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Tries for Better Single Incision Laparoscopic Surgery (SILS)
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Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S169–S178
Ultrasound evaluation at 9 weeks and 2 days demonstrated a multi cystic right ovarian mass measuring 13.9x 9.6x 12.8 cm. She was taken to the operating room at 13 weeks and 2 days where a multi cystic mass originating from the sigmoid colon was discovered with normal tubes and ovaries. The mass was resected without injury to the colonic wall and intra operative colonoscopy with underwater inspection was done documenting no injury to colonic mucosa. Final pathology showed benign cystic Leiomyoma. The patient is in her 3rd trimester now. The purpose of our video is to further promote the safety of laparoscopy in pregnancy.
574 Diode Laser Laparoscopic Excision of Rectovaginal Deep Endometriotic Lesion with Shaving Technique Lee JY,1 Kim YJ.2 1Center for Advanced Gynecologic Endoscopy, Ahn’s Women Hospital, Seoul, Republic of Korea; 2Department of OB/GYN, Hanyang University Medical Center, Seoul, Republic of Korea This video is intended to demonstrate the availability of a diode laser system for the shaving technique of laparoscopic excision of the deep endometriotic rectovaginal lesion. We introduce two cases of endometriosis patients presenting with symptom of severe dysmenorrhea and bluish lesions protruding into the posterior vaginal fornix. On proper preoperative evaluation deep endometriotic rectovaginal nodule was identified at both cases. There was no rectal mucosal involvement. Surgical techniques include seperation of the anterior rectum from the posterior vagina and excision of the endometriosis in that area. Careful dissection is carried out using a diode laser system. Total procedure time was 120 and 90 minutes respectively. The patients were discharged on the third postoperative day without any complications. The shaving surgical approach with a diode laser system leads to a safe and effective laparoscopic dissection of deep endometriotic lesions.
575 Laparoscopic Excision of Rudimentary Uterine Horn Moria A, Tulandi T. Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada In this video, we outline the technic of laparoscopic excision of a Rudimentary uterine horn. Patient was a 18 year old female with increasing sever left lower abdominal pain over the past two years. MRI showed cavitated and non-communicating rudimentary uterine horn, due to the sever abdominal pain and the risk of uterine rupture during pregnancy Laparoscopic Excision of the rudimentary horn was performed.
576 Laparoscopic Approach to Torsion of the Massive Ovary Orady ME. Obstetrics, Gynecology, and Women’s Health, Henry Ford Health System, Detroit, Michigan Ovarian torsion is an acute process often involving an enlarged ovary. The laparoscopic approach allows for shorter hospitalization, faster recovery, and early return to work. Care is needed to remove a large ovary intact, especially when there is concern for malignancy, presenting a challenge to the surgeon. This is a case of a 45 year old morbidly obese female (BMI of 40) presenting with acute abdominal pain suspicious for ovarian torsion. CAT scan revealed a 15 centimeter cystic structure thought to arise from the left ovary. Despite doppler flow to the ovary on ultrasound, the patients pain increased and WBC count elevated, and she was taken for diagnostic laparoscopy. Torsion of a massively enlarged right ovary with edema and necrosis was discovered. This video illustrates the laparoscopic approach to this case, including the identification and isolation of the blood supply and the laparoscopic removal of the massive ovary without spillage.
577 Tries for Better Single Incision Laparoscopic Surgery (SILS) Park Y. Gynecology, CHA University, Gangnam CHA Hospital, Seoul, Korea Current techniques of single incision laparoscopic surgery(SILS) have many barriers disturbing its popularization. To find out the better(e.g., safer, simpler, easier, faster, and even cheaper) way of SILS including total laparoscopic hysterectomy, current procedures were analysed. My tries to overcome these barriers are 1) modified direct trocar insertion under periumbilical incision, which is more convenient, and gives faster decision whether to convert to multi-port surgey or laparotomy than Haesson technique, 2) anchoring sutures for faster, easier closure of the large single-port, 3) modified homemade port including better smoke drainage and less trocar heads’ fighting, 4) easier removal of Allexis inner ring with vein retractor, 5) percutaneous sling suture saving additional port in total laparoscopic hysterectomy, myomectomy, ovarian cystectomy, 6) laparoscopic morcellation with morcellating knife, and, 7) better laparoscopic vault closure technique using vaginal tube. And all SILS is performed only with traditional straight instrumentations.
578 An Unsual Case of a Posterior Vaginal Wall Parasitic Fibroid Pistofidis GA, Dimitriou EN, Filipides M, Bardis N, Mpalinakos P. Gynaecology Dept, Leukos Stauros Hospital, Athens, Greece A 65 year old woman presented with vaginal bleeding. From the examination and the investigations a round shaped 6 cm mass was found at the top of the posterior wall of the vagina very close to the cervix which had an ulcerated surface and was bleeding. MRI scans did not show any spread of the lump to the lateral pelvic wall. The access was very difficult vaginally as the woman was nulliparus and there was very little descent due to the size of the mass. Therefore the laparoscopic approach was prefered. A TLH was performed first and then the mass was released from the rectovaginal septum and the pelvic side wall and removed completely in healthy planes. The histology showed a myoma.
579 3 Extreme Cases of Laparoscopic Removal of Fibroids: Video Presentation Pistofidis G, Dimitriou E, Filipides M, Bardis N, Mpalinakos P. Gynaecology Dept, Leukos Stauros Hospital, Athens, Greece 1: A big ligamental fibroid with very distorted anatomy of the parametrium, particularly the left ureter: This video demonstrates how much vigilant one has to be to avoid damage to the urinary tract and big parametrial vessels in such cases of big broad ligament myomas 2: 2 big ligamental fibroids one on the left side and one on the right, bridging the two Iliac vessels. Both were mobilised and extracted successfully with this new tecnique. All three cases are uncommon and the videos demonstrate difficulties, hazards, tips and techniques for overcoming problems, for suturing and for a good surgical result.
580 Bilateral Salpingo-Oophorectomy with Modified ‘‘Glove’’ Port Rosenblatt PL, Apostolis CA, Awtrey CS. Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, Massachusetts Although single incision surgery is a new and evolving technique, there are already an abundance of novel port site devices available. We present a case of risk reduction single port prophylactic bilateral salpingo-oophorectomy in a 64 year-old woman using a simple and inexpensive single port device. An Alexis wound retractor and standard surgical glove are used to create the port, along with several disposable trocar housings that are
Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S169–S178
Ultrasound evaluation at 9 weeks and 2 days demonstrated a multi cystic right ovarian mass measuring 13.9x 9.6x 12.8 cm. She was taken to the operating room at 13 weeks and 2 days where a multi cystic mass originating from the sigmoid colon was discovered with normal tubes and ovaries. The mass was resected without injury to the colonic wall and intra operative colonoscopy with underwater inspection was done documenting no injury to colonic mucosa. Final pathology showed benign cystic Leiomyoma. The patient is in her 3rd trimester now. The purpose of our video is to further promote the safety of laparoscopy in pregnancy.
574 Diode Laser Laparoscopic Excision of Rectovaginal Deep Endometriotic Lesion with Shaving Technique Lee JY,1 Kim YJ.2 1Center for Advanced Gynecologic Endoscopy, Ahn’s Women Hospital, Seoul, Republic of Korea; 2Department of OB/GYN, Hanyang University Medical Center, Seoul, Republic of Korea This video is intended to demonstrate the availability of a diode laser system for the shaving technique of laparoscopic excision of the deep endometriotic rectovaginal lesion. We introduce two cases of endometriosis patients presenting with symptom of severe dysmenorrhea and bluish lesions protruding into the posterior vaginal fornix. On proper preoperative evaluation deep endometriotic rectovaginal nodule was identified at both cases. There was no rectal mucosal involvement. Surgical techniques include seperation of the anterior rectum from the posterior vagina and excision of the endometriosis in that area. Careful dissection is carried out using a diode laser system. Total procedure time was 120 and 90 minutes respectively. The patients were discharged on the third postoperative day without any complications. The shaving surgical approach with a diode laser system leads to a safe and effective laparoscopic dissection of deep endometriotic lesions.
575 Laparoscopic Excision of Rudimentary Uterine Horn Moria A, Tulandi T. Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada In this video, we outline the technic of laparoscopic excision of a Rudimentary uterine horn. Patient was a 18 year old female with increasing sever left lower abdominal pain over the past two years. MRI showed cavitated and non-communicating rudimentary uterine horn, due to the sever abdominal pain and the risk of uterine rupture during pregnancy Laparoscopic Excision of the rudimentary horn was performed.
576 Laparoscopic Approach to Torsion of the Massive Ovary Orady ME. Obstetrics, Gynecology, and Women’s Health, Henry Ford Health System, Detroit, Michigan Ovarian torsion is an acute process often involving an enlarged ovary. The laparoscopic approach allows for shorter hospitalization, faster recovery, and early return to work. Care is needed to remove a large ovary intact, especially when there is concern for malignancy, presenting a challenge to the surgeon. This is a case of a 45 year old morbidly obese female (BMI of 40) presenting with acute abdominal pain suspicious for ovarian torsion. CAT scan revealed a 15 centimeter cystic structure thought to arise from the left ovary. Despite doppler flow to the ovary on ultrasound, the patients pain increased and WBC count elevated, and she was taken for diagnostic laparoscopy. Torsion of a massively enlarged right ovary with edema and necrosis was discovered. This video illustrates the laparoscopic approach to this case, including the identification and isolation of the blood supply and the laparoscopic removal of the massive ovary without spillage.
577 Tries for Better Single Incision Laparoscopic Surgery (SILS) Park Y. Gynecology, CHA University, Gangnam CHA Hospital, Seoul, Korea Current techniques of single incision laparoscopic surgery(SILS) have many barriers disturbing its popularization. To find out the better(e.g., safer, simpler, easier, faster, and even cheaper) way of SILS including total laparoscopic hysterectomy, current procedures were analysed. My tries to overcome these barriers are 1) modified direct trocar insertion under periumbilical incision, which is more convenient, and gives faster decision whether to convert to multi-port surgey or laparotomy than Haesson technique, 2) anchoring sutures for faster, easier closure of the large single-port, 3) modified homemade port including better smoke drainage and less trocar heads’ fighting, 4) easier removal of Allexis inner ring with vein retractor, 5) percutaneous sling suture saving additional port in total laparoscopic hysterectomy, myomectomy, ovarian cystectomy, 6) laparoscopic morcellation with morcellating knife, and, 7) better laparoscopic vault closure technique using vaginal tube. And all SILS is performed only with traditional straight instrumentations.
578 An Unsual Case of a Posterior Vaginal Wall Parasitic Fibroid Pistofidis GA, Dimitriou EN, Filipides M, Bardis N, Mpalinakos P. Gynaecology Dept, Leukos Stauros Hospital, Athens, Greece A 65 year old woman presented with vaginal bleeding. From the examination and the investigations a round shaped 6 cm mass was found at the top of the posterior wall of the vagina very close to the cervix which had an ulcerated surface and was bleeding. MRI scans did not show any spread of the lump to the lateral pelvic wall. The access was very difficult vaginally as the woman was nulliparus and there was very little descent due to the size of the mass. Therefore the laparoscopic approach was prefered. A TLH was performed first and then the mass was released from the rectovaginal septum and the pelvic side wall and removed completely in healthy planes. The histology showed a myoma.
579 3 Extreme Cases of Laparoscopic Removal of Fibroids: Video Presentation Pistofidis G, Dimitriou E, Filipides M, Bardis N, Mpalinakos P. Gynaecology Dept, Leukos Stauros Hospital, Athens, Greece 1: A big ligamental fibroid with very distorted anatomy of the parametrium, particularly the left ureter: This video demonstrates how much vigilant one has to be to avoid damage to the urinary tract and big parametrial vessels in such cases of big broad ligament myomas 2: 2 big ligamental fibroids one on the left side and one on the right, bridging the two Iliac vessels. Both were mobilised and extracted successfully with this new tecnique. All three cases are uncommon and the videos demonstrate difficulties, hazards, tips and techniques for overcoming problems, for suturing and for a good surgical result.
580 Bilateral Salpingo-Oophorectomy with Modified ‘‘Glove’’ Port Rosenblatt PL, Apostolis CA, Awtrey CS. Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, Massachusetts Although single incision surgery is a new and evolving technique, there are already an abundance of novel port site devices available. We present a case of risk reduction single port prophylactic bilateral salpingo-oophorectomy in a 64 year-old woman using a simple and inexpensive single port device. An Alexis wound retractor and standard surgical glove are used to create the port, along with several disposable trocar housings that are