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1603 Fibroid Mapping with MRI to Optimize Surgical Planning
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
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functional horn is diagnosed, principles used in laparoscopic hysterectomy and myomectomy can be combined to safely remove it. Our 4 quadrant laparoscopic technique allows both surgeon and assistant to actively participate in most minimally invasive gynecologic surgery in an ergonomic fashion.
circumferential dissection of the artery, the temporary occlusion is conducted using 2-0 polyester suture. Posterior approach, lateral to the infundibulopelvic ligament: For the ligation of the uterine artery posteriorly to the uterus and laterally to the pelvic infundibulum, the opening of the peritoneum of the broad ligament should start immediately below the round ligament, parallel to the external iliac vessels towards the base of the pelvic infundibulum. The avascular space is dissected by blunt dissection identifying the following landmarks:
Virtual Poster Session 1: Laparoscopy (10:10 AM — 10:20 AM) 10:10 AM: STATION D 1603 Fibroid Mapping with MRI to Optimize Surgical Planning Ramadan H,1,* Shaves S,2 Hudgens JL,1 Ito TE1. 1Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA; 2Radiology, Eastern Virginia Medical School, Norfolk, VA *Corresponding author. Video Objective: This video discusses the use of preoperative Magnetic Resonance Imaging (MRI) to optimize surgical planning of laparoscopic myomectomies in patients with multiple fibroids desiring future fertility. Setting: University hospital that serves as a referral center for patients desiring myomectomies. We will present two patients with multiple fibroids and infertility who elected to undergo surgical intervention. MRI’s were obtained and we will highlight the use of imaging to assist in the surgical planning of the myomectomy procedure. Interventions: For both patients, preoperative pelvic MRI (with and without contrast) was performed. Multiple fibroids were found and T2 images in 3 planes were used to map fibroid location in relation to key anatomical structures (Endometrium, cornua, cervix, etc). This critical information allows for efficient intra-operative management and resection of fibroids reducing the risk of recurrence. Anticipating endometrial involvement may allow for resection without compromising the integrity of the endometrial cavity which could have a significant impact on fertility and mode of delivery. Conclusion: In the setting of 4 or more fibroids, MRI is likely superior to ultrasound for the purposes of preoperative planning. Mapping techniques helps surgeons plan efficient resection of the pathology to optimize surgical outcomes. Virtual Poster Session 1: Laparoscopy (10:10 AM — 10:20 AM) 10:10 AM: STATION E 2953 Temporary Uterine Artery Ligation During Laparoscopic Myomectomy - Different Surgical Approaches Cabrera R,1,* Vigueras Smith A,2 Ribeiro R,2 Zomer MT,3 Kondo W4. 1 Minimally Invasive Surgery, Angels Hospital, City of Mexico, Mexico; 2 Minimal Invasive Surgery, Vita Batel Hospital, Curitiba, Brazil; 3 Minimal Invasive Surgery, Vita Batel Hospital, Curitiba, Brazil; 4 Minimally Invasive Surgery, Ceagic - NaCoes ¸ Hospital, Curitiba, Brazil *Corresponding author. Video Objective: Laparoscopic Uterine Artery Ligation may be performed during myomectomy in order to reduce the amount of blood loss during surgery. Setting: Step-by-step video demonstration of three different techniques. Interventions: Main steps of uterine artery ligation are described in detail as well as different laparoscopic variants to this procedure. Anterior Approach: The impression of the uterine vessels can usually be seen anterior and laterally to the uterine cervix. After the identification of the path of the uterine arteries, the peritoneum of the anterior cul-de-sac is opened over the vessels and the uterine artery is carefully dissected next to the lateral border of the uterine cervix. This dissection must be extremely cautious because the uterine veins are very close to the artery. After the
Lateral: external iliac vessels; Medial: pelvic infundibulum and the ureter attached to the peritoneum. The external iliac artery is dissected cranially in order to find the bifurcation of the common iliac artery and the internal iliac artery. The first medial branch of the anterior division of the internal iliac is normally the uterine artery. After dissection of the uterine artery it may be ligated according to the same technique described above. Conclusion: Laparoscopic Uterine Artery legation may be performed during laparoscopic myomectomy to reduce intraoperative blood loss. According to surgical scenario, the surgeon may choose among one of the above-mentioned techniques to perform it. Virtual Poster Session 1: Laparoscopy (10:10 AM — 10:20 AM) 10:10 AM: STATION F 2979 Laparoscopic Removal of Parasitic Leiomyomas Khadraoui WK,1,* Menderes G,2 Tierney C1. 1OB/GYN, YNNH Bridgeport Hospital, Bridgeport, CT; 2Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT *Corresponding author. Video Objective: The objective of this video is to describe the presentation, diagnosis and surgical approach to parasitic leiomyoma. We describe a case report of a postmenopausal patient who presented with incidental adnexal masses, underwent a diagnostic laparoscopy and was ultimately diagnosed with parasitic leiomyoma. We discuss the differential diagnosis, symptomatology, origin and epidemiology of this rare diagnosis. Setting: A university tertiary care hospital. Interventions: This is a case report of a patient with an incidentally diagnosed adnexal mass that was found to have parasitic leiomyoma. Conclusion: Parasitic leiomyoma is an unusual variant of fibroid presentation. There are several hypotheses regarding their development, most importantly following morcellation after laparoscopic myomectomy. Others include the possibility of pedunculated fibroids that detach from the uterus and latch onto nearby viscera. This case illustrates the incidental finding of a parasitic leiomyoma, appropriate workup and differential diagnosis. We also elaborate on the surgical technique for removal of parasitic leiomyomas. We conclude that parasitic leiomyoma should be on the differential diagnosis for adnexal masses. Virtual Poster Session 1: Laparoscopy (10:10 AM — 10:20 AM) 10:10 AM: STATION G 1543 Laparoscopic Nerve Sparing Radical Trachelectomy Puntambekar SP,* Pattanaik S, Nihlani H, Goel A. Galaxy CARE Laparoscopy Institute Pvt. Ltd, Pune, India *Corresponding author. Video Objective: This video is a demonstration of radical trachelectomy done laparoscopically with a nerve sparing approach. The uniqueness of the surgery lies in the fact that it is nerve sparing which helps prevent urinary dysfunction, anorectal problems and sexual issues postoperatively which is the ultimate goal for any surgeon doing a radical fertility sparing
S111
functional horn is diagnosed, principles used in laparoscopic hysterectomy and myomectomy can be combined to safely remove it. Our 4 quadrant laparoscopic technique allows both surgeon and assistant to actively participate in most minimally invasive gynecologic surgery in an ergonomic fashion.
circumferential dissection of the artery, the temporary occlusion is conducted using 2-0 polyester suture. Posterior approach, lateral to the infundibulopelvic ligament: For the ligation of the uterine artery posteriorly to the uterus and laterally to the pelvic infundibulum, the opening of the peritoneum of the broad ligament should start immediately below the round ligament, parallel to the external iliac vessels towards the base of the pelvic infundibulum. The avascular space is dissected by blunt dissection identifying the following landmarks:
Virtual Poster Session 1: Laparoscopy (10:10 AM — 10:20 AM) 10:10 AM: STATION D 1603 Fibroid Mapping with MRI to Optimize Surgical Planning Ramadan H,1,* Shaves S,2 Hudgens JL,1 Ito TE1. 1Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA; 2Radiology, Eastern Virginia Medical School, Norfolk, VA *Corresponding author. Video Objective: This video discusses the use of preoperative Magnetic Resonance Imaging (MRI) to optimize surgical planning of laparoscopic myomectomies in patients with multiple fibroids desiring future fertility. Setting: University hospital that serves as a referral center for patients desiring myomectomies. We will present two patients with multiple fibroids and infertility who elected to undergo surgical intervention. MRI’s were obtained and we will highlight the use of imaging to assist in the surgical planning of the myomectomy procedure. Interventions: For both patients, preoperative pelvic MRI (with and without contrast) was performed. Multiple fibroids were found and T2 images in 3 planes were used to map fibroid location in relation to key anatomical structures (Endometrium, cornua, cervix, etc). This critical information allows for efficient intra-operative management and resection of fibroids reducing the risk of recurrence. Anticipating endometrial involvement may allow for resection without compromising the integrity of the endometrial cavity which could have a significant impact on fertility and mode of delivery. Conclusion: In the setting of 4 or more fibroids, MRI is likely superior to ultrasound for the purposes of preoperative planning. Mapping techniques helps surgeons plan efficient resection of the pathology to optimize surgical outcomes. Virtual Poster Session 1: Laparoscopy (10:10 AM — 10:20 AM) 10:10 AM: STATION E 2953 Temporary Uterine Artery Ligation During Laparoscopic Myomectomy - Different Surgical Approaches Cabrera R,1,* Vigueras Smith A,2 Ribeiro R,2 Zomer MT,3 Kondo W4. 1 Minimally Invasive Surgery, Angels Hospital, City of Mexico, Mexico; 2 Minimal Invasive Surgery, Vita Batel Hospital, Curitiba, Brazil; 3 Minimal Invasive Surgery, Vita Batel Hospital, Curitiba, Brazil; 4 Minimally Invasive Surgery, Ceagic - NaCoes ¸ Hospital, Curitiba, Brazil *Corresponding author. Video Objective: Laparoscopic Uterine Artery Ligation may be performed during myomectomy in order to reduce the amount of blood loss during surgery. Setting: Step-by-step video demonstration of three different techniques. Interventions: Main steps of uterine artery ligation are described in detail as well as different laparoscopic variants to this procedure. Anterior Approach: The impression of the uterine vessels can usually be seen anterior and laterally to the uterine cervix. After the identification of the path of the uterine arteries, the peritoneum of the anterior cul-de-sac is opened over the vessels and the uterine artery is carefully dissected next to the lateral border of the uterine cervix. This dissection must be extremely cautious because the uterine veins are very close to the artery. After the
Lateral: external iliac vessels; Medial: pelvic infundibulum and the ureter attached to the peritoneum. The external iliac artery is dissected cranially in order to find the bifurcation of the common iliac artery and the internal iliac artery. The first medial branch of the anterior division of the internal iliac is normally the uterine artery. After dissection of the uterine artery it may be ligated according to the same technique described above. Conclusion: Laparoscopic Uterine Artery legation may be performed during laparoscopic myomectomy to reduce intraoperative blood loss. According to surgical scenario, the surgeon may choose among one of the above-mentioned techniques to perform it. Virtual Poster Session 1: Laparoscopy (10:10 AM — 10:20 AM) 10:10 AM: STATION F 2979 Laparoscopic Removal of Parasitic Leiomyomas Khadraoui WK,1,* Menderes G,2 Tierney C1. 1OB/GYN, YNNH Bridgeport Hospital, Bridgeport, CT; 2Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT *Corresponding author. Video Objective: The objective of this video is to describe the presentation, diagnosis and surgical approach to parasitic leiomyoma. We describe a case report of a postmenopausal patient who presented with incidental adnexal masses, underwent a diagnostic laparoscopy and was ultimately diagnosed with parasitic leiomyoma. We discuss the differential diagnosis, symptomatology, origin and epidemiology of this rare diagnosis. Setting: A university tertiary care hospital. Interventions: This is a case report of a patient with an incidentally diagnosed adnexal mass that was found to have parasitic leiomyoma. Conclusion: Parasitic leiomyoma is an unusual variant of fibroid presentation. There are several hypotheses regarding their development, most importantly following morcellation after laparoscopic myomectomy. Others include the possibility of pedunculated fibroids that detach from the uterus and latch onto nearby viscera. This case illustrates the incidental finding of a parasitic leiomyoma, appropriate workup and differential diagnosis. We also elaborate on the surgical technique for removal of parasitic leiomyomas. We conclude that parasitic leiomyoma should be on the differential diagnosis for adnexal masses. Virtual Poster Session 1: Laparoscopy (10:10 AM — 10:20 AM) 10:10 AM: STATION G 1543 Laparoscopic Nerve Sparing Radical Trachelectomy Puntambekar SP,* Pattanaik S, Nihlani H, Goel A. Galaxy CARE Laparoscopy Institute Pvt. Ltd, Pune, India *Corresponding author. Video Objective: This video is a demonstration of radical trachelectomy done laparoscopically with a nerve sparing approach. The uniqueness of the surgery lies in the fact that it is nerve sparing which helps prevent urinary dysfunction, anorectal problems and sexual issues postoperatively which is the ultimate goal for any surgeon doing a radical fertility sparing