Single Incision Total Laparoscopic Hysterectomy with Temperature Controlled Advaced Bipolar System

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Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S189–S194

657 Intact Ovarian Dermoid Cystectomy: A Laparoscopic Approach Smith KS, Lord KA, Cadogan K-A. Obstetrics and Gynecology, Howard University Hospital, Washington, District of Columbia Iatrogenic development of chemical peritonitis from rupture of ovarian cystic teratomas during surgical treatment poses an intimidating deterrent to a laparoscopic approach. Alternatively, laparotomic management results in increased periods of hospitalization, longer recuperation, more postoperative pain and does not preclude spillage of cystic contents. We present our technique for laparoscopic management and demonstrate intact enucleation of a large ovarian cystic teratoma.

followed 1, 3, 6 months later op. age of pt: A 37.48(SD5.21), B 47.35 (SD7.57), Iindication of operation Dysmenorrhea: A 97(30%), B 27(10%), menorrhagia: A 49(15%), B 81(30%), Both: A 146(45%), B 148(55%), others: A 33(17%), B 14(5%), Op time: A; 58.03(SD 12.13), B 75 (SD16.50), blood loss: A 155.38(SD58.02), B 280.24(SD30.11), bladder or ureteral injury: A 5, B 3, bowel injury: A none, B 3, satisfied relief of pain: A 205/243(85%), B156/175(90%), disappear of menorrhagia: A 179/195 (92%), B 229/229(100%). Conclusions: laparoscopic resection and myolysis of symptomatic adenomyoma patients who want to preserve the uterus is beneficial and safe method comparing to laparoscopically supracervical hysterectomy. 661

658 Laparoscopic Hysterosacropexy Wang AMH, Lin W-CW, Xiao H-D, Hong Y-C. OBS/GYN, China Medical University Hospital, Taichung, Taiwan This video demonstrates modified procedure for hysterosacropexy that is simple, safe and easy even for younger surgeons. It is effective for treatment as well as avoiding rectum injury, a common complication of this type of procedure. This procedure caused less obstruction of the structure, which is beneficial for younger patients for improvements on sexual functions. Procedure started with laparoscopy approached to retroperitoneal space under the promontory. Then with soft tissue dissect away, and rectum pushed to the opposite site, the anatomy of the presacrum area was clearly seen. Under the map of middle sacral vein, and the anterior sacral foramina, we identify the mesh fixation area. Then the mesh was implanted through the opening from vagina, with laparoscopic assist, the mesh was fixed safely on the pre-sacrum area. Then the round ligament was shortened to complete this safe, easy and simple procedure.

Nerve Sparing Robotic Radical Hysterectomy Lee YS, Hong DG, Chong GO, Park NY, Cho YL, Park IS. Obstetrics and Gynecology, Kyungpook National University Hospital, Daegu, Korea This video demonstrated nerve sparing laparoscopic radical hysterectomy using da Vinci robotic system for 36 years old woman with cervical cancer, FIGO stage IB1 adenocarcinoma. We started right side pelvic lymphadenectomy initially. We used 2 robotic instruments. The cardinal ligament was separated by dissector. With careful separation of deep vessel to the base of cardinal ligament, we found the pelvic plexus. Sometimes the branches of inferior hypogastric plexus were sacrificed due to dissection of deep vessel. After anterior part of vesicouterine ligament was separated, the posterior vesicouterine ligament was exposed. Then, we can find the branches of inferior hypogastric plexus. After vaginotomy vaginal mucosa was closed by interrupted suture. After procedures with da Vinci robotic system, we checked routine laparoscopic examination of postoperative field. we consider da Vinci robotic system as more comfortable and stable operation system in Nerve Sparing Robotic Radical Hysterectomy. 662

VIDEO POSTER SESSION–LAVH; LSH; TLH; VH (HYSTERECTOMIES) 659 The Laparoscopic Point of View: An Argument for Early Posterior Colpotomy Andelin CO, Thomas JL. Department of Obstetrics, Gynecology and Women’s Health, University of Missouri School of Medicine, Columbia, Missouri Laparoscopic surgery has naturally borrowed surgical techniques from open surgery. The visual perspective of laparoscopic surgery offers a different advantage compared with laparotomy. We submit that the laparoscopic viewpoint and angle of operative instrumentation favors a posterior colpotomy rather than an anterior colpotomy. In our experience, entering the upper vagina posteriorly is rarely a challenge and the surgical planes are easily identified as the colpotomy is expanded laterally and anteriorly. The bladder flap is created in the process of dividing the endopelvic fascia–from below. This approach seems to decrease operative time, blood loss and use of lateral electrocautery. Research is needed to support novel surgical techniques. As more surgeons use straight stick or robotic assistance for hysterectomy, thoughtful surgical approaches should be encouraged. The posterior colpotomy seems more logical and practical for colpotomy at time of laparoscopic hysterectomy.

Abstract Withdrawn from Publication 663 Cosmetogynecology I: Combined Vaginal Hysterectomy and Minimally Invasive Lipoabdominoplasty Pelosi MA II, Pelosi MA III. Pelosi Medical Center, Bayonne, New Jersey Gynecologists are frequently requested by patients undergoing hysterectomy for benign conditions to perform liposuction or abdominoplasty. The combination of abdominoplasty with abdominal or laparoscopic hysterectomy remains controversial because concerns with prolonged anesthesia and operating time, excessive blood loss, deep vein thrombosis, pulmonary emboli, & prolonged postoperative recovery period. An additional concern is the increased risk of serious infections because the potential contact between the abdominal contents & the anterior abdominal wall. Vaginal hysterectomy does not require abdominal wall incisions & is associated with a lower complication rate. As a result, the performance of an abdominoplasty is less likely to compromise the postoperative recovery period or to increase the morbidity of the vaginal hysterectomy. This video illustrates the authors’ combined vaginal hysterectomy & minimally invasive lipoabdominoplasty technique. All patients were satisfied with the results & appreciated the minimal downtime & the economic advantages provided by the combination of the two procedures. 664

660 Analysis on Comparing of Laparoscopic Reduction and Myolysis of Adenomyosis with RF to Laparoscopically Supracervical Hysterectomy for the Relief of Symptom of Adenomyosis Eun D, Choi J, Choi Y, Jeong B, Shin K, Park J. Obstetrics & Gynecology, Eun’s Hospatil, Gwang-Ju, Jeonlanamdo, Republic of Korea To evaluate safety and relief of symptoms of laparoscopic reduction and myolysis of adenomyosis. Measurements & Main Results: all patients were

Single Incision Total Laparoscopic Hysterectomy with Temperature Controlled Advaced Bipolar System Sendag F. Department of Obstetrics and Gynecology, Ege University, Izmir, Turkey An alternative to conventional laparoscopy is single-incision laparoscopic surgery, in which articulating or bent instrumentation with specialized multilumen ports is used. The aim of this video is to present single incision total laparoscopic hysterectomy with bilateral salpingo-oopherectomy by using

Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S189–S194 advanced energy modality with positive thermostatic control called ‘‘En Seal’’. In this case articulating and rigid instruments, 30 degrees 10 mm telescope and SILS port were used. En Seal was employed during coagulation and dissection as well as sealing the vessels. Thereby we performed the operation without the need to replace the instruments. Vaginal cuff was sutured laparoscopically. Sutures were tied with extracorporeal technique. The mean operation time was 80 minutes almost without any bleeding. In conclusion; with the usage of this technique difficulties during single incision total laparoscopic hysterectomy may be diminished.

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procedure. We used an Alexis wound Retractor to perform laparoscopic ultraminilaparotomy myomectomy .We transform the suture procedure and removal of myoma into laparotomy type which is more familiar to most surgeons. Myomectomy includes five major parts. 1 Control of blood loss, 2 Enucleation of myoma, 3 Suture of uterine defect, 4 Removal of myoma, 5 Adhesion prevention. We compared the surgical procedure in both surgical techniques in this five major steps. 668

VIDEO POSTER SESSION–NEW INSTRUMENTATION 665 How To Perform Isobaric Gasless Myomectomy Cammareri G, Rollo D, Cirillo F, Macalli EA, Ferrazzi EM. Obstetric and Gynaecology, ICP, Hospital V. Buzzi, Milano, Italy To perform isobaric myomectomy we use a subcutaneous lifting system, Lucini’s LaparoTenserÒ, and conventional laparotomic instruments. The patient is a 42 years old symptomatic nulliparous woman with an intramural posterior myoma of 5,5 cm ! 6,0 cm. The intervention was made on spino-epidural anaesthesia. We describe carefully the external preparation of the intervention: the assembly of laparotenser, the curved subcutaneous needles, the creation of the intra abdominal space and the lateral incisions on the abdominal wall. Then we show the surgical part: incision, enucleation of the myoma, suture and morcellation. Conclusions: Isobaric myomectomy joins the advantages of open and laparoscopic surgeries: good visualization, minimal invasivity, tactile feedback, simple movements and classic laparotomic instrumentation. As we can see in the video, gasless myomectomy is a simple and reliable procedure and it is possible to be performed for large intramural myomas, with good suturing results on the uterine wall.

666 The Application Procedure of Seprafilm in Alexis Wound Retractor Laparoscopic Ultraminilaparotomy Myomectomy V.S Total Laparoscopic Myomectomy Chuang Y-C, Ho S-Y, Kan YY. Obs&GYN, Fooyin University Hospital, Pingtung, Taiwan Although laparoscopic myomectomy has been reported to have less adhesion post-operatively than abdominal myomectomy. Myomectomy procedure is still considered at high risk of De Novo adhesion formation. Anti-adhesion barrier –seprafilm has been proved effective in decreasing adhesion formation in abdominal myomectomy, though it is sticky and brittle and most surgeons deem it difficult to use in laparoscopic procedure. We try to apply the seprafilm to cover the post-operative rough surface by the technique described by Chuang et al .on two myomectomy procedures ‘‘Total laparoscopic myomectomy VS Alexis Wound Retractor laparoscopic ultra-mini-laparotomy myomectomy.’’ The tips and tricks of applying seprafilm will be described. A second look Laparoscope on 5th day post-myomectomy showed the seprafilm remained between the rough surface of uterus and intestines as its physical barrier effect. 667 Alexis Wound Retractor Laparoscopic Ultraminilaparotomy Myomectomy V.S Total Laparoscopic Myomectomy (Surgical Procedure Comparison) Chuang Y-C,1 Chen M-J,2 Ho S-Y,1 Kan Y-Y.1 1OBS&GYN, Fooyin University Hospital, Pintung, Taiwan; 2OBS&GYN, Veterans General Hospital -TaiChung, TaiChung, Taiwan Total laparoscopic myomectomy has gained popularity due to less wound pain, less hospital stay, less adhesion, however, the surgical procedure is time-consuming and technique challenging. It needs a long learning curve to be an expertise and a proficient surgical assistant to be present in every

Advancing Hysteroscopy Skills: EssureÒ Procedure Virtual Reality Simulator Training Denison EH. Conceptus Inc., Mountain View, California To demonstrate the educational benefits of the EssureÒ Simulator among physicians seeking to enhance their in-office hysteroscopic skills. The Essure Simulator is a virtual reality-based procedural training platform developed for use on a standard laptop computer. This technology monitors, and realistically simulates, the Essure procedure and offers physicians an innovative teaching opportunity. Minimally invasive, office-based gynecological procedures such as diagnostic and operative hysteroscopy, including global endometrial ablation and hysteroscopic sterilization, are becoming preferred treatment options that require increased skills to meet patient demand and ensure positive outcomes. The Essure Simulator was developed in conjunction with the OBGYN community to meet this need. The video will demonstrate comparability of an Essure Simulator procedure and a real-life procedure and will discuss the subsequent physician educational and training advantages derived from this technology and expected patient benefits.

669 Single Port Laparoscopic Myomectomy for Large Myoma Han C-M, Su H, Wu P-J, Wang C-J, Lee C-L, Yen C-F, Wu K-Y. Dept of Obs/Gyn, Gynecologic Endoscopic Division, Chang Gung Memorial Hospital, Linkou, Taiwan, Guishan Township, Taoyuan County, Taiwan To present our initial experience with Single-port access laparoscopic myomectomy. Patients: We performed the Single-port access laparoscopic myomectomy in 8 patients from March 2010 to April 2010. Interventions: A prospective study was performed to evaluate patient outcomes after Singleport gynecologic laparoscopy. Measurements & Main Results: Demographic data including age, body mass index, port insertion time, operative time, estimated blood loss, operative indications, complications, and postoperative Visual Analog Pain Scale scores were accrued. Between March 2010 and April 2010, 8 patients underwent Single-port gynecologic laparoscopic myopmectomy. Conclusions: Single port Laparoscopic Surgery seems to be a safe alternative to traditional Laparoscopy for the procedures performed in this study. Surgical time, safety and feasibility is similar, were as the cosmetic result and the post operative pain levels seem to be better accepted by the female patient .Further studies need to be performed and new instrumentation is necessary in order to perform more complicated cases. 670 Laparo-Endoscopic Single-Site BSO Using Olympus HiQ LS Curved Instruments Nimaroff ML, Atkin RP. OB/GYN Division of Minimally Invasive Surgery, North Shore University Hospital, Manhasset, New York Laparo-endoscopic single-site (LESS) surgery is an advanced, minimally invasive surgical technique in which an endoscope and hand instruments are inserted through an access port via a single 2cm incision in the umbilicus. The Key to the procedure is to minimize the clashing of the instruments brought through the one single incision and maintain triangulation. Olympus has introduced new reusable surgical instruments specifically designed for LESS surgery. The new HiQ LS curved 5-mm diameter hand instruments feature a shaft with curved distal and proximal ends to prevent interference with other LESS surgical devices inside the body. The purpose of this video is to demonstrate the use of these instruments in performing a LESS BSO.