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Laparoscopic Single-Site Myomectomy of 11 cm Intramural Fibroid
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253 474 Diagnostic Hysteroscopy: Preparation for a Successful Procedure Vander Tuig BI, Moukarzel L, Scheib SA. Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland
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with immunohistochemistry staining was consistent with a recurrence of the cervical adenocarcinoma in situ. This case demonstrates a rare isolated recurrence to the ovary of an adequately treated endocervical adenocarcinoma in situ of the cervix. 478
Diagnostic hysteroscopy is one of the most common gynecologic procedures. This video describes how to prepare for a successful procedure. Indications and contraindications for hysteroscopy are reviewed. Important components of informed consent are reviewed. The setup of the hysteroscope and fluid management system are described, including the settings that should be used. It is important that any surgeon who performs diagnostic hysteroscopy be familiar with the equipment and setup. 475
Video Posters – Laparoscopic Surgeries
Articulating Enseal to Simply Singe Incision Hysterectomy With Uterosacral Ligament Suspension Guan X, Walsh TM, Blazek K, Osial P, Xu D. Baylor College of Medicine, Houston, Texas We present a video of a single-site total laparoscopic hysterectomy in a 51y with chronic pelvic pain. Single-site laparoscopic hysterectomies are traditionally more complicated mostly due to the non-ergnonomic positioning of the straight stick laparoscopic instruments. This video highlights the articulating ENSEALÒ and how it facilitates the performance of a single-site hysterectomy. In this video we will also show that a high uterosacral ligament suspension is feasible in laparoscopic single-site and provides advice to successfully preforming this prolapse procedure. 476 Patient at 15 Weeks Gestation With a Large Adnexal Mass Frazzini PM, Bugosh MD, Maurice JM. Obstetrics and Gynecology, Rush University Medical Center, Chicago, Illinois A 22-year-old at 15 weeks gestation presented to the Emergency Room with increasing abdominal pain. Radiologic imaging demonstrated a large, left ovarian cyst and a live intrauterine pregnancy at 15 weeks gestation. We present a surgical video demonstrating the laparoscopic removal of the large, left ovarian cyst in a patient in her second trimester. We demonstrate the feasibility of laparoscopic surgery in gravid patients, and emphasize that laparoscopic removal of a symptomatic adnexal mass is a safe and appropriate intervention in patients with a concomitant pregnancy. 477 Laparoscopic Oophorectomy and Radical Lymph Node Dissection for a Recurrent Adenocarcinoma In Situ of the Cervix El Hachem L,1 Pereira E,1 Momeni M,1 Andikyan V,1 Nguyen L,1 Stevens R,2 Raff J,2 Eisen R,2 Gretz HF.1 1Minimally Invasive Gynecology and Gynecologic Oncology, Icahn School of Medicine at Mount Sinai, New York, New York; 2Minimally Invasive Gynecology and Gynecologic Oncology, White Plains Hospital Center, White Plains, New York The surgical steps of a laparoscopic oohphorectomy and pelvic lymph node dissection are demonstrated in this video. This is the case of a 48 year-old female presenting with new onset back pain and found to have a 10 cm complex left ovarian mass. She has a history of adenocarcinoma in situ of the cervix treated 5 years prior with cold knife cone biopsy followed by a laparoscopic simple hysterectomy with bilateral salpingectomy with no residual disease on surgical specimen. The patient underwent a laparoscopic bilateral oophorectomy, pelvic and paraaortic lymph node dissection and omentectomy with no residual disease at the conclusion of the procedure. Pathologic assessment along
Total Laparoscopic Hysterectomy: Didelphic Uterus Arvizo C,1 Jernigan AM,1 Leonelli JE,2 DeBernardo RL.1 1Women’s Health Institute, Cleveland Clinic, Cleveland, Ohio; 2St. Elizabeth Boardman Hospital, Youngstown, Ohio We aim to delineate the steps for successful laparoscopic removal of the didelphic uterus. The patient is a 48-year-old woman, gravida 0, who presented with heavy vaginal bleeding and subsequently failed medical management. She eventually opted for definitive surgical management and proceeded with a hysterectomy. The didelphic uterus poses a challenge. Not only is the uterus enlarged, but special attention to the ureter is necessitated given the association between uterus didelphys and renal agenesis. Additionally, the two cervices preclude the use of a typical Koh cup. Instead, we use the larger McCartney tube for the colpotomy. Finally, we demonstrate the removal of the specimen through the vagina with an EndoCatch bag. 479 In Bag Mechanical Morcellation Agarwal S, Rajakumar C, Shenassa H, Lortie K, Chen I, Singh SS. Department of Obstetrics, Gynecology and newborn care, The Ottawa Hospital, Ottawa, Ontario, Canada A recent concerning event brought focus on the issues of use of power morcellators as well as spread of underlying occult cancer in otherwise benign fibroids. The major societies as well as the government bodies have addressed these issues and there is a growing support for the use of contained morcellation. In this video we describe a stepwise approach to the technique of contained mechanical morcellation that can be performed either vaginally through colpotomy or abdominally. The described technique maintains the benefits of minimally invasive approach and provide benefits of low cost and avoiding injury to vessels and bowel, when compared to power morcellators. In our initial experience with this technique uteri ranging from 217-831 grams have been removed without any intraoperative complications or tear in the bag and no major limitations. Thus, our technique is a safe, effective and inexpensive alternative to the use of power morcellators. 480 Laparoscopic Radical Hysterectomy Zhu J, Xia H, Liu X. Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China A surgical demonstration of laparoscopic radical hysterectomy for a stage Ib1 cervical cancer patient. 481 Laparoscopic Single-Site Myomectomy of 11 cm Intramural Fibroid Xiaoming G, Walsh TM, Osial P, Xu D. Baylor College of Medicine, Houston, Texas We present a case of laparoscopic single-site myomectomy of a 11 cm intramural fibroid. Single-site laparoscopy has traditionally been associated with poor ergonomics, however we have found that the articulating ENSEALÒ enables completion of complex surgical procedures not traditionally associated with single-site laparoscopy. This video demonstrates our techniques to successfully accomplish a singlesite laparoscopic myomectomy including the importance of vertical closure with VlocÒ at the surgical site.
S143
with immunohistochemistry staining was consistent with a recurrence of the cervical adenocarcinoma in situ. This case demonstrates a rare isolated recurrence to the ovary of an adequately treated endocervical adenocarcinoma in situ of the cervix. 478
Diagnostic hysteroscopy is one of the most common gynecologic procedures. This video describes how to prepare for a successful procedure. Indications and contraindications for hysteroscopy are reviewed. Important components of informed consent are reviewed. The setup of the hysteroscope and fluid management system are described, including the settings that should be used. It is important that any surgeon who performs diagnostic hysteroscopy be familiar with the equipment and setup. 475
Video Posters – Laparoscopic Surgeries
Articulating Enseal to Simply Singe Incision Hysterectomy With Uterosacral Ligament Suspension Guan X, Walsh TM, Blazek K, Osial P, Xu D. Baylor College of Medicine, Houston, Texas We present a video of a single-site total laparoscopic hysterectomy in a 51y with chronic pelvic pain. Single-site laparoscopic hysterectomies are traditionally more complicated mostly due to the non-ergnonomic positioning of the straight stick laparoscopic instruments. This video highlights the articulating ENSEALÒ and how it facilitates the performance of a single-site hysterectomy. In this video we will also show that a high uterosacral ligament suspension is feasible in laparoscopic single-site and provides advice to successfully preforming this prolapse procedure. 476 Patient at 15 Weeks Gestation With a Large Adnexal Mass Frazzini PM, Bugosh MD, Maurice JM. Obstetrics and Gynecology, Rush University Medical Center, Chicago, Illinois A 22-year-old at 15 weeks gestation presented to the Emergency Room with increasing abdominal pain. Radiologic imaging demonstrated a large, left ovarian cyst and a live intrauterine pregnancy at 15 weeks gestation. We present a surgical video demonstrating the laparoscopic removal of the large, left ovarian cyst in a patient in her second trimester. We demonstrate the feasibility of laparoscopic surgery in gravid patients, and emphasize that laparoscopic removal of a symptomatic adnexal mass is a safe and appropriate intervention in patients with a concomitant pregnancy. 477 Laparoscopic Oophorectomy and Radical Lymph Node Dissection for a Recurrent Adenocarcinoma In Situ of the Cervix El Hachem L,1 Pereira E,1 Momeni M,1 Andikyan V,1 Nguyen L,1 Stevens R,2 Raff J,2 Eisen R,2 Gretz HF.1 1Minimally Invasive Gynecology and Gynecologic Oncology, Icahn School of Medicine at Mount Sinai, New York, New York; 2Minimally Invasive Gynecology and Gynecologic Oncology, White Plains Hospital Center, White Plains, New York The surgical steps of a laparoscopic oohphorectomy and pelvic lymph node dissection are demonstrated in this video. This is the case of a 48 year-old female presenting with new onset back pain and found to have a 10 cm complex left ovarian mass. She has a history of adenocarcinoma in situ of the cervix treated 5 years prior with cold knife cone biopsy followed by a laparoscopic simple hysterectomy with bilateral salpingectomy with no residual disease on surgical specimen. The patient underwent a laparoscopic bilateral oophorectomy, pelvic and paraaortic lymph node dissection and omentectomy with no residual disease at the conclusion of the procedure. Pathologic assessment along
Total Laparoscopic Hysterectomy: Didelphic Uterus Arvizo C,1 Jernigan AM,1 Leonelli JE,2 DeBernardo RL.1 1Women’s Health Institute, Cleveland Clinic, Cleveland, Ohio; 2St. Elizabeth Boardman Hospital, Youngstown, Ohio We aim to delineate the steps for successful laparoscopic removal of the didelphic uterus. The patient is a 48-year-old woman, gravida 0, who presented with heavy vaginal bleeding and subsequently failed medical management. She eventually opted for definitive surgical management and proceeded with a hysterectomy. The didelphic uterus poses a challenge. Not only is the uterus enlarged, but special attention to the ureter is necessitated given the association between uterus didelphys and renal agenesis. Additionally, the two cervices preclude the use of a typical Koh cup. Instead, we use the larger McCartney tube for the colpotomy. Finally, we demonstrate the removal of the specimen through the vagina with an EndoCatch bag. 479 In Bag Mechanical Morcellation Agarwal S, Rajakumar C, Shenassa H, Lortie K, Chen I, Singh SS. Department of Obstetrics, Gynecology and newborn care, The Ottawa Hospital, Ottawa, Ontario, Canada A recent concerning event brought focus on the issues of use of power morcellators as well as spread of underlying occult cancer in otherwise benign fibroids. The major societies as well as the government bodies have addressed these issues and there is a growing support for the use of contained morcellation. In this video we describe a stepwise approach to the technique of contained mechanical morcellation that can be performed either vaginally through colpotomy or abdominally. The described technique maintains the benefits of minimally invasive approach and provide benefits of low cost and avoiding injury to vessels and bowel, when compared to power morcellators. In our initial experience with this technique uteri ranging from 217-831 grams have been removed without any intraoperative complications or tear in the bag and no major limitations. Thus, our technique is a safe, effective and inexpensive alternative to the use of power morcellators. 480 Laparoscopic Radical Hysterectomy Zhu J, Xia H, Liu X. Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China A surgical demonstration of laparoscopic radical hysterectomy for a stage Ib1 cervical cancer patient. 481 Laparoscopic Single-Site Myomectomy of 11 cm Intramural Fibroid Xiaoming G, Walsh TM, Osial P, Xu D. Baylor College of Medicine, Houston, Texas We present a case of laparoscopic single-site myomectomy of a 11 cm intramural fibroid. Single-site laparoscopy has traditionally been associated with poor ergonomics, however we have found that the articulating ENSEALÒ enables completion of complex surgical procedures not traditionally associated with single-site laparoscopy. This video demonstrates our techniques to successfully accomplish a singlesite laparoscopic myomectomy including the importance of vertical closure with VlocÒ at the surgical site.