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Strategy of Cervical Myoma under Laparoscopy
Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S103eS157 458 Single Port Access (SPA) Laparoscopy Versus Conventional Laparoscopy in Management of Presumptive Benign Ovarian Tumor: A Comparison of Perioperative Outcomes Lee Y-Y, Kim T-J, Kim CJ, Kim J, Choi CH, Lee J-W, Kim B-G, Lee J-H, Bae D-S. Department of Obstetrics and Gynecology, Samsung Medical Center, Seoul, Republic of Korea Study Objective: The objective of the study was to compare perioperative outcomes including operation time, length of hospital stay, bleeding during operation and post operaion pain in oophorectomy or cystectomy by single port access (SPA) laparoscopic surgery or by conventional laparoscopy. Design: A retrospective case control study (Canadian Task Force classification II-2). Setting: University hospital, research hospital and a tertiary center. Patients: We preformed oophorectomy or cystectomy though SPA in 17 patients and conventional method in 34 patients from December 1, 2008 to March 30, 2009. Intervention: Oophorectomy or cystectomy by SPA or conventional pelviscopy. Measurements and Main Results: SPA group and conventional group were balanced well in basal characteristics. There was no difference in age (years, 44.7 in SPA group vs 39.9 in conventional group), body mass index (kg/m2, 22.8 vs 23.3), percent of previous abdominal operation history (35.3% vs 44.1%), the longest diameter of ovarian tumor (cm, 5.6 vs 6.2) and bilaterality (1 case vs 2 cases) measured by transvaginal sonogram between two groups. During operation, the proportion of cystectomy (29.4% vs 41.2%) and oophorectomy (70.6% vs 58.8%), the frequency of adhesion according severity (mild/moderate/ severe, 29.4%/11.8%/17.6% vs 23.5%/8.8%/8.9%) and pathological findings were not different in both groups. Comparing operative outcomes between two groups, in SPA group, hospital stay (days, 2 vs 2), operation time (min, 64 vs 57.5) and hemoglobin change (Hb, 1.3 vs 1.1) before and after surgery was comparable to conventional group. There was a tendency of decreased usage of additional pain killer (total amount of pain killer, 7 vs 28, P 5 0.132) in SPA group, not statistically significantly. Conclusion: Pelviscopic management of presumptive benign ovarian tumor though SPA has comparable operative outcomes against conventional approach.
460 Strategy of Cervical Myoma under Laparoscopy Matsuoka S, Kitade M, Kikuchi I, Kumakiri J, Kuroda K, Kuroda M, Takeda S. Obstetrics and Gynecology, Juntendo Univercity School of Medicine, Tokyo, Japan Study Objective: To evaluate strategy of laparoscopic excision of cervical myoma. Design: Retrospective study. Setting: University-affiliated hospital. Patients: 7 patients who had requested the preservation of fertility and were suffering from intracervical myoma. Intervention: Laparoscopic myomectomy. Anterior wall of Cervical myoma was enucleated, after that the bladder was separated from anterior wall of uterus with blunt dissection. Posterior Cervical myoma and intracervical myoma was enucleated from post cervical median incision, and the wound was sutured in two layers intracorporeally. Clipping of the uterine artery and diluted vasopressin injection were performed to decrease bleeding during laparoscopy. Measurements and Main Results: Laparoscopic myomectomy could be performed in all patients. The mean operation time, blood loss and myoma weight was 92 (range: 48e150) minutes, 37 (10e150) mL, and 151 (18e640) grams, respectively. Conclusion: This is a minimally invasive and safe technique for cervical myoma. Surgical treatment of cervical myoma is empirically difficult, it
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is important that approach should be changed by part, size and shape of myoma.
461 A Modified Open Access Technique for Primary Trocar Using the Umbilical Cicatrix Pillar in Laparoscopic Surgery Miyabe Y, Mochizuki A, Itoh H, Kanayama N. Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan Study Objective: To describe the safety and feasibility of a modified open trocar placement using the umbilical cicatrix pillar in laparoscopic surgery. Design: Prospective study. Setting: Hamamatsu University Hospital. Patients: Eighty-six patients undergoing laparoscopic surgery from May 2008 to March 2009. Intervention: After the incision was made in the superior or inferior umbilical fold, the subcutaneous fat was separated from the umbilical cicatrix pillar. The umbilical cicatrix pillar was picked up by the towel clip and retracted up to lift the abdominal wall. A vertical incision was made on the junction of the umbilical cicatrix pillar and the linea alba. The peritoneum was opened bluntly or sharply to create a pneumoperitoneum. Measurements and Main Results: In all 86 women, the primary trocar was placed correctly to create a pneumoperitoneum. The median time taken was 3.7 ( 1.4) minutes (2e10). No intraoperative complications occurred during trocar insertion. Gas leakage did not occur in any of the cases. Conclusion: This is a simple technique that is safe and easy to learn. Lifting up the umbilical cicatrix pillar with a towel clip is crucial to this procedure in order to allow enough distance to avoid visceral and vascular injury. This method is reliable for the insertion of the primary trocar placement under direct vision.
462 Laparoscopic Metroplasty of Unicornuate Uterus with Lt. Noncommunicated Rudimentary Horn with Endometrial Polyp Namkung J,1 Kim S-M.2 1Obstetrics & Gynecology, Seoul St. Mary’s Hospital, Seoul, Republic of Korea; 2Obstetrics & Gynecology, The Catholic University, Seoul, Korea Study Objective: Congenital anomalies of the female reproductive tract may involve the uterus, cervix, fallopian tubes, or vagina. The incidence of reproductive females is about 0.5~1.8%. Among patients with relatively rare unicornuate uterus, noncommunicated rudimentary horn without endometrial cavity is most common. Women with this type may be complaining dysmenorrhea, dyspareunia, pelvic mass, urologic anomalies or pelvic endometriosis. Design: N/A Setting: N/A Patients: We have experienced a case of unicornuate uterus with left noncommunicated rudimentary horn with endometrial polyp in a 26 years old woman with severe dysmenorrhea. We observed noncommunicating uterine horn with functional endometrium. Her uterine cavity was quite normal except endometrial polyp, however, the tubal opening of left side was not visualized. Intervention: Her rudimentary uterine horn was enucleated with monopolar scissors and Harmonic scalpel by operative laparoscopy. The remained defect was sutured in two-layers. For prevention of ectopic pregnancy, left salpingectomy was performed. We removed endometrial polyp by hysteroscopy. Her symptom was cured completely after laparoscopic metroplasty. Measurements and Main Results: N/A Conclusion: Many cases of uterine anomalies have been documented but, there have been few reported cases about laparoscopic metroplasty of unicornuate uterus with noncommunicated rudimentary horn by Harmony scarpel. Thus hereby we are presenting this case with a review of literatures.
460 Strategy of Cervical Myoma under Laparoscopy Matsuoka S, Kitade M, Kikuchi I, Kumakiri J, Kuroda K, Kuroda M, Takeda S. Obstetrics and Gynecology, Juntendo Univercity School of Medicine, Tokyo, Japan Study Objective: To evaluate strategy of laparoscopic excision of cervical myoma. Design: Retrospective study. Setting: University-affiliated hospital. Patients: 7 patients who had requested the preservation of fertility and were suffering from intracervical myoma. Intervention: Laparoscopic myomectomy. Anterior wall of Cervical myoma was enucleated, after that the bladder was separated from anterior wall of uterus with blunt dissection. Posterior Cervical myoma and intracervical myoma was enucleated from post cervical median incision, and the wound was sutured in two layers intracorporeally. Clipping of the uterine artery and diluted vasopressin injection were performed to decrease bleeding during laparoscopy. Measurements and Main Results: Laparoscopic myomectomy could be performed in all patients. The mean operation time, blood loss and myoma weight was 92 (range: 48e150) minutes, 37 (10e150) mL, and 151 (18e640) grams, respectively. Conclusion: This is a minimally invasive and safe technique for cervical myoma. Surgical treatment of cervical myoma is empirically difficult, it
S125
is important that approach should be changed by part, size and shape of myoma.
461 A Modified Open Access Technique for Primary Trocar Using the Umbilical Cicatrix Pillar in Laparoscopic Surgery Miyabe Y, Mochizuki A, Itoh H, Kanayama N. Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan Study Objective: To describe the safety and feasibility of a modified open trocar placement using the umbilical cicatrix pillar in laparoscopic surgery. Design: Prospective study. Setting: Hamamatsu University Hospital. Patients: Eighty-six patients undergoing laparoscopic surgery from May 2008 to March 2009. Intervention: After the incision was made in the superior or inferior umbilical fold, the subcutaneous fat was separated from the umbilical cicatrix pillar. The umbilical cicatrix pillar was picked up by the towel clip and retracted up to lift the abdominal wall. A vertical incision was made on the junction of the umbilical cicatrix pillar and the linea alba. The peritoneum was opened bluntly or sharply to create a pneumoperitoneum. Measurements and Main Results: In all 86 women, the primary trocar was placed correctly to create a pneumoperitoneum. The median time taken was 3.7 ( 1.4) minutes (2e10). No intraoperative complications occurred during trocar insertion. Gas leakage did not occur in any of the cases. Conclusion: This is a simple technique that is safe and easy to learn. Lifting up the umbilical cicatrix pillar with a towel clip is crucial to this procedure in order to allow enough distance to avoid visceral and vascular injury. This method is reliable for the insertion of the primary trocar placement under direct vision.
462 Laparoscopic Metroplasty of Unicornuate Uterus with Lt. Noncommunicated Rudimentary Horn with Endometrial Polyp Namkung J,1 Kim S-M.2 1Obstetrics & Gynecology, Seoul St. Mary’s Hospital, Seoul, Republic of Korea; 2Obstetrics & Gynecology, The Catholic University, Seoul, Korea Study Objective: Congenital anomalies of the female reproductive tract may involve the uterus, cervix, fallopian tubes, or vagina. The incidence of reproductive females is about 0.5~1.8%. Among patients with relatively rare unicornuate uterus, noncommunicated rudimentary horn without endometrial cavity is most common. Women with this type may be complaining dysmenorrhea, dyspareunia, pelvic mass, urologic anomalies or pelvic endometriosis. Design: N/A Setting: N/A Patients: We have experienced a case of unicornuate uterus with left noncommunicated rudimentary horn with endometrial polyp in a 26 years old woman with severe dysmenorrhea. We observed noncommunicating uterine horn with functional endometrium. Her uterine cavity was quite normal except endometrial polyp, however, the tubal opening of left side was not visualized. Intervention: Her rudimentary uterine horn was enucleated with monopolar scissors and Harmonic scalpel by operative laparoscopy. The remained defect was sutured in two-layers. For prevention of ectopic pregnancy, left salpingectomy was performed. We removed endometrial polyp by hysteroscopy. Her symptom was cured completely after laparoscopic metroplasty. Measurements and Main Results: N/A Conclusion: Many cases of uterine anomalies have been documented but, there have been few reported cases about laparoscopic metroplasty of unicornuate uterus with noncommunicated rudimentary horn by Harmony scarpel. Thus hereby we are presenting this case with a review of literatures.