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Open Laparoscopy
Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252 Interventions: Laparoscopic excision of uterine niche is performed after intra-operative hysteroscopic transillumination landmarks the niche. Defect margins are marked laparoscopically. A uterine manipulator identifies the cervical canal. Reconstruction is performed in two layers, using a barbed suture in a running fashion. Adhesion barrier is applied to the reconstructed area. Conclusion: Laparoscopic excision of uterine niche defect and reconstruction using hysteroscopy to aid with anatomical landmarking is an effective conservative surgical technique that should be considered for patients in whom fertility sparing is desired. 508 Laparoscopic Excision of a Pelvic Mass in a Patient with Primary Amenorrhea Madar JL, Rattray DD. Obstetrics, Gynecology and Reproductive Sciences, University of Saskatchewan, Regina, Saskatchewan, Canada The objective of this video is to demonstrate laparoscopic resection of an adherent pelvic mass in a patient with primary amenorrhea. The workup and management of this diagnostic dilemma will be discussed. A 27 yearold G0 woman presented with primary amenorrhea and hypogonadotrophic hypogonadism. There was a discrepancy between her pelvic ultrasound, which reported hematometra, and her MRI, which queried an adnexal mass. The patient was consented for a hysteroscopy, laparoscopic salpingectomy, possible ovarian cystectomy, and possible salpingo-oophorectomy. Consent was obtained for video recording. In the operating room, the patient was found to have sexual infantilism and a large left ovarian mass. The mass was adherent to the omentum, sigmoid colon, right and left pelvic sidewall, right ovary, posterior uterus, and cul-de-sac. Frozen section showed an at least borderline serous papillary cystadenoma. Gynecologic oncology was called for further management. 509 The Supreme Training of Laparoscopic Suture and Ligation – Go Beyond Your Limit Shirane A, Andou M, Kanno K, Yanai S, Nakajima S, Kurotsuchi S, Hada T, Ota Y. Kurashiki Medical Center, Kurashiki, Okayama, Japan We have a difficulty in ligation and suture laparoscopically.There are three reasons. They are the lack of mobility,the poor sense of distance and the poor sense of touch. To overcome the lack of mobility, there are three tips. The first thing is making use of the gravity and the thread tension.The second is doing your wrist work freely. And the third is moving the ground.To overcome the poor sense of distance,there are also three tips.The first thing is always moving forceps and threads.The second is working in a small area.And the third thing is not staring at forceps,but overlook on the short tail of thread.To overcome the poor sense of touch,I can show you two tips.The one is feeling the texture with your eyes. The other is getting skills to ligate tightly anytime and anywhere. This time,we can show you seven techniques of laparoscopic surgeon’s knot and training routines. 510 Retroperitoneal 10 cm Cyst Removal with Low Pressure (7mmHg) Laparoscopy Sroussi J,1 Cornelis F,2 Fazel A,1 Mezzadri M,1 Cornet N,1 Benifla J-L.1 1 Gynecology and Obstetrics, Lariboisiere, Paris, France; 2Cytopathology, Lariboisiere, Paris, France We report a case of a 25-year-old nulligravida woman who complained about pelvic pain. The MRI showed a 10-centimeter left adnexal mass, which evocated an ovarian cyst or hydrosalpinx. Levels of CA 125, CEA, CA 19-9 were normal. Laparoscopic exploration with low pressure (7 mm Hg) pneumoperitoneum was performed and revealed a retroperitoneal cyst. Ovaries and tubes had no abnormalities. No sign of peritoneal carcinomatosis was found. Incision of the cyst wall, dissection, coagulation and section of umbilical artery, and of the peripheral vessels were performed. Complete low impact laparoscopic cyst removal was finally achieved. The patient had no complication and was discharged the
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same day following laparoscopy. Pathologic exam revealed a cystic lymphangioma, which is a benign condition. 511 Vestigial Cyst of the Uterus from First Imaging to Laparoscopic Resection: A Case Report Levy-Zauberman YV,1 Ruiz M,1 Fekir A,2 Bay A,3 Levaillant J-M,1 Fernandez H.1 1Gynaecology and Obstetrics Department, H^opital Universitaire de Bic^etre, Le Kremlin Bic^etre, France; 2Radiology Department, H^opital Universitaire de Bic^etre, Le Kremlin Bic^etre, France; 3 Pathology Department, H^opital Universitaire de Bic^etre, Le Kremlin Bic^etre, France The submitted video abstract describes a rare case of large vestigial uterus cysts, followed-up over the course of 6 years and operated on laparoscopically. The video focuses on clinical history, imaging and surgical aspects of the case. A 41 year-old patient presented with a cystic-mass during pregnancy. The mass partially regressed after delivery and was explored with various ultrasounds and MRIs on several occasions during a 5-year follow-up period. The cystic structure became symptomatic as it grew larger and the patient sought surgical treatment. Laparoscopic resection of the tumor was performed. Preoperative imaging, intraoperative findings and pathology analysis confirmed the suspected diagnosis of vestigial cyst of the uterus. The purpose of this video is to take the viewer through a diagnostic journey, beginning with the first imaging, and finishing with the surgical treatment. The video includes ultrasounds, MRI pictures and a surgical video. 512 Vaginal Laparoscopy Abidi A, Park SJ, Jebelli B, Luna EN, Jones KD, Spencer LY. Kaiser Permanent, Riverside, California Vaginal Laparoscopy can be used as an alternative to standard abdominal approach for removing adnexal structures and may be technically easier in multigravida and obese patients. In this video we present a laparoscopic vaginal Bilateral Salpingooophorectomy as a prophylactic procedure for a 45 year old G2p2 patient with BRCA-1 mutation after a vaginal hysterectomy is completed. 513 A Novel Technique for Intact Laparoscopic Removal of a Large Benign Pelvic Mass Moulton L, DeBernardo R. Gynecologic Oncology, Cleveland Clinic Foundation, Cleveland, Ohio This video demonstrates a new technique in removing a benign pelvic mass laparoscopically. This technique was borne out of the common occurrence of large pelvic masses obscuring visual planes and identifiable structures during the laparoscopic dissection and excision. We suggest, under direct visualization, placing a trocar followed by a aspirator device directly into the mass, which then greatly reduces the size of the mass and its contents from the abdomen. This video demonstrates the effectiveness of this technique in a case involving a right sided pelvic mass and subsequent laparoscopic bilateral salpingooophorectomy. 514 Open Laparoscopy Arms R,1 Chandler J,2 Farnam R.3 1Obstetrics and Gynecology, Creighton University Medical Center, Omaha, Nebraska; 2Obstetrics and Gynecology, Texas Tech University, El Paso, Texas; 3Gynecology, Texas Urogynecology and Laser Surgery Center, El Paso, Texas
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Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252
Purpose: In this video, the technique of open (Hasson) entry to the peritoneal cavity is discussed. This technique is reviewed in comparison to closed entry with insufflation by Veress needle and also direct entry with visualization. The surgical steps of open entry are listed and described using written, verbal, and figurative means. The advantages and disadvantages of this approach are discussed. 515 Total Laparoscopic Hysterectomy with Left Salpingoophorectomy Using Sutures without the Use of Any Energy Source Marwah V, Dasgupta S, Mittal P. Division of Minimally Invasive Gynaecology, Max Superspeciality Hospital, New Delhi, Delhi, India Total laparoscopic hysterectomy with left salpingoophorectomy was carried out using sutures only, in a case of left tubo ovarian mass with left ovarian endometriotic cyst with severe endometriosis, adenomyosis uteri, and myoma uterus, with a history of previous myomectomy and ovarian cystectomy. The dissection aided with application of Marwah’s Uterine Manipulator vaginally,involved opening the anterior leaf of broad ligament through the avascular triangle on left side for delineation of uterine vessels. As access was not available on right side for the uterine vessels, the roof of broad ligament was incised for uterine artery. Ureter was identified and uterine artery ligated. Infundibulopelvic ligament, round ligament on left side, tubo ovarian and round ligament on right side ligated and cut. Colpotomy performed with hook scissors.The entire procedure was carried out with blunt and sharp dissection and with sutures only,without using any energy source, thus making it safer and better for the patient. 516 Laparoscopic Management of Huge Myoma Nascendi Sendag F, Peker N, G€ undogan S, Aydeniz EG. Obstetrics and Gynecology, Acibadem University, Istanbul, Turkey Objectives: To present a case with huge cervical myoma protruding from cervical external os managed with laparoscopic approach Methods: We performed laparoscopic myomectomy at patients with huge intramural-submucous myoma located at uterine corpus and protruding from cervical external os. The incision was closed three layer suturing with barbed suture. Conclusion: Cervical myoma with huge size should be managed laparoscopically Keywords: Laparoscopy, myoma, cervical. 517 Bladder Hydro-Dissection to Overcome the Loss of Laparoscopic Triangulation Adajar AA. Minimally Invasive Gynecologic Surgery, Illinois Institute of Gynecology & Advanced Pelvic Surgery, Chicago, Illinois Objective: The following video demonstrates the utility of hydro-dissection in laparoscopic bladder dissection, when performed from a mid-line instrument port. Description: The advancement of minimally invasive gynecologic surgery gives rise to new challenges, and techniques to overcome them. The advent of less invasive, scar-less surgical approaches, often results in decreased ergonomics from the loss of port placement triangulation. This creates challenges due to limited instrument utilization. This is especially true when performing bladder dissection. Hydro-dissection is a technique wherein pressurized fluid is delivered into the tissue, entering into the plane of least resistance. When used during bladder dissection, pressurized fluid is used to dissect into an avascular plane. The following video demonstrates the utility of bladder hydrodissection from a mid-line instrument port.
Conclusion: When performed from a mid-line instrument port, this technique allows the surgeon to overcome some of the challenges encountered from a mid-line instrument port. 518 Techniques to Increase Efficiency of Laparoscopic Suturing with Barbed Sutures Nguyen NT,1 Jeffries MJ,1 Regehr R,1 Yamamoto M,2 Zaritsky EF.1 1Kaiser Permanente Oakland, Oakland, California; 2Kaiser Permanente San Leandro, San Leandro, California It is well known that efficient laparoscopic techniques help decrease time of surgery. Using materials such as barbed sutures have allowed for more efficient laparoscopic surgery to be performed when suturing is involved. This video will provide a novel technique using barbed suture in an efficient way during laparoscopic suturing that may help surgeons decrease the surgical time associated with laparoscopic suturing. 519 Total Laparoscopic Hysterectomy Making Easy: The Technique and Tools – 8-Year Experience Quayyum MA, Farhat S. Ob/Gyn, Feni Pvt. Hospital and Laparoscopy Institute, Feni, Ctg, Bangladesh The aim of this video to evaluate our surgical technique with regards to the success of total laparoscopic hysterectomy (TLH) for the removal of the uterus. Methods: A Retrospective observational study was carried out at Feni pvt. Hospital(FPH), Feni and Chowmuhani general hospital(CGH) Noakhali, Bangladesh based on TLH operations performed from January 2008 to December 2015. The Q-Colpotomizer system a very simple uterine manipulator device were used . The Pneumoperitoneum was maintained by sterile wet sponge vaginal pack. Four thousands and ninty six women consented for TLH. Four thousands forty eight women (98.8.%) had successful TLH with twenty four minilaparotomy and twenty-four laparotomy conversions (1.2% failure rate). Conclusion: Total laparoscopic hysterectomy can be carried out successfully with very simple equipments and adequate training is associated with low morbidity, few complications and a high success rate. 520 Vagina-Assisted Laparoscopic Sacro-CervicoColpopexy with Prolene Mesh and Metal Screw and Bilateral Round Ligament Shortening Wang Y-T. Ob/Gyn, China Medical University Hospital, Taichung, Taiwan Laparoscopic sacral colpopexy is a surgical procedure to correct the prolapse of vagina. But, the procedure will be more difficult if the patient asks to preserve the uterus. The video also demonstrate the method via the vagina-assisted approach to reduce the difficulty of the operation. The video also states the important anatomy of pre-sacral space. And, in order to strengthen the prognosis of the surgery, we could perform bilateral round ligament shortening by electrocauterization and suture. This modified method has better effects of uterine suspension with greater satisfaction degree. 521 Bilateral Adhesiolysis and Tubal Plasty with Low Pressure (7mmHg) MicroLaparoscopy (3 mm) Sroussi J, Fazel A, Mezzadri M, Elies A, Benifla J-L. Gynecology and Obstetrics, Lariboisiere, Paris, France
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same day following laparoscopy. Pathologic exam revealed a cystic lymphangioma, which is a benign condition. 511 Vestigial Cyst of the Uterus from First Imaging to Laparoscopic Resection: A Case Report Levy-Zauberman YV,1 Ruiz M,1 Fekir A,2 Bay A,3 Levaillant J-M,1 Fernandez H.1 1Gynaecology and Obstetrics Department, H^opital Universitaire de Bic^etre, Le Kremlin Bic^etre, France; 2Radiology Department, H^opital Universitaire de Bic^etre, Le Kremlin Bic^etre, France; 3 Pathology Department, H^opital Universitaire de Bic^etre, Le Kremlin Bic^etre, France The submitted video abstract describes a rare case of large vestigial uterus cysts, followed-up over the course of 6 years and operated on laparoscopically. The video focuses on clinical history, imaging and surgical aspects of the case. A 41 year-old patient presented with a cystic-mass during pregnancy. The mass partially regressed after delivery and was explored with various ultrasounds and MRIs on several occasions during a 5-year follow-up period. The cystic structure became symptomatic as it grew larger and the patient sought surgical treatment. Laparoscopic resection of the tumor was performed. Preoperative imaging, intraoperative findings and pathology analysis confirmed the suspected diagnosis of vestigial cyst of the uterus. The purpose of this video is to take the viewer through a diagnostic journey, beginning with the first imaging, and finishing with the surgical treatment. The video includes ultrasounds, MRI pictures and a surgical video. 512 Vaginal Laparoscopy Abidi A, Park SJ, Jebelli B, Luna EN, Jones KD, Spencer LY. Kaiser Permanent, Riverside, California Vaginal Laparoscopy can be used as an alternative to standard abdominal approach for removing adnexal structures and may be technically easier in multigravida and obese patients. In this video we present a laparoscopic vaginal Bilateral Salpingooophorectomy as a prophylactic procedure for a 45 year old G2p2 patient with BRCA-1 mutation after a vaginal hysterectomy is completed. 513 A Novel Technique for Intact Laparoscopic Removal of a Large Benign Pelvic Mass Moulton L, DeBernardo R. Gynecologic Oncology, Cleveland Clinic Foundation, Cleveland, Ohio This video demonstrates a new technique in removing a benign pelvic mass laparoscopically. This technique was borne out of the common occurrence of large pelvic masses obscuring visual planes and identifiable structures during the laparoscopic dissection and excision. We suggest, under direct visualization, placing a trocar followed by a aspirator device directly into the mass, which then greatly reduces the size of the mass and its contents from the abdomen. This video demonstrates the effectiveness of this technique in a case involving a right sided pelvic mass and subsequent laparoscopic bilateral salpingooophorectomy. 514 Open Laparoscopy Arms R,1 Chandler J,2 Farnam R.3 1Obstetrics and Gynecology, Creighton University Medical Center, Omaha, Nebraska; 2Obstetrics and Gynecology, Texas Tech University, El Paso, Texas; 3Gynecology, Texas Urogynecology and Laser Surgery Center, El Paso, Texas
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Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252
Purpose: In this video, the technique of open (Hasson) entry to the peritoneal cavity is discussed. This technique is reviewed in comparison to closed entry with insufflation by Veress needle and also direct entry with visualization. The surgical steps of open entry are listed and described using written, verbal, and figurative means. The advantages and disadvantages of this approach are discussed. 515 Total Laparoscopic Hysterectomy with Left Salpingoophorectomy Using Sutures without the Use of Any Energy Source Marwah V, Dasgupta S, Mittal P. Division of Minimally Invasive Gynaecology, Max Superspeciality Hospital, New Delhi, Delhi, India Total laparoscopic hysterectomy with left salpingoophorectomy was carried out using sutures only, in a case of left tubo ovarian mass with left ovarian endometriotic cyst with severe endometriosis, adenomyosis uteri, and myoma uterus, with a history of previous myomectomy and ovarian cystectomy. The dissection aided with application of Marwah’s Uterine Manipulator vaginally,involved opening the anterior leaf of broad ligament through the avascular triangle on left side for delineation of uterine vessels. As access was not available on right side for the uterine vessels, the roof of broad ligament was incised for uterine artery. Ureter was identified and uterine artery ligated. Infundibulopelvic ligament, round ligament on left side, tubo ovarian and round ligament on right side ligated and cut. Colpotomy performed with hook scissors.The entire procedure was carried out with blunt and sharp dissection and with sutures only,without using any energy source, thus making it safer and better for the patient. 516 Laparoscopic Management of Huge Myoma Nascendi Sendag F, Peker N, G€ undogan S, Aydeniz EG. Obstetrics and Gynecology, Acibadem University, Istanbul, Turkey Objectives: To present a case with huge cervical myoma protruding from cervical external os managed with laparoscopic approach Methods: We performed laparoscopic myomectomy at patients with huge intramural-submucous myoma located at uterine corpus and protruding from cervical external os. The incision was closed three layer suturing with barbed suture. Conclusion: Cervical myoma with huge size should be managed laparoscopically Keywords: Laparoscopy, myoma, cervical. 517 Bladder Hydro-Dissection to Overcome the Loss of Laparoscopic Triangulation Adajar AA. Minimally Invasive Gynecologic Surgery, Illinois Institute of Gynecology & Advanced Pelvic Surgery, Chicago, Illinois Objective: The following video demonstrates the utility of hydro-dissection in laparoscopic bladder dissection, when performed from a mid-line instrument port. Description: The advancement of minimally invasive gynecologic surgery gives rise to new challenges, and techniques to overcome them. The advent of less invasive, scar-less surgical approaches, often results in decreased ergonomics from the loss of port placement triangulation. This creates challenges due to limited instrument utilization. This is especially true when performing bladder dissection. Hydro-dissection is a technique wherein pressurized fluid is delivered into the tissue, entering into the plane of least resistance. When used during bladder dissection, pressurized fluid is used to dissect into an avascular plane. The following video demonstrates the utility of bladder hydrodissection from a mid-line instrument port.
Conclusion: When performed from a mid-line instrument port, this technique allows the surgeon to overcome some of the challenges encountered from a mid-line instrument port. 518 Techniques to Increase Efficiency of Laparoscopic Suturing with Barbed Sutures Nguyen NT,1 Jeffries MJ,1 Regehr R,1 Yamamoto M,2 Zaritsky EF.1 1Kaiser Permanente Oakland, Oakland, California; 2Kaiser Permanente San Leandro, San Leandro, California It is well known that efficient laparoscopic techniques help decrease time of surgery. Using materials such as barbed sutures have allowed for more efficient laparoscopic surgery to be performed when suturing is involved. This video will provide a novel technique using barbed suture in an efficient way during laparoscopic suturing that may help surgeons decrease the surgical time associated with laparoscopic suturing. 519 Total Laparoscopic Hysterectomy Making Easy: The Technique and Tools – 8-Year Experience Quayyum MA, Farhat S. Ob/Gyn, Feni Pvt. Hospital and Laparoscopy Institute, Feni, Ctg, Bangladesh The aim of this video to evaluate our surgical technique with regards to the success of total laparoscopic hysterectomy (TLH) for the removal of the uterus. Methods: A Retrospective observational study was carried out at Feni pvt. Hospital(FPH), Feni and Chowmuhani general hospital(CGH) Noakhali, Bangladesh based on TLH operations performed from January 2008 to December 2015. The Q-Colpotomizer system a very simple uterine manipulator device were used . The Pneumoperitoneum was maintained by sterile wet sponge vaginal pack. Four thousands and ninty six women consented for TLH. Four thousands forty eight women (98.8.%) had successful TLH with twenty four minilaparotomy and twenty-four laparotomy conversions (1.2% failure rate). Conclusion: Total laparoscopic hysterectomy can be carried out successfully with very simple equipments and adequate training is associated with low morbidity, few complications and a high success rate. 520 Vagina-Assisted Laparoscopic Sacro-CervicoColpopexy with Prolene Mesh and Metal Screw and Bilateral Round Ligament Shortening Wang Y-T. Ob/Gyn, China Medical University Hospital, Taichung, Taiwan Laparoscopic sacral colpopexy is a surgical procedure to correct the prolapse of vagina. But, the procedure will be more difficult if the patient asks to preserve the uterus. The video also demonstrate the method via the vagina-assisted approach to reduce the difficulty of the operation. The video also states the important anatomy of pre-sacral space. And, in order to strengthen the prognosis of the surgery, we could perform bilateral round ligament shortening by electrocauterization and suture. This modified method has better effects of uterine suspension with greater satisfaction degree. 521 Bilateral Adhesiolysis and Tubal Plasty with Low Pressure (7mmHg) MicroLaparoscopy (3 mm) Sroussi J, Fazel A, Mezzadri M, Elies A, Benifla J-L. Gynecology and Obstetrics, Lariboisiere, Paris, France