- Email: [email protected]
Robotic Assisted Laparoscopic Repair of a Vesico-Uterine Fistula with Omental J-Flap
Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S71–S90 244
Video Session 7dUrogynecology (2:24 PM d 2:31 PM)
Imaging in the Diagnosis and Management of Two Failed Colpocleisis Procedures Hart S, Bassaly R, Parsons A. Obstetrics and Gynecology, University of South Florida, Tampa, Florida Colpocleisis is an effective surgical procedure for the correction of advanced pelvic organ prolapse, with an overall low failure rate. This procedure is typically reserved for older patients with significant prolapse who are not suitable candidates for pelvic reconstructive surgery. This video demonstrates the imaging findings, and surgical repair, of two patients who underwent a colpocleisis procedure with subsequent postoperative recurrence of a vaginal bulge. In conclusion, post-operative recurrence of pelvic organ prolapse after a colpocleisis procedure can be effectively managed with a site-specific repair. Pre-operative imaging is useful in counseling patients prior to repeat surgical correction, as well as in the diagnosis and management of these complex conditions.
245
Video Session 7dUrogynecology (2:32 PM d 2:40 PM)
Laparoscopic Supracervical Hysterectomy with Transcervical Morcellation and Sacrocervicopexy Rosenblatt PL, Shapiro A, DiSciullo AJ. Urogynecology and Reconstructive Pelvic Surgery, Mount Auburn Hospital, Cambridge, Massachusetts The purpose of this video is to demonstrate a novel laparoscopic technique for the treatment of uterovaginal prolapse, using a transcervical access port to minimize laparoscopic incision size. The procedure consists of a laparoscopic supracervical hysterectomy (LSH) with transcervical morcellation and laparoscopic sacrocervicopexy with an anterior and posterior mesh extension. Access to the abdominal cavity is obtained by coring out the cervix after the LSH through the vagina using CISH instruments. A trocar placed through the cervix is used for insertion and retrieval of synthetic mesh, sutures and needles. Following removal of the cervical trocar, the cervical defect is closed with a vaginally-placed purse string suture. We report on 47 women who have undergone this procedure for advanced uterovaginal prolapse. There have been no intraoperative complications and all procedures were completed laparoscopically with only 5 mm abdominal port sites. There were no cases of mesh erosion or postoperative infections.
246
Video Session 7dUrogynecology (2:41 PM d 2:48 PM)
Combined Robotic Supra Vaginal Hysterectomy, Sacrocolpopexy and Ventral Rectopexy for Severe Combined Prolapse Schraffordt Koops SE,1 Lenters E,1 Consten EJ,2 Broeders IA.2 1Obstetrics & Gynecology, Meander Medical Centre, Amersfoort, Utrecht, Netherlands; 2Colorectal Surgery, Meander Medical Centre, Amersfoort, Utrecht, Netherlands The recto-vaginal septum acts as a continuous layer of support for the posterior compartment of the vagina and the intimately associated distal rectum. Disruption and loss of this anatomical support results in rectal and genital prolapse. Combined abdominal surgical management of the genital and rectal prolapse is a rational approach to overcome the combined defects. Reports of combined surgical procedures to simultaneously manage these defects are rare. Our institution is a high volume referral centre for combined prolapse surgery. We started to perform the procedure by laparotomy and changed in the beginning of this century to laparoscopic approach. We now perform this procedure with the aid of the Da Vinci robot. This video presentation shows the procedure and set up for the ongoing study.
247
S77
Video Session 7dUrogynecology (2:49 PM d 2:57 PM)
Laparoscopic Sacrocervicopexy – Tips and Tricks Einarsson JI, Cohen S. Division of Minimally Invasive Gynecologic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts We present several tips and tricks for facilitating the performance of a laparoscopic sacrocervicopexy. We prefer to conserve the cervix at the time of hysterectomy since preliminary data seems to support decreased risk of mesh erosion as compared to a total laparoscopic hysterectomy. We will demonstrate how to obtain adequate exposure to the promontory, tips for performing the rectovaginal and vesicovaginal dissection, suturing tips as well as suggestions for easier peritoneal closure. 248
Video Session 7dUrogynecology (2:58 PM d 3:05 PM)
Robotic Assisted Laparoscopic Repair of a Vesico-Uterine Fistula with Omental J-Flap Castellanos ME, Hibner M. Division of Gynecologic Surgery, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona This video demonstrates the use of the robotic surgical system for the repair of a vesico-uterine fistula. This patient is a 30 year old G2P2 who underwent a scheduled repeat cesarean section complicated by an unrecognized cystotomy. Immediately post operatively, she began leaking urine vaginally. A CT-scan of the pelvis demonstrated a large vesico-uterine fistula. The diagnosis was confirmed, through visualization of the intrauterine cavity via cystoscopy. Bilateral ureteral stents were placed in preparation for the surgical repair. The uterine defect and cystotomy was repaired using robotic-assisted laparoscopy. The repair site was supplemented with an omental J-flap. The patient, now 1 year post operative, is doing well without complications. 249
Video Session 7dUrogynecology (3:06 PM d 3:14 PM)
Laparoscopic Uterosacral Vaginal Vault Suspension Kane SM, Pollard R. Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, MetroHealth Medical Center, Cleveland, Ohio The vaginal route of prolapse repair is favored for decreased complications and morbidity, and also faster recovery times. Abdominal prolapse repair shows higher anatomic success rates, but carries risk of mesh erosion and higher morbidities. Combining the laparoscopic approach to hysterectomy (TLH) with laparoscopic correction of prolapse offers limited options. A laparoscopic or robotic sacral colpopexy at the time of TLH comes with an increased risk of mesh erosion. In this video, we demonstrate a laparoscopic method of prolapse correction that does not have the risks of mesh in women undergoing TLH with a secondary diagnosis of prolapse. Alterations of this technique using multiple separate sutures or delayed absorbable suture could be made based on preference. This video describes our method of laparoscopic uterosacral suspension, which has achieved excellent short term results, and is a viable option for prolapse correction at the time of laparoscopic hysterectomy. 250
Video Session 8dRobotics (2:15 PM d 2:22 PM)
daVinci LTH with Dual Energy Technique Douso MI. Department of Minimally Invasive Surgery, Capital Regional Medical Center, Tallahassee, Florida Presented is a novel technique for total hysterectomy using the daVinci S SystemÒ, which normally allows for the use of up to five port sites (camera, 3 instruments and one assistant), reduced to three total ports (camera, 3 instruments and one assistant), reduced to three total ports (1 camera and 2 instruments). The use of dual energy systems is complementary and allows the use of two grasping instruments, each with
Video Session 7dUrogynecology (2:24 PM d 2:31 PM)
Imaging in the Diagnosis and Management of Two Failed Colpocleisis Procedures Hart S, Bassaly R, Parsons A. Obstetrics and Gynecology, University of South Florida, Tampa, Florida Colpocleisis is an effective surgical procedure for the correction of advanced pelvic organ prolapse, with an overall low failure rate. This procedure is typically reserved for older patients with significant prolapse who are not suitable candidates for pelvic reconstructive surgery. This video demonstrates the imaging findings, and surgical repair, of two patients who underwent a colpocleisis procedure with subsequent postoperative recurrence of a vaginal bulge. In conclusion, post-operative recurrence of pelvic organ prolapse after a colpocleisis procedure can be effectively managed with a site-specific repair. Pre-operative imaging is useful in counseling patients prior to repeat surgical correction, as well as in the diagnosis and management of these complex conditions.
245
Video Session 7dUrogynecology (2:32 PM d 2:40 PM)
Laparoscopic Supracervical Hysterectomy with Transcervical Morcellation and Sacrocervicopexy Rosenblatt PL, Shapiro A, DiSciullo AJ. Urogynecology and Reconstructive Pelvic Surgery, Mount Auburn Hospital, Cambridge, Massachusetts The purpose of this video is to demonstrate a novel laparoscopic technique for the treatment of uterovaginal prolapse, using a transcervical access port to minimize laparoscopic incision size. The procedure consists of a laparoscopic supracervical hysterectomy (LSH) with transcervical morcellation and laparoscopic sacrocervicopexy with an anterior and posterior mesh extension. Access to the abdominal cavity is obtained by coring out the cervix after the LSH through the vagina using CISH instruments. A trocar placed through the cervix is used for insertion and retrieval of synthetic mesh, sutures and needles. Following removal of the cervical trocar, the cervical defect is closed with a vaginally-placed purse string suture. We report on 47 women who have undergone this procedure for advanced uterovaginal prolapse. There have been no intraoperative complications and all procedures were completed laparoscopically with only 5 mm abdominal port sites. There were no cases of mesh erosion or postoperative infections.
246
Video Session 7dUrogynecology (2:41 PM d 2:48 PM)
Combined Robotic Supra Vaginal Hysterectomy, Sacrocolpopexy and Ventral Rectopexy for Severe Combined Prolapse Schraffordt Koops SE,1 Lenters E,1 Consten EJ,2 Broeders IA.2 1Obstetrics & Gynecology, Meander Medical Centre, Amersfoort, Utrecht, Netherlands; 2Colorectal Surgery, Meander Medical Centre, Amersfoort, Utrecht, Netherlands The recto-vaginal septum acts as a continuous layer of support for the posterior compartment of the vagina and the intimately associated distal rectum. Disruption and loss of this anatomical support results in rectal and genital prolapse. Combined abdominal surgical management of the genital and rectal prolapse is a rational approach to overcome the combined defects. Reports of combined surgical procedures to simultaneously manage these defects are rare. Our institution is a high volume referral centre for combined prolapse surgery. We started to perform the procedure by laparotomy and changed in the beginning of this century to laparoscopic approach. We now perform this procedure with the aid of the Da Vinci robot. This video presentation shows the procedure and set up for the ongoing study.
247
S77
Video Session 7dUrogynecology (2:49 PM d 2:57 PM)
Laparoscopic Sacrocervicopexy – Tips and Tricks Einarsson JI, Cohen S. Division of Minimally Invasive Gynecologic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts We present several tips and tricks for facilitating the performance of a laparoscopic sacrocervicopexy. We prefer to conserve the cervix at the time of hysterectomy since preliminary data seems to support decreased risk of mesh erosion as compared to a total laparoscopic hysterectomy. We will demonstrate how to obtain adequate exposure to the promontory, tips for performing the rectovaginal and vesicovaginal dissection, suturing tips as well as suggestions for easier peritoneal closure. 248
Video Session 7dUrogynecology (2:58 PM d 3:05 PM)
Robotic Assisted Laparoscopic Repair of a Vesico-Uterine Fistula with Omental J-Flap Castellanos ME, Hibner M. Division of Gynecologic Surgery, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona This video demonstrates the use of the robotic surgical system for the repair of a vesico-uterine fistula. This patient is a 30 year old G2P2 who underwent a scheduled repeat cesarean section complicated by an unrecognized cystotomy. Immediately post operatively, she began leaking urine vaginally. A CT-scan of the pelvis demonstrated a large vesico-uterine fistula. The diagnosis was confirmed, through visualization of the intrauterine cavity via cystoscopy. Bilateral ureteral stents were placed in preparation for the surgical repair. The uterine defect and cystotomy was repaired using robotic-assisted laparoscopy. The repair site was supplemented with an omental J-flap. The patient, now 1 year post operative, is doing well without complications. 249
Video Session 7dUrogynecology (3:06 PM d 3:14 PM)
Laparoscopic Uterosacral Vaginal Vault Suspension Kane SM, Pollard R. Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, MetroHealth Medical Center, Cleveland, Ohio The vaginal route of prolapse repair is favored for decreased complications and morbidity, and also faster recovery times. Abdominal prolapse repair shows higher anatomic success rates, but carries risk of mesh erosion and higher morbidities. Combining the laparoscopic approach to hysterectomy (TLH) with laparoscopic correction of prolapse offers limited options. A laparoscopic or robotic sacral colpopexy at the time of TLH comes with an increased risk of mesh erosion. In this video, we demonstrate a laparoscopic method of prolapse correction that does not have the risks of mesh in women undergoing TLH with a secondary diagnosis of prolapse. Alterations of this technique using multiple separate sutures or delayed absorbable suture could be made based on preference. This video describes our method of laparoscopic uterosacral suspension, which has achieved excellent short term results, and is a viable option for prolapse correction at the time of laparoscopic hysterectomy. 250
Video Session 8dRobotics (2:15 PM d 2:22 PM)
daVinci LTH with Dual Energy Technique Douso MI. Department of Minimally Invasive Surgery, Capital Regional Medical Center, Tallahassee, Florida Presented is a novel technique for total hysterectomy using the daVinci S SystemÒ, which normally allows for the use of up to five port sites (camera, 3 instruments and one assistant), reduced to three total ports (camera, 3 instruments and one assistant), reduced to three total ports (1 camera and 2 instruments). The use of dual energy systems is complementary and allows the use of two grasping instruments, each with