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11: Natural orifice sacrohysteropexy
Videofests
11 Natural orifice sacrohysteropexy Arnulfo Martinez1,2 1
Obstetrics and Gynecologic Services, Hospital Regional Monterrey ISSSTE, Monterrey Nuevo Leon, Nuevo Leon, Mexico, 2Professor, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
OBJECTIVE: The purpose of this video is to describe the natural orifice
sacrohysteropexy technique through the retroperitoneal approach. DESCRIPTION: Sacrohysteropexy has been performed by abdominal,
laparoscopic, and robotic assisted; however, the retroperitoneal approach through the natural orifice has not been investigated. We present the case of 54-year old female, gravida 4, para 4, with ultrasound and magnetic resonance of a normal uterus. Vaginal cytology and endometrial samples were normal. The technique described herein includes a first sacral phase, through the retroperitoneal approach in which a graft is attached to the anterior longitudinal ligament of the sacrum at the level of first vertebra sacra, followed by the cervical phase that involves the fixation of another pericervical graft. Both sacral and pericervical grafts are attached to each other to restore the uterus’ normal intra-pelvic position. The post-operative magnetic resonance image shows the results. CONCLUSION: In select cases, Natural Orifice Sacrohysteropexy through the retroperitoneal approach is feasible. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Arnulfo Martinez: Nothing to disclose.
12 Robotically assisted resection of pericardial endometriosis M. Wasson, J. F. Magrina, P. Magtibay Gynecologic Surgery, Mayo Clinic Arizona, Phoenix, AZ
OBJECTIVE: The objective of this video is to demonstrate techniques
for minimally invasive removal of endometriosis involving the pericardium. DESCRIPTION: Endometriosis involving the pericardium is a rare phenomenon that occurs in 2.1% of patients with diaphragmatic endometriosis. It is recommended that when diaphragmatic endometriosis is encountered, full-thickness resection be completed. Prior reports have described techniques for treatment of endometriosis involving the diaphragm and pericardium via laparotomy. This video describes techniques to treat endometriosis involving the pericardium via a minimally invasive approach in two patients. CONCLUSION: Robotically assisted resection of endometriosis involving the pericardium is a safe and feasible option. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Megan Wasson: Nothing to disclose; Javier F. Magrina: Nothing to disclose; Paul Magtibay: Nothing to disclose.
13 Complete colpectomy and colpocleisis: A model for simulation A. Petrikovets1, J. Himler2, J. W. Henderson1, R. James1, R. R. Pollard2, J. Mangel2, S. T. Mahajan1 1 Female Pelvic Medicine & Reconstructive Surgery, University Hospitals Case Medical Center, Cleveland, OH, 2Urogynecology & Reconstructive Pelvic Surgery, MetroHealth Medical Center, Cleveland, OH
OBJECTIVE: To demonstrate a complete colpectomy and colpocleisis model for simulation for residents and faculty in OB/GYN.
ajog.org
DESCRIPTION: The largest population growth in the United States is
women over sixty and in their lives, up to 10% will have pelvic organ prolapse surgery. There is an increase in patients with pelvic organ prolapse in their 70s and 80s with medical comorbidities who are not sexually active. For patients with symptomatic prolapse with medical comorbidities, who are not sexually active, and have previously failed prolapse surgery or pessary trials, obliterative procedures may be indicated. There are two types, the LeFort, in patients with a uterus, and the complete colpectomy and colpocleisis in the patient with a previous hysterectomy. In the United States, there is limited exposure to colpocleisis in residency. Providers that have graduated less than 10 years ago are less likely to offer colpocleisis than otherwise. In our two hospitals, graduating residents have performed 1-3 colpocleisis as surgeon. Given other models for the LeFort colpocleisis, the purpose of this video is to demonstrate a simple model for complete colpectomy and colpocleisis. CONCLUSION: This may be a useful and inexpensive model that may demonstrate the complete colpectomy and colpocleisis procedure to the obstetrician and gynecologist and trainees. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Andrey Petrikovets: Nothing to disclose; Justin Himler: Nothing to disclose; J. W. Henderson: Nothing to disclose; Rebecca James: Nothing to disclose; Robert R. Pollard: Nothing to disclose; Jeffrey Mangel: Nothing to disclose; Sangeeta T. Mahajan: Nothing to disclose.
14 Robotic-assisted laparoscopic removal of eroded transobturator midurethral sling after failed cystoscopic excision K. Schwirian1, C. Bowling2 1 Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, TN, 2Urogynecology, University of Tennessee Medical Center, Knoxville, TN
OBJECTIVE: To present an alternative to traditional laparotomy to
resect eroded mesh from the bladder wall after failed cystoscopic excision. DESCRIPTION: This video details the case of a 77-year-old woman with a transobturator midurethral sling who presented to the office with pelvic pain and recurrent urinary tract infections. On office cystoscopy, the mesh was visibly eroded through the right bladder wall with several adherent stones. She subsequently underwent an operative cystoscopy, which was only partially successful at excising the mesh secondary to the degree of detrusor muscle involvement and lateral angle. We then performed a robotic-assisted laparoscopic intravesical mesh excision, during which an incision was made into the dome of the bladder under cystoscopic guidance. The mesh and stones were removed via an elliptical incision into the bladder wall, and the mesh bed thoroughly irrigated with cystoscopic assistance. After closure of the dome, the bladder was backfilled to verify integrity. Total operative time was 154 minutes with an estimated blood loss of less than 10 mL. Our patient underwent an uncomplicated postoperative course and was discharged to home with an indwelling catheter the morning after surgery. She experienced full resolution of her irritative voiding symptoms by her first postoperative visit.
S512 American Journal of Obstetrics & Gynecology Supplement to APRIL 2016
11 Natural orifice sacrohysteropexy Arnulfo Martinez1,2 1
Obstetrics and Gynecologic Services, Hospital Regional Monterrey ISSSTE, Monterrey Nuevo Leon, Nuevo Leon, Mexico, 2Professor, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
OBJECTIVE: The purpose of this video is to describe the natural orifice
sacrohysteropexy technique through the retroperitoneal approach. DESCRIPTION: Sacrohysteropexy has been performed by abdominal,
laparoscopic, and robotic assisted; however, the retroperitoneal approach through the natural orifice has not been investigated. We present the case of 54-year old female, gravida 4, para 4, with ultrasound and magnetic resonance of a normal uterus. Vaginal cytology and endometrial samples were normal. The technique described herein includes a first sacral phase, through the retroperitoneal approach in which a graft is attached to the anterior longitudinal ligament of the sacrum at the level of first vertebra sacra, followed by the cervical phase that involves the fixation of another pericervical graft. Both sacral and pericervical grafts are attached to each other to restore the uterus’ normal intra-pelvic position. The post-operative magnetic resonance image shows the results. CONCLUSION: In select cases, Natural Orifice Sacrohysteropexy through the retroperitoneal approach is feasible. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Arnulfo Martinez: Nothing to disclose.
12 Robotically assisted resection of pericardial endometriosis M. Wasson, J. F. Magrina, P. Magtibay Gynecologic Surgery, Mayo Clinic Arizona, Phoenix, AZ
OBJECTIVE: The objective of this video is to demonstrate techniques
for minimally invasive removal of endometriosis involving the pericardium. DESCRIPTION: Endometriosis involving the pericardium is a rare phenomenon that occurs in 2.1% of patients with diaphragmatic endometriosis. It is recommended that when diaphragmatic endometriosis is encountered, full-thickness resection be completed. Prior reports have described techniques for treatment of endometriosis involving the diaphragm and pericardium via laparotomy. This video describes techniques to treat endometriosis involving the pericardium via a minimally invasive approach in two patients. CONCLUSION: Robotically assisted resection of endometriosis involving the pericardium is a safe and feasible option. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Megan Wasson: Nothing to disclose; Javier F. Magrina: Nothing to disclose; Paul Magtibay: Nothing to disclose.
13 Complete colpectomy and colpocleisis: A model for simulation A. Petrikovets1, J. Himler2, J. W. Henderson1, R. James1, R. R. Pollard2, J. Mangel2, S. T. Mahajan1 1 Female Pelvic Medicine & Reconstructive Surgery, University Hospitals Case Medical Center, Cleveland, OH, 2Urogynecology & Reconstructive Pelvic Surgery, MetroHealth Medical Center, Cleveland, OH
OBJECTIVE: To demonstrate a complete colpectomy and colpocleisis model for simulation for residents and faculty in OB/GYN.
ajog.org
DESCRIPTION: The largest population growth in the United States is
women over sixty and in their lives, up to 10% will have pelvic organ prolapse surgery. There is an increase in patients with pelvic organ prolapse in their 70s and 80s with medical comorbidities who are not sexually active. For patients with symptomatic prolapse with medical comorbidities, who are not sexually active, and have previously failed prolapse surgery or pessary trials, obliterative procedures may be indicated. There are two types, the LeFort, in patients with a uterus, and the complete colpectomy and colpocleisis in the patient with a previous hysterectomy. In the United States, there is limited exposure to colpocleisis in residency. Providers that have graduated less than 10 years ago are less likely to offer colpocleisis than otherwise. In our two hospitals, graduating residents have performed 1-3 colpocleisis as surgeon. Given other models for the LeFort colpocleisis, the purpose of this video is to demonstrate a simple model for complete colpectomy and colpocleisis. CONCLUSION: This may be a useful and inexpensive model that may demonstrate the complete colpectomy and colpocleisis procedure to the obstetrician and gynecologist and trainees. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Andrey Petrikovets: Nothing to disclose; Justin Himler: Nothing to disclose; J. W. Henderson: Nothing to disclose; Rebecca James: Nothing to disclose; Robert R. Pollard: Nothing to disclose; Jeffrey Mangel: Nothing to disclose; Sangeeta T. Mahajan: Nothing to disclose.
14 Robotic-assisted laparoscopic removal of eroded transobturator midurethral sling after failed cystoscopic excision K. Schwirian1, C. Bowling2 1 Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, TN, 2Urogynecology, University of Tennessee Medical Center, Knoxville, TN
OBJECTIVE: To present an alternative to traditional laparotomy to
resect eroded mesh from the bladder wall after failed cystoscopic excision. DESCRIPTION: This video details the case of a 77-year-old woman with a transobturator midurethral sling who presented to the office with pelvic pain and recurrent urinary tract infections. On office cystoscopy, the mesh was visibly eroded through the right bladder wall with several adherent stones. She subsequently underwent an operative cystoscopy, which was only partially successful at excising the mesh secondary to the degree of detrusor muscle involvement and lateral angle. We then performed a robotic-assisted laparoscopic intravesical mesh excision, during which an incision was made into the dome of the bladder under cystoscopic guidance. The mesh and stones were removed via an elliptical incision into the bladder wall, and the mesh bed thoroughly irrigated with cystoscopic assistance. After closure of the dome, the bladder was backfilled to verify integrity. Total operative time was 154 minutes with an estimated blood loss of less than 10 mL. Our patient underwent an uncomplicated postoperative course and was discharged to home with an indwelling catheter the morning after surgery. She experienced full resolution of her irritative voiding symptoms by her first postoperative visit.
S512 American Journal of Obstetrics & Gynecology Supplement to APRIL 2016