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Obturator Neuralgia a Rare Complication of TVT Sling: Complete Resolution After Laparoscopic TVT Removal
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S1–S44 21
Video Session 1 - Oncology (11:28 AM - 11:34 AM)
Sentinel Lymph Node Mapping for Endometrial Cancer: A Contemporary Approach to Surgical Staging Liu L,1 Barbi A,1 Kolev T,1 Kolev V.2 1OB/GYN, Lenox Hill Hospital, New York, New York; 2OB/GYN, Mount Sinai Beth Israel, New York, New York Sentinel lymph node (SLN) mapping may be an acceptable surgical strategy between a complete lymphadenectomy and no nodal evaluation in patients with endometrial cancer. The most recent National Comprehensive Cancer Network guidelines includes recommendations and techniques for SLN mapping for endometrial cancer. The use of pericervical injection of fluorescent indocyanide green dye, combined with infrared camera and the laparoscopic approach can aid in identification, isolation, and removal of SLNs. 22
Video Session 1 - Oncology (11:35 AM - 11:41 AM)
Successful Pregnancy after Targeted Hysteroscopy for Endometrial Adenocarcinoma Arendas K,1 Ibrahim Al-Dossary M,1 Leader A,2 Leyland NA.1 1Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada; 2 Obstetrics, Gynecology and Medicine (Endocrinology), Univerity of Ottawa, Ottawa Fertility Centre, Ottawa, Ontario, Canada Endometrial carcinoma can affect young women under the age of 40 in 3-5% of cases. In patients who desire future fertility and refuse hysterectomy, conservative therapy after detailed counseling can be a option. This video describes a case of stage IA endometrial adenocarcinoma treated with targeted hysteroscopic resection. The patient subsequently conceived using assisted reproductive technology and had a successful pregnancy with excellent outcome. Two case series where focal hysteroscopic resection was used to manage stage IA endometrial carcinoma with subsequent attempts at pregnancy among the treated patients are also reviewed. Key points to successful hysteroscopic management of early stage endometrial cancer are using a multi-disciplinary approach, thorough counseling of the patient and availability of a surgical team skilled in hysteroscopic resection. Finally, there is a need for consensus guidelines for management of early stage endometrial carcinoma in young women desiring fertility.
Suture to Standard Techniques. It Is Safe, Feasible and Effective Nahas S. Gynecologic Oncology, Trillium Health Partners, Credit Valley Hospital, University of Toronto, Mississauga, Ontario, Canada Objective: To demonstrate a new surgical technique in minimal invasive infra renal para aortic lymphadenectomy compared to standard techniques. Method: Retrospective data collection for all cases with high risk endometrial cancer and ovarian cancer that required a full staging. Result: A total of 23 patients were included, ten cases without the use of Vlock (group 1), and 13 with the use of V-lock suture (group 2). Comparing group 1 to group 2, they had an average age 60 to 63, BMI 28.5 to 29, length of stay (LOS) 1 to 1, EBL 140 to 120, operative time 233 to 251 minutes, number of lymph node 7 to 13, post operative complication 0 to 1, and readmission rate 0 in both groups. Conclusion: The new technique using the V-lock suture yields to a significantly higher lymph node count with similar operative time, LOS, EBL, and readmission rate. 759
Video Session 1 - Oncology (11:42 AM - 11:48 AM)
Complete Laparoscopic Cytoreduction in Advance Fallopian Tube Adenocarcinoma Stage IIIC: Case Report Tejerizo A, Marqueta L, L opez G, Alvarez C, Mu~noz L, Mu~noz JL, Jimenez J. Gynecology Oncology and Endoscopy, Hospital 12 de Octubre, Madrid, Spain Introduction: The most important prognostic factor for patients with advance ovarian / Fallopian cancer is an optimal cytoreduction with a maximal debulking surgery. Material and methods: A 61 years old patient diagnosed of a high grade Fallopian tube carcinoma after a laparoscopic bilateral adnexectomy because of a complex adnexal mass. The CT imaging presented several implants in the pelvic peritoneum, the sigmoid and the small intestine. After a laparoscopic exploration for staging the disease, a complete laparoscopic cytoreduction was performed. We presente the video of the laproscopic procedure. Conclusion: In selected patients with expert laparoscopic surgeons, cytoreduction of ovarian / tube carcinoma can be performed safely by laparoscopy. For survival analysis is necessary to promote multicenter prospective studies. 24
Video Session 1 - Oncology (11:49 AM - 11:55 AM)
Comparing New Technique for Minimal Invasive Para Aortic Infra Renal Lymphadenectomy Using Barb
Video Session 2 - Urogynecology (11:00 AM - 11:06 AM)
Obturator Neuralgia a Rare Complication of TVT Sling: Complete Resolution After Laparoscopic TVT Removal Miklos JR, Moore RD, Chinthakanan O. International Urogynecology Associates, Alpharetta, Georgia. Obturator neuralgia is a rare complication of suburethral sling placement but it normally associated with transobturator (TOT) slings. We present a patient with a case of obturator neuralgia and gait disturbance after a tension free vaginal tape (TVT) type retropubic sling. The patient’s condition was remedied after complete TVT removal from the obturator internus muscle and resection from the obturator nerve using combined vaginal and laparoscopic approach. The purpose of this video: 1) present an extremely rare complication of TVT retropubic slings 2) present symptoms and signs of obturator nerve compression 3) show the normal and the actual position of this patient’s TVT sling 4) describe the the laparoscopic removal of the TVT sling 5) as well as present the postoperative course and resolution of the patient’s pain. 25
23
S7
Video Session 2 - Urogynecology (11:07 AM - 11:13 AM)
Neovaginoplasty Using Labial and Vestibular Advancement Flap in Patients with M€ ullerian Agenesis Moon HS, Kim SG, Choi JK, Park GS, Koo JS. Ob/Gyn, Good Moonhwa Hospital, Busan, Korea M€ullerian agenesis is a rare congenital anomaly of the female genital tract with an incidence of 1 in 4000 female births and accounts for approximately 10% of primary amenorrhea. Affected individuals have absence of the vagina and uterus with normal 46XX female karyotype, functional ovaries and normal development of secondary sexual characteristics. Various surgical techniques have been suggested for neovagina formation in patients with m€ullerian agenesis. The most widely used surgical techniques include McIndoe operation, laparoscopic Davydov procedure, and laparoscopic Vechietti procedure. We would like to present a simple method of neovaginoplasty using labial and vestibular advancement flap. This simple technique is safe, minimally invasive and effective while minimizing the morbidity associated with other grafting techniques commonly used in practice. 26
Video Session 2 - Urogynecology (11:14 AM - 11:20 AM)
Robotic-Assisted Vesicovaginal Fistula Repair Samuel SA, Patel N, Vakili B. Department of Women’s Health, Christiana Care Health Systems, Newark, Delaware This video demonstrates the use of the DaVinci robotic operating system in minimally invasive management of vesico-vaginal fistula. The purpose of
Video Session 1 - Oncology (11:28 AM - 11:34 AM)
Sentinel Lymph Node Mapping for Endometrial Cancer: A Contemporary Approach to Surgical Staging Liu L,1 Barbi A,1 Kolev T,1 Kolev V.2 1OB/GYN, Lenox Hill Hospital, New York, New York; 2OB/GYN, Mount Sinai Beth Israel, New York, New York Sentinel lymph node (SLN) mapping may be an acceptable surgical strategy between a complete lymphadenectomy and no nodal evaluation in patients with endometrial cancer. The most recent National Comprehensive Cancer Network guidelines includes recommendations and techniques for SLN mapping for endometrial cancer. The use of pericervical injection of fluorescent indocyanide green dye, combined with infrared camera and the laparoscopic approach can aid in identification, isolation, and removal of SLNs. 22
Video Session 1 - Oncology (11:35 AM - 11:41 AM)
Successful Pregnancy after Targeted Hysteroscopy for Endometrial Adenocarcinoma Arendas K,1 Ibrahim Al-Dossary M,1 Leader A,2 Leyland NA.1 1Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada; 2 Obstetrics, Gynecology and Medicine (Endocrinology), Univerity of Ottawa, Ottawa Fertility Centre, Ottawa, Ontario, Canada Endometrial carcinoma can affect young women under the age of 40 in 3-5% of cases. In patients who desire future fertility and refuse hysterectomy, conservative therapy after detailed counseling can be a option. This video describes a case of stage IA endometrial adenocarcinoma treated with targeted hysteroscopic resection. The patient subsequently conceived using assisted reproductive technology and had a successful pregnancy with excellent outcome. Two case series where focal hysteroscopic resection was used to manage stage IA endometrial carcinoma with subsequent attempts at pregnancy among the treated patients are also reviewed. Key points to successful hysteroscopic management of early stage endometrial cancer are using a multi-disciplinary approach, thorough counseling of the patient and availability of a surgical team skilled in hysteroscopic resection. Finally, there is a need for consensus guidelines for management of early stage endometrial carcinoma in young women desiring fertility.
Suture to Standard Techniques. It Is Safe, Feasible and Effective Nahas S. Gynecologic Oncology, Trillium Health Partners, Credit Valley Hospital, University of Toronto, Mississauga, Ontario, Canada Objective: To demonstrate a new surgical technique in minimal invasive infra renal para aortic lymphadenectomy compared to standard techniques. Method: Retrospective data collection for all cases with high risk endometrial cancer and ovarian cancer that required a full staging. Result: A total of 23 patients were included, ten cases without the use of Vlock (group 1), and 13 with the use of V-lock suture (group 2). Comparing group 1 to group 2, they had an average age 60 to 63, BMI 28.5 to 29, length of stay (LOS) 1 to 1, EBL 140 to 120, operative time 233 to 251 minutes, number of lymph node 7 to 13, post operative complication 0 to 1, and readmission rate 0 in both groups. Conclusion: The new technique using the V-lock suture yields to a significantly higher lymph node count with similar operative time, LOS, EBL, and readmission rate. 759
Video Session 1 - Oncology (11:42 AM - 11:48 AM)
Complete Laparoscopic Cytoreduction in Advance Fallopian Tube Adenocarcinoma Stage IIIC: Case Report Tejerizo A, Marqueta L, L opez G, Alvarez C, Mu~noz L, Mu~noz JL, Jimenez J. Gynecology Oncology and Endoscopy, Hospital 12 de Octubre, Madrid, Spain Introduction: The most important prognostic factor for patients with advance ovarian / Fallopian cancer is an optimal cytoreduction with a maximal debulking surgery. Material and methods: A 61 years old patient diagnosed of a high grade Fallopian tube carcinoma after a laparoscopic bilateral adnexectomy because of a complex adnexal mass. The CT imaging presented several implants in the pelvic peritoneum, the sigmoid and the small intestine. After a laparoscopic exploration for staging the disease, a complete laparoscopic cytoreduction was performed. We presente the video of the laproscopic procedure. Conclusion: In selected patients with expert laparoscopic surgeons, cytoreduction of ovarian / tube carcinoma can be performed safely by laparoscopy. For survival analysis is necessary to promote multicenter prospective studies. 24
Video Session 1 - Oncology (11:49 AM - 11:55 AM)
Comparing New Technique for Minimal Invasive Para Aortic Infra Renal Lymphadenectomy Using Barb
Video Session 2 - Urogynecology (11:00 AM - 11:06 AM)
Obturator Neuralgia a Rare Complication of TVT Sling: Complete Resolution After Laparoscopic TVT Removal Miklos JR, Moore RD, Chinthakanan O. International Urogynecology Associates, Alpharetta, Georgia. Obturator neuralgia is a rare complication of suburethral sling placement but it normally associated with transobturator (TOT) slings. We present a patient with a case of obturator neuralgia and gait disturbance after a tension free vaginal tape (TVT) type retropubic sling. The patient’s condition was remedied after complete TVT removal from the obturator internus muscle and resection from the obturator nerve using combined vaginal and laparoscopic approach. The purpose of this video: 1) present an extremely rare complication of TVT retropubic slings 2) present symptoms and signs of obturator nerve compression 3) show the normal and the actual position of this patient’s TVT sling 4) describe the the laparoscopic removal of the TVT sling 5) as well as present the postoperative course and resolution of the patient’s pain. 25
23
S7
Video Session 2 - Urogynecology (11:07 AM - 11:13 AM)
Neovaginoplasty Using Labial and Vestibular Advancement Flap in Patients with M€ ullerian Agenesis Moon HS, Kim SG, Choi JK, Park GS, Koo JS. Ob/Gyn, Good Moonhwa Hospital, Busan, Korea M€ullerian agenesis is a rare congenital anomaly of the female genital tract with an incidence of 1 in 4000 female births and accounts for approximately 10% of primary amenorrhea. Affected individuals have absence of the vagina and uterus with normal 46XX female karyotype, functional ovaries and normal development of secondary sexual characteristics. Various surgical techniques have been suggested for neovagina formation in patients with m€ullerian agenesis. The most widely used surgical techniques include McIndoe operation, laparoscopic Davydov procedure, and laparoscopic Vechietti procedure. We would like to present a simple method of neovaginoplasty using labial and vestibular advancement flap. This simple technique is safe, minimally invasive and effective while minimizing the morbidity associated with other grafting techniques commonly used in practice. 26
Video Session 2 - Urogynecology (11:14 AM - 11:20 AM)
Robotic-Assisted Vesicovaginal Fistula Repair Samuel SA, Patel N, Vakili B. Department of Women’s Health, Christiana Care Health Systems, Newark, Delaware This video demonstrates the use of the DaVinci robotic operating system in minimally invasive management of vesico-vaginal fistula. The purpose of