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Surgisis Used in Robotic Sacrocolpopexy with Mesh
Abstracts / Journal of Minimally Invasive Gynecology 19 (2012) S123–S150 401
Video Session 13dAdvanced Endoscopy (9:23 AM d 9:31 AM)
Adenoma Malignum, or Lobular Endocervical Glandular Hyperplasia: That Is the Question Moon HS, Koo JS, Kim HJ, Kim KS, Song SJ, Kim BJ. Center for Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Good Moonhwa Hospital, Busan, Republic of Korea Lobular endocervical glandular hyperplasia (LEGH) is non-invasive proliferation of endocervical glandular cells. Adenoma malignum is an endocervical type of highly differentiated mucinous adenocarcinoma with well-formed glands resembling LEGH, but accompanied by components of invasive adenocarcinoma. Treatment of LEGH is simple hysterectomy, but in case of adenoma malignum, radical hysterectomy with lymph node dissection is the treatment of choice. Due to such apparent differences, an accurate preoperative differential diagnosis is required. Since clinical symptom and TVUS or MRI findings are almost identical in the two diseases, differential diagnosis is rather difficult. Pap smears are usually normal and conization is not an appropriate diagnostic method in case of deep and highly located lesion. We present a 42-year-old woman who complained of profuse watery vaginal discharge for 3 years. We performed excisional biopsy with frozen section for differential diagnosis during laparoscopic operation, and after confirming LEGH on biopsy we proceeded with simple hysterectomy.
402
Video Session 13dAdvanced Endoscopy (9:32 AM d 9:38 AM)
Laparoscopic Hysterectomy with an Obliterated Posterior Cul-de-Sac Della Badia CR, Grias I. OB/GYN, Drexel University College of Medicine, Philadelphia, Pennyslvania This video demonstrates the use of a vessel sealing device to perform a laparoscopic hysterectomy with an obliterated posterior cul-de-sac. This technique demonstrates how to dissect the anterior compartment first. Then we controlled the large uterine vessels. At this point the anterior colpotomy was performed. This made it easier to dissect the posterior compartment. The adnexa were remove last and a sigmoidoscopy and cystoscopy were performed at the end of the case.
403
Video Session 13dAdvanced Endoscopy (9:39 AM d 9:44 AM)
Surgisis Used in Robotic Sacrocolpopexy with Mesh Masone M, Jarnagin B, Tatalovich J. Center for Pelvic Health, Franklin, Tennessee
S123
Diagnostic laparoscopy revealed extensive lesions that were variable in size located throughout the pelvis with bowel involvement. Histology confirmed spleenic auto-implants. Splenosis can be caused by the autotransplantation of splenic tissue secondary to spillage of cells from the pulp of the damaged spleen. Differential diagnosis include endometriosis, hemangiomas, malignancy, and accessory spleen. Presentation can vary from being asymptomatic to sever abdominal pain, intra-abdominal hemorrhage and bowel obstruction. The diagnosis of splenosis should be considered in patients with chronic pelvic pain with history of previous splenic injury. Laparoscopy is idea for both diagnosis and management of this condition. 405
Video Session 14dAdvanced Endoscopy (8:00 AM d 8:06 AM)
Total Pelvic Floor Reconstruction with Uterine Conservation Sprague ML,1 Liu CY.2 1Department of Gynecology, Cleveland Clinic Florida, Weston, Florida; 2Women’s Surgery Center, Chattanooga, Tennessee Uterine conservation is feasible for selected individuals undergoing laparoscopic repair of pelvic organ prolapse. Here, we outline and demonstrate our technique for total pelvic floor reconstruction with uterine conservation using a polypropylene graft. Unlike traditional sacrohysteropexy, the graft material has attachments to the sacral promontory, anterior cervix, posterior vagina, perineal body, uterosacral ligaments, and the medial fascia of the levator ani muscles. In our experience, this technique adequately restores functional anatomy and affords a durable, long-lasting repair. 406
Video Session 14dAdvanced Endoscopy (8:07 AM d 8:15 AM)
Pelvic Vascular Anatomy: A Deliberate Teaching Technique for Gynecology Residents and Medical Students Lichtman AS. Clinical Professor, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California Pelvic Anatomy has been taught primarily utilizing cadavers along with static two-dimensional texts and atlases. Video provides the ability to enhance the teaching of anatomy and surgical technique. Combining high definition video images from surgery with schematic representations, along with didactic narration, creates a dynamic teaching tool. Deliberate identification of anatomical parts provides greater understanding of pelvic anatomy as applied to gynecologic surgery for medical students and residents. This particular video is an example of such a teaching technique, as it clearly demonstrates the critical relationship of the pelvic vasculature to the ureter. Incorporating traditional teaching of anatomy into a highly edited, appropriately narrated, high definition video of actual surgeries, is an important new teaching strategy that can be broadly applied to other areas of anatomy and surgery as well. In so doing a complete video textbook of anatomy, as applied to surgery, may be created.
This video demonstrates the use of graft to aid in the prevention of future mesh exposure when a patient’s tissue planes are noted to be of poor quality.
407
404
Total Laparoscopic Hysterectomy – Achieving the Best Technique for Vaginal Cuff Closure Sunyecz JA. The Uniontown Hospital, Uniontown, Pennyslvania
Video Session 13dAdvanced Endoscopy (9:45 AM d 9:51 AM)
Laparoscopic Management of Pelvic Splenosis Serur E, Lakhi NA. Department of Gynecologic Oncology, Richmond University Medical Center, Staten Island, New York A 37 y/o presented with a 10 year history of chronic pelvic pain. Past history was significant for a automobile accident 10 years previously requiring open spleenectomy. Ultrasound showed multiple solid pelvic nodules. A probable diagnosis of endometriosis was established.
Video Session 14dAdvanced Endoscopy (8:16 AM d 8:23 AM)
Minimally invasive hysterectomy is becoming a very common procedure, although significant concerns about the procedure voiced by many gynecologists are twofold: 1) The ability to confidently close the vaginal cuff laparoscopically and 2) The fear of cuff dehiscence. This has resulted in many practitioners closing the cuff vaginally, which increases operating time, or converting to LSH. We have developed a vaginal cuff closure technique following TLH that incorporates the same surgical principles as closure for an abdominal hysterectomy, is easy to learn and
Video Session 13dAdvanced Endoscopy (9:23 AM d 9:31 AM)
Adenoma Malignum, or Lobular Endocervical Glandular Hyperplasia: That Is the Question Moon HS, Koo JS, Kim HJ, Kim KS, Song SJ, Kim BJ. Center for Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Good Moonhwa Hospital, Busan, Republic of Korea Lobular endocervical glandular hyperplasia (LEGH) is non-invasive proliferation of endocervical glandular cells. Adenoma malignum is an endocervical type of highly differentiated mucinous adenocarcinoma with well-formed glands resembling LEGH, but accompanied by components of invasive adenocarcinoma. Treatment of LEGH is simple hysterectomy, but in case of adenoma malignum, radical hysterectomy with lymph node dissection is the treatment of choice. Due to such apparent differences, an accurate preoperative differential diagnosis is required. Since clinical symptom and TVUS or MRI findings are almost identical in the two diseases, differential diagnosis is rather difficult. Pap smears are usually normal and conization is not an appropriate diagnostic method in case of deep and highly located lesion. We present a 42-year-old woman who complained of profuse watery vaginal discharge for 3 years. We performed excisional biopsy with frozen section for differential diagnosis during laparoscopic operation, and after confirming LEGH on biopsy we proceeded with simple hysterectomy.
402
Video Session 13dAdvanced Endoscopy (9:32 AM d 9:38 AM)
Laparoscopic Hysterectomy with an Obliterated Posterior Cul-de-Sac Della Badia CR, Grias I. OB/GYN, Drexel University College of Medicine, Philadelphia, Pennyslvania This video demonstrates the use of a vessel sealing device to perform a laparoscopic hysterectomy with an obliterated posterior cul-de-sac. This technique demonstrates how to dissect the anterior compartment first. Then we controlled the large uterine vessels. At this point the anterior colpotomy was performed. This made it easier to dissect the posterior compartment. The adnexa were remove last and a sigmoidoscopy and cystoscopy were performed at the end of the case.
403
Video Session 13dAdvanced Endoscopy (9:39 AM d 9:44 AM)
Surgisis Used in Robotic Sacrocolpopexy with Mesh Masone M, Jarnagin B, Tatalovich J. Center for Pelvic Health, Franklin, Tennessee
S123
Diagnostic laparoscopy revealed extensive lesions that were variable in size located throughout the pelvis with bowel involvement. Histology confirmed spleenic auto-implants. Splenosis can be caused by the autotransplantation of splenic tissue secondary to spillage of cells from the pulp of the damaged spleen. Differential diagnosis include endometriosis, hemangiomas, malignancy, and accessory spleen. Presentation can vary from being asymptomatic to sever abdominal pain, intra-abdominal hemorrhage and bowel obstruction. The diagnosis of splenosis should be considered in patients with chronic pelvic pain with history of previous splenic injury. Laparoscopy is idea for both diagnosis and management of this condition. 405
Video Session 14dAdvanced Endoscopy (8:00 AM d 8:06 AM)
Total Pelvic Floor Reconstruction with Uterine Conservation Sprague ML,1 Liu CY.2 1Department of Gynecology, Cleveland Clinic Florida, Weston, Florida; 2Women’s Surgery Center, Chattanooga, Tennessee Uterine conservation is feasible for selected individuals undergoing laparoscopic repair of pelvic organ prolapse. Here, we outline and demonstrate our technique for total pelvic floor reconstruction with uterine conservation using a polypropylene graft. Unlike traditional sacrohysteropexy, the graft material has attachments to the sacral promontory, anterior cervix, posterior vagina, perineal body, uterosacral ligaments, and the medial fascia of the levator ani muscles. In our experience, this technique adequately restores functional anatomy and affords a durable, long-lasting repair. 406
Video Session 14dAdvanced Endoscopy (8:07 AM d 8:15 AM)
Pelvic Vascular Anatomy: A Deliberate Teaching Technique for Gynecology Residents and Medical Students Lichtman AS. Clinical Professor, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California Pelvic Anatomy has been taught primarily utilizing cadavers along with static two-dimensional texts and atlases. Video provides the ability to enhance the teaching of anatomy and surgical technique. Combining high definition video images from surgery with schematic representations, along with didactic narration, creates a dynamic teaching tool. Deliberate identification of anatomical parts provides greater understanding of pelvic anatomy as applied to gynecologic surgery for medical students and residents. This particular video is an example of such a teaching technique, as it clearly demonstrates the critical relationship of the pelvic vasculature to the ureter. Incorporating traditional teaching of anatomy into a highly edited, appropriately narrated, high definition video of actual surgeries, is an important new teaching strategy that can be broadly applied to other areas of anatomy and surgery as well. In so doing a complete video textbook of anatomy, as applied to surgery, may be created.
This video demonstrates the use of graft to aid in the prevention of future mesh exposure when a patient’s tissue planes are noted to be of poor quality.
407
404
Total Laparoscopic Hysterectomy – Achieving the Best Technique for Vaginal Cuff Closure Sunyecz JA. The Uniontown Hospital, Uniontown, Pennyslvania
Video Session 13dAdvanced Endoscopy (9:45 AM d 9:51 AM)
Laparoscopic Management of Pelvic Splenosis Serur E, Lakhi NA. Department of Gynecologic Oncology, Richmond University Medical Center, Staten Island, New York A 37 y/o presented with a 10 year history of chronic pelvic pain. Past history was significant for a automobile accident 10 years previously requiring open spleenectomy. Ultrasound showed multiple solid pelvic nodules. A probable diagnosis of endometriosis was established.
Video Session 14dAdvanced Endoscopy (8:16 AM d 8:23 AM)
Minimally invasive hysterectomy is becoming a very common procedure, although significant concerns about the procedure voiced by many gynecologists are twofold: 1) The ability to confidently close the vaginal cuff laparoscopically and 2) The fear of cuff dehiscence. This has resulted in many practitioners closing the cuff vaginally, which increases operating time, or converting to LSH. We have developed a vaginal cuff closure technique following TLH that incorporates the same surgical principles as closure for an abdominal hysterectomy, is easy to learn and