusion: The laparoscopic psoas hitch, Boari flap and ilieal ureter are reconstructive techniques that allow for more extensive resection of endometriosis by minimally invasive surgery. These techniques provide tension-free adaptation after extensive resection of the ureter. Open Communications 17: Laparoscopy (11:00 AM − 12:45 PM) 12:10 PM Getting Out of a Sticky Situation: Approaching Intra-Abdominal Adhesions Givens M,1,* Louie M,2 Tyan P3. 1University of North Carolina, Chapel Hill, NC; 2Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC; 3The University of North Carolina, Chapel Hill, NC *Corresponding author. Video Objective: This video aims to review how to anticipate and evaluate a patient for the presence of adhesions, review surgical tips and tricks for approaching lysis of adhesions, and review evidence for products made reducing formation of adhesions. Setting: This is done through a case study of a patient presenting with pelvic pain through to be secondary to adhesive disease Interventions: We present surgical video of the techniques, tips, and tricks used for laparoscopic adhesiolysis. Conclusion: This video will help surgeons at all levels learn how to evaluate a patient for the presence of adhesions, some surgical techniques to approach adhesions, and to understand evidence behind adhesion preventing products. Open Communications 17: Laparoscopy (11:00 AM − 12:45 PM) 12:17 PM Laparoscopic Myomectomy in the 2nd Trimester of Pregnancy Kulkarni A,*,1 McCaffrey C,2 Bodley J,2 Kung R.C2. 1Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada; 2 Division of Urogynecology, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada *Corresponding author. Video Objective: The purpose of this video is to demonstrate surgical management of a symptomatic fibroid in the 2nd trimester of pregnancy. Setting: This patient is a 26 year old G1P0 who presented to a tertiary care centre at 18 weeks and 3 days gestational age with severe abdominal pain. This was her third presentation to hospital for abdominal pain during pregnancy. She was given intravenous and oral narcotics, which did not alleviate her pain. She was otherwise healthy, with no previous surgeries. This pregnancy was a spontaneous conception. She was incidentally diagnosed with a fibroid at approximately 7 weeks gestational age on her dating ultrasound. On presentation, she was uncomfortable at rest, with stable vitals. Her abdomen was soft, with involuntary guarding. She had severe pain on light palpation of her right lower quadrant. An MRI of her abdomen and pelvis delineated this to be a pedunculated fundal uterine fibroid, measuring 19.4 by 13.2 by 16.2cm, retroplacental in location.

S69 Her pregnancy has otherwise been uncomplicated, with a normal enhanced first trimester screen and normal anatomy ultrasound. She continued to experience episodes of refractory severe pain. Ultimately, she was consented for a laparoscopic myomectomy, with mini-laparotomy and morcellation. Interventions: Laparoscopic myomectomy, with mini-laparotomy and morcellation of the fibroid at 18 weeks and 5 days gestational age. Conclusion: This case is an example of safe antenatal surgical management for symptomatic fibroids in patients who fail conservative medical management. Antenatal surgical management has generally been recommended against due to the risk of pregnancy loss. With proper patient selection, a myomectomy can be safely done in the antenatal period for patients who fail conservative medical management. Open Communications 17: Laparoscopy (11:00 AM − 12:45 PM) 12:24 PM Robotic Assisted Laparoscopic Cervical Myomectomy Valentine LN,1,* Li L,2 Harkins GJ3. 1OB/GYN MIGS, Penn State Hershey Medical Center, Hershey, PA; 2Ob/Gyn, Penn State Hershey Medical Center, Hershey, PA; 3Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA *Corresponding author. Video Objective: The goal of this video is to describe and illustrate a laparoscopic approach to an exophytic cervical leiomyoma. Setting: Academic tertiary care hospital. Interventions: A robotic-assisted laparoscopic approach for a large cervical myomectomy is demonstrated in a patient with a complex surgical history. The use of a vaginal sponge-stick helps elevate and define the cervical myoma. Bladder is back-filled with sterile fluid to further assist in delineation of bladder edges with respect to the myoma. Vesico-uterine peritoneum is incised, and fibroid is dissected with the use of blunt and sharp dissection. Cystoscopy is performed at the completion of the case, given close proximity to bladder throughout dissection. Conclusion: We depict a safe and reproducible robotic-assisted laparoscopic approach to cervical leiomyoma. Open Communications 18: Basic Science/Research/Education (2:00 PM − 2:15 PM) 2:00 PM Pain Management and Subject Comfort During an Endometrial Ablation Treatment with the Cerene Cryotherapy Device Fortin CA*. Obstetrics and Gynecology, McGill University Health Centre, Montreal, QC, Canada *Corresponding author. Study Objective: To evaluate the use of medications to manage pain and/ or anxiety and the subjects’ level of perioperative pain related to an endometrial ablation treatment with the Cerene Cryotherapy Device (Channel Medsystems, Emeryville, CA). Design: A prospective, multi-center, single-arm, open-label, non-randomized study. Setting: At 11 academic and private practice settings across North America: 8 sites in the US, 1 site in Mexico, and 2 sites in Canada. Patients or Participants: 242 subjects comprise the Intent-to-Treat (ITT) population. Interventions: Subjects were treated with the Cerene Device, which delivers a 2.5-minute cryoablation of the endometrium. Analgesia and local anesthesia were administered per investigator discretion. Subjects rated their pain at screening, 5 time points during treatment, and