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1364 Tips & Tricks: Step by Step How to Do Two-Port Contained Power Morcellation in A Specialized Bag
S142
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Conclusion: This study demonstrates the feasibility of direct trocar insertion under visualization. Our application of light pressure and twisting while visualizing abdominal layer without having to tent up the abdominal wall allows excellent control and visualization of abdominal wall layers and prevents inadvertent popping of the trocar. It also helps avoid trocar skiving keeping the appropriate distance from targeted anatomy.
Conclusion: It is important to include torsion of parasitic leiomyoma in the differential diagnosis of acute abdomen, especially, for the patients who had medical history of laparoscopic myomectomy.
Virtual Poster Session 2: Laparoscopy (1:10 PM − 1:20 PM)
1:10 PM: STATION I
1:10 PM: STATION G 1806 Tricky and Inexpensive Way to Aspirate Large Hemoperitoneum Epprecht JP*. Ginecology, Santa Casa de Miseric ordia de S~ ao Paulo, S~ ao Paulo, Brazil *Corresponding author. Video Objective: show a inexpensive, safe and fast way to aspirate large hemoperitoneum during a laparoscopy Setting: large amounts of blood in the abdominal cavity delays a lot during a laparoscopy for ectopic pregnancy or an hematic ovarian cyst, using a regular 5mm aspirator Interventions: make a small, inexpensive, reversible and safe modification in a regular aspirator hose with scissors Conclusion: this reversible and fast modification improve the operation time without harm for the patient during aspiration of large hemoperitoneum Virtual Poster Session 2: Laparoscopy (1:10 PM − 1:20 PM) 1:10 PM: STATION H 2075 A Case of Acute Abdomen Caused by Torsion of Parasitic Leiomyoma Murakami N,* Arakane F. Department of Obstetrics and Gynecology, Japanese Red Cross Kumamoto Hospital, Kumamoto city, Japan *Corresponding author. Study Objective: The reports of parasitic leiomyoma increase with the spread of the laparoscopic surgery. The origin is considered spontaneous or iatrogenic. In iatrogenic cases, many reports mention that the cause of parasitic leiomyoma is the using morcellator for laparoscopic myomectomy or hysterectomy of leiomyoma. This condition shows various symptoms, and it may develop acute abdomen. We describe the management of this condition and discuss about parasitic leiomyoma together with a review of the literature. Design: A case report. Setting: A tertiary care hospital. Patients or Participants: A 46-year-old, gravida 1, para 1, Japanese woman. Her past history is a laparoscopic myomectomy and excision of endometriosis in several years ago. Interventions: Laparoscopic surgery. Measurements and Main Results: The patient visited a practicing physician with a chief complaint of acute abdominal pain. Transabdominal ultrasound showed huge pelvic mass, and she referred to our hospital. MRI scan of the pelvic revealed a 15 cm diameter polycystic mass contained with water in the right adnexal region. Since she complained severe pain at the point of the mass, we suspected torsion of ovarian tumor, and we performed emergency laparoscopic surgery. During the procedure, we found the huge mass in the pelvis without connecting to right ovary. The mass was fed by vessels extending from the mesocolon of sigmoid colon and was twisted 1.5 rotations clockwise around the stalk. The mass was resected by the surgeon because GIST was suspected. A histopathological examination showed a leiomyoma. In immune-histological examination, c-kit was negative. Her postoperative course was uneventful.
Virtual Poster Session 2: Laparoscopy (1:10 PM − 1:20 PM)
1364 Tips & Tricks: Step by Step How to Do Two-Port Contained Power Morcellation in A Specialized Bag Freeman A*. Evin Women’s Health, Brisbane, QLD, Australia *Corresponding author. Video Objective: To explain and demonstrate: 1. Laparoscopic port placement, 2. Step by step technique for the two-port contained power morcellation in a specialized bag (Morcellation Containment System by Espiner Medical), 3. Tips and tricks on each step of contained morcellation Setting: Risks of electromechanical morcellation are spreading undiagnosed cancer, diffuse leiomyomatosis, and visceral injury. Food and Drug Administration (FDA) safety communication discouraged use of power morcellators for leiomyoma extraction after the case of disseminated leiomyosarcoma following a laparoscopic hysterectomy. Since FDA warning, laparoscopic contained (in bag) morcellation became popular. However, it can be challenging. Interventions: A 27 years old, G0P0, woman was presented with heavy periods and pelvic pain. Her medical and surgical history was unremarkable. Ultrasound showed and anterior/broad ligament fibroid with size of 7.6 £ 5.2 £ 5.5 cm. After discussing the treatment option, she was consented and had laparoscopic myomectomy and two-port contained morcellation in a specialized bag. Post-operative care was uneventful. Patient was discharged home same day. Histopathology showed benign fibroid. Conclusion: The Morcellation Containment System is a feasible tool to extract a pelvic mass. However, it is important to be aware of its challenges like any other contained morcellation system. Virtual Poster Session 2: Laparoscopy (1:10 PM − 1:20 PM) 1:10 PM: STATION J 1277 Trends and Factors Associated with Antibiotic Use by Gynecologic Surgeons during Myomectomy Cho M,1,* Shin JH2. 1OB/GYN (Minimally Invasive Gynecologic Surgery), Montefiore Hospital/Albert Einstein College of Medicine, Bronx, NY; 2OB/ GYN (Minimally Invasive Gynecologic Surgery), Montefiore Hospital / Albert Einstein College of Medicine, Bronx, NY *Corresponding author. Study Objective: There are limited guidelines regarding antibiotic use for myomectomies. The objective of this study was to determine perioperative factors that influence antibiotic use by gynecologic surgeons for myomectomies, and to assess adverse postoperative outcomes with and without perioperative antibiotics. Design: Retrospective chart review. Setting: Tertiary care academic center. Patients or Participants: Patients that underwent abdominal (ABD), laparoscopic or robotic (LSC/RA), and hysteroscopic (HSC) myomectomies, from April 2018 and earlier. Interventions: ABD, LSC/RA, or HSC myomectomies. Measurements and Main Results: One hundred patients were included in each of the myomectomy categories. In the ABD group, 85% of patients received perioperative antibiotics. There were no identifiable factors between those that received antibiotics and those that did not. In the LSC/ RA group, 65% of patients received perioperative antibiotics. Minimally invasive gynecologic surgeons were more likely to give antibiotics (72.7%
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Conclusion: This study demonstrates the feasibility of direct trocar insertion under visualization. Our application of light pressure and twisting while visualizing abdominal layer without having to tent up the abdominal wall allows excellent control and visualization of abdominal wall layers and prevents inadvertent popping of the trocar. It also helps avoid trocar skiving keeping the appropriate distance from targeted anatomy.
Conclusion: It is important to include torsion of parasitic leiomyoma in the differential diagnosis of acute abdomen, especially, for the patients who had medical history of laparoscopic myomectomy.
Virtual Poster Session 2: Laparoscopy (1:10 PM − 1:20 PM)
1:10 PM: STATION I
1:10 PM: STATION G 1806 Tricky and Inexpensive Way to Aspirate Large Hemoperitoneum Epprecht JP*. Ginecology, Santa Casa de Miseric ordia de S~ ao Paulo, S~ ao Paulo, Brazil *Corresponding author. Video Objective: show a inexpensive, safe and fast way to aspirate large hemoperitoneum during a laparoscopy Setting: large amounts of blood in the abdominal cavity delays a lot during a laparoscopy for ectopic pregnancy or an hematic ovarian cyst, using a regular 5mm aspirator Interventions: make a small, inexpensive, reversible and safe modification in a regular aspirator hose with scissors Conclusion: this reversible and fast modification improve the operation time without harm for the patient during aspiration of large hemoperitoneum Virtual Poster Session 2: Laparoscopy (1:10 PM − 1:20 PM) 1:10 PM: STATION H 2075 A Case of Acute Abdomen Caused by Torsion of Parasitic Leiomyoma Murakami N,* Arakane F. Department of Obstetrics and Gynecology, Japanese Red Cross Kumamoto Hospital, Kumamoto city, Japan *Corresponding author. Study Objective: The reports of parasitic leiomyoma increase with the spread of the laparoscopic surgery. The origin is considered spontaneous or iatrogenic. In iatrogenic cases, many reports mention that the cause of parasitic leiomyoma is the using morcellator for laparoscopic myomectomy or hysterectomy of leiomyoma. This condition shows various symptoms, and it may develop acute abdomen. We describe the management of this condition and discuss about parasitic leiomyoma together with a review of the literature. Design: A case report. Setting: A tertiary care hospital. Patients or Participants: A 46-year-old, gravida 1, para 1, Japanese woman. Her past history is a laparoscopic myomectomy and excision of endometriosis in several years ago. Interventions: Laparoscopic surgery. Measurements and Main Results: The patient visited a practicing physician with a chief complaint of acute abdominal pain. Transabdominal ultrasound showed huge pelvic mass, and she referred to our hospital. MRI scan of the pelvic revealed a 15 cm diameter polycystic mass contained with water in the right adnexal region. Since she complained severe pain at the point of the mass, we suspected torsion of ovarian tumor, and we performed emergency laparoscopic surgery. During the procedure, we found the huge mass in the pelvis without connecting to right ovary. The mass was fed by vessels extending from the mesocolon of sigmoid colon and was twisted 1.5 rotations clockwise around the stalk. The mass was resected by the surgeon because GIST was suspected. A histopathological examination showed a leiomyoma. In immune-histological examination, c-kit was negative. Her postoperative course was uneventful.
Virtual Poster Session 2: Laparoscopy (1:10 PM − 1:20 PM)
1364 Tips & Tricks: Step by Step How to Do Two-Port Contained Power Morcellation in A Specialized Bag Freeman A*. Evin Women’s Health, Brisbane, QLD, Australia *Corresponding author. Video Objective: To explain and demonstrate: 1. Laparoscopic port placement, 2. Step by step technique for the two-port contained power morcellation in a specialized bag (Morcellation Containment System by Espiner Medical), 3. Tips and tricks on each step of contained morcellation Setting: Risks of electromechanical morcellation are spreading undiagnosed cancer, diffuse leiomyomatosis, and visceral injury. Food and Drug Administration (FDA) safety communication discouraged use of power morcellators for leiomyoma extraction after the case of disseminated leiomyosarcoma following a laparoscopic hysterectomy. Since FDA warning, laparoscopic contained (in bag) morcellation became popular. However, it can be challenging. Interventions: A 27 years old, G0P0, woman was presented with heavy periods and pelvic pain. Her medical and surgical history was unremarkable. Ultrasound showed and anterior/broad ligament fibroid with size of 7.6 £ 5.2 £ 5.5 cm. After discussing the treatment option, she was consented and had laparoscopic myomectomy and two-port contained morcellation in a specialized bag. Post-operative care was uneventful. Patient was discharged home same day. Histopathology showed benign fibroid. Conclusion: The Morcellation Containment System is a feasible tool to extract a pelvic mass. However, it is important to be aware of its challenges like any other contained morcellation system. Virtual Poster Session 2: Laparoscopy (1:10 PM − 1:20 PM) 1:10 PM: STATION J 1277 Trends and Factors Associated with Antibiotic Use by Gynecologic Surgeons during Myomectomy Cho M,1,* Shin JH2. 1OB/GYN (Minimally Invasive Gynecologic Surgery), Montefiore Hospital/Albert Einstein College of Medicine, Bronx, NY; 2OB/ GYN (Minimally Invasive Gynecologic Surgery), Montefiore Hospital / Albert Einstein College of Medicine, Bronx, NY *Corresponding author. Study Objective: There are limited guidelines regarding antibiotic use for myomectomies. The objective of this study was to determine perioperative factors that influence antibiotic use by gynecologic surgeons for myomectomies, and to assess adverse postoperative outcomes with and without perioperative antibiotics. Design: Retrospective chart review. Setting: Tertiary care academic center. Patients or Participants: Patients that underwent abdominal (ABD), laparoscopic or robotic (LSC/RA), and hysteroscopic (HSC) myomectomies, from April 2018 and earlier. Interventions: ABD, LSC/RA, or HSC myomectomies. Measurements and Main Results: One hundred patients were included in each of the myomectomy categories. In the ABD group, 85% of patients received perioperative antibiotics. There were no identifiable factors between those that received antibiotics and those that did not. In the LSC/ RA group, 65% of patients received perioperative antibiotics. Minimally invasive gynecologic surgeons were more likely to give antibiotics (72.7%