Laparoscopic Uterosacral Ligament Suspension for Apical Support

Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252 In this video we demonstrate the steps used to perform a conventional laparoscopic sacrocolpopexy and sacrocervicopexy.One case of each procedure is presented and the steps are demonstrated. 481 Direct Vision Box Training for Surgical Trainees with Little or No Prior Laparoscopic Experience Kanno K, Andou M, Hada T, Shirane A, Yanai S, Nakajima S, Ebisawa K, Kurotsuchi S, Ota H. Department of Gynecology, Kurashiki Medical Center, Kurashiki, Okayama, Japan With the wide adoption of laparoscopic surgery, various methods and theories have been developed to enable surgeons to acquire and improve their skills. One such method is off-the-job training using a dry box trainer. Monitor vision training (MVT) using a display monitor as in actual laparoscopic surgery is currently in general use. For surgical trainees with little or no prior laparoscopic experience, however, jumping straight into MVT is as difficult as actual laparoscopy. In this case, starting out with direct vision training (DVT) in which trainees can see what they are doing directly, rather than on the display monitor, provides them with an easier way to start laparoscopic surgery and encourages progress. In this presentation, the importance of DVT from the perspectives of (1) temporary separation of bi-hand (BH) and hand-eye (HE) coordination, and (2) improving three-dimensional visuospatial ability is described, and experimental data suggesting its value is provided. 482 Laparoscopic Uterosacral Ligament Suspension for Apical Support Mohling SI, Elkattah R, Furr RS, Liu CY. Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, Tennessee This video demonstrates laparoscopic uterosacral ligament suspension performed at the time of hysterectomy. Many women have prolapse of the vagina following hysterectomy because the apex was not well repaired or supported at the time of their original surgery. The pericervical ring is the point of confluence of the pubocervical fascia anteriorly, the rectovaginal septum posteriorly, and the uterosacral ligaments at the level of the ischial spines. Defects in the fascia connected to any part of the ring may result in pelvic floor prolapse. If the pericervical ring is not re-established and suspended to the level of the ischial spines at the time of hysterectomy, vaginal vault prolapse or other vaginal compartment defect may develop. When the apex of the vagina is suspended to the proximal part of the uterosacral ligaments at the level of the ischial spine, normal vaginal length and axis is usually restored. 483 Comprehensive Review of Techniques for Endoscopic Suture Placement and Retrieval Farnam RW. Urogynecology, Las Palmas Medical Center, El Paso, Texas This video demonstrates techniques for placement and retrieval of sutures during endoscopic surgery. It is intended to instruct surgeons transitioning from open and vaginal surgery to laparoscopic and robotic access. Suture preference is not always compatible with trocar use, and this video describes a comprehensive approach to endoscopic suture passage. Specifically three suture placement options and two suture retrieval options are discussed. This informative video demonstrates techniques that will help the beginning MIS practitioner to improve the safety and efficiency of endoscopic needle placement, and contains pearls that expert surgeons will find helpful.

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Laparoscopic placement of the abdominal cerclage is a good alternative to open abdominal cerclage, and is associated with less morbidity. However, literature for laparoscopic cerclage placement during pregnancy is scarce, and no case reports were found for those with twin pregnancies during a PubMed search. We present a case of a patient G7P1 with recurrent pregnancy loss due to incompetent cervix with two-failed vaginal cerclage and one abdominal cerclage. While planning for tubal ligation, presents with amenorrhea and is found to have twin pregnancy. Transvaginal ultrasound assisted laparoscopic abdominal cerclage was performed successfully at 10 weeks gestation and patient is now at 15 weeks and cervix remains 4cm in length. Laparoscopic cerclage is feasible and should be encouraged as the procedure is tolerated with less pain and quicker recovery than an open cerclage. 485 Laparoscopic Essure Removal and Review of Anatomy Arvizo C, Emery J, Uy-Kroh MJ. Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio We present the case of a 27 year-old patient who presented with hypopigmented skin lesions, severe vulvar dermatitis and pelvic pain 6 weeks after Essure placement. Given her presentation and concern for nickel hypersensitivity, decision was made to proceed with removal of the Essure. In our video, we discuss the pertinent anatomy and procedural technique of Essure coil removal with subsequent bilateral salpingectomy. 486 Laparoscopic Life Hacks: A Video Survival Guide Sandoval-Herrera C. Obstetrics and Gynecology, Mount Sinai Hospital and Medical Center, Chicago, Illinois Surgical challenges in the day to day practice of minimally invasive gynecology can represent an impediment for completion of the procedure and at times a potential for prolonged surgical and anesthetic times or conversion to laparotomy and frustration to the surgeon. The video demonstrates a few ‘‘laparoscopic life hacks’’ that can aid in solving some of those challenges. The maneuvers presented in the video are detailed or highlighted and sometimes in slow motion. The technique modifications and maneuvers shown are performed with the principle to maintain the patient’s safety during the surgery. 487 Laparoscopic Apical Support. The Perfect Technique to Minimize Failure Rivero J,1 Bosque V,1 Alicyoy A,1 Patricia Y,1 Carugno J.2 1Minimally Invasive Gynecology, Centro Clinico Docente La Trinidad, Caracas, Distrito Federal, Venezuela; 2Obstetrics and Gynecology, University of Miami, Miami, Florida This video demonstrates different laparoscopic techniques for the management of apical prolapse, providing level I DeLancey’s pelvic supports and maintaining vaginal length without narrowing its caliber. We present the techniques that we have been using in our program to teach fellows. This educational video demonstrates an easy to learn, safe and effective laparoscopic techniques to treat apical prolapse. Conclusion: The treatment of apical prolapse should be considered at the time of hysterectomy. Different techniques are available. We strongly suggest surgeons to master at least one technique and to incorporate it as routine in patients undergoing hysterectomy.

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Transvaginal Ultrasound-Assisted Laparascopic Abdominal Cerclage for Twin Pregnancy at 10 Weeks Guan X, Gisseman J, Kliethermes C. Baylor College of Medicine, Houston, Texas

Isolated Chronic Tubal Torsion and Considerations on Its Pathophysiology Dede M, Bodur S, Ulubay M, Yenen MC. Obstetrics and Gynecology, Gulhane Military Medical Academy, Ankara, Turkey