1904 Laparoscopy Combined with Hysteroscopy in the Treatment of Cesarean Scar Pregnancy

Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231 Diagnosis of Lymph Node Metastasis During Robotic or Laparoscopic Surgery for Endometrial Cancer Park JY,* Kim JH. Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea, Republic of (South) *Corresponding author. Study Objective: The lymph node status is the most important prognostic factor for endometrial cancer. This study aimed to assess whether sentinel lymph node mapping (SLNM) is applicable in endometrial cancer. Design: A retrospective review of patients with endometrial cancer who were diagnosed and treated at a single institute (Asan Medical Center, Seoul, Korea) from September 2015 to December 2017 was conducted. One hundred patients underwent robotic (da VinciÒ ) or laparoscopic surgical treatment, including SLNM with indocyanine green (ICG) fluorescence detection using the FireflyÒ and NIR/ICG systems. Setting: University Hospital. Patients or Participants: 100 patients with early stage endometrial cancer. Interventions: Robotic or laparoscopic staging surgery. Measurements and Main Results: All patients underwent intraoperative SLNM. At least one lymph node area was observed in 100% of SLNM cases. Sentinel node detection and frozen biopsy were performed in all cases, and all patients with metastasis were found on SLNM. The sensitivity and negative predictive value were both 100% in the patient-by-patient and station-by-station analyses. Conclusion: SLNM appears to be a feasible method to reduce the morbidity and increase the detection rate in early-stage endometrial carcinoma. Virtual Poster Session 1: Laparoscopy (10:30 AM — 10:40 AM) 10:30 AM: STATION J 1975 Pre-Operative Medical Optimization of Women Undergoing Myomectomy: A Retrospective Cohort Study Gill P,1,* Nensi A,2 Simpson A,2 Robertson D2. 1Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada; 2Obstetrics and Gynecology, St. Michael’s Hospital, Toronto, ON, Canada *Corresponding author. Study Objective: Myomectomy is associated with significant blood loss and pre-operative medical optimization can improve surgical outcomes including minimizing transfusions rates and associated complications. The purpose of this study was to determine the proportion of women who are medically optimized prior to undergoing myomectomy with interventions to correct anemia and reduce fibroid volume. Design: Retrospective cohort study. Setting: Large academic, university-affiliated hospital in Canada. Patients or Participants: All patients undergoing myomectomy (open, laparoscopic and robot-assisted) between February 2015 and June 2018 were included. Interventions: N/A Measurements and Main Results: 225 myomectomies were completed between February 2015 and June 2018. 158 (70%), 25 (11%) and 42 (19%) of myomectomies were completed using open, laparoscopic and robot assisted approaches, respectively. Across all approaches, 68 (30%) of patients had a hemoglobin<120g/L prior to surgery and 155 (69%) were on a form of medical pre-operative optimization three months before surgery. The most common medications used for pre-operative optimization were oral iron supplementation (51%), Ulipristal Acetate (49%) and GnRH agonist (17%). 27(17%) patients who had an open myomectomy required a peri-operative transfusion. None of laparoscopic myomectomy patients required a transfusion. Five (12%) robotic-assisted patients had a post-operative transfusion. Conclusion: At the time of myomectomy, a third of women in our study were anemic yet only two-thirds were medically optimized within 3 months of surgery. 17% of open myomectomy patients required a

S125 perioperative transfusion. More efforts should be directed at optimizing patients prior to myomectomy in the hope of decreasing rates of peri-operative transfusions, particularly when an open procedure is planned. Virtual Poster Session 1: Laparoscopy (10:30 AM — 10:40 AM) 10:30 AM: STATION K 1904 Laparoscopy Combined with Hysteroscopy in the Treatment of Cesarean Scar Pregnancy WANG Q,* Yan L, Yu K. The Third Department of Gynaecology, Ningbo Children and Women Hospital, Ningbo, China *Corresponding author. Video Objective: To introduce a treatment of Cesarean Scar Pregnancy. Setting: Patient information:Age:34y.Chief complaint:pregnancy at 10 weeks and a little vaginal bleeding for 20 days. Past history:underwent two cesarean sections in 7 years ago and 5 years ago ;received removal of CSP by hysteroscopy after uterine artery embolization last year. No other special past history.Investigation information: 1.B-ultrasound: sac size: 41*27*35mm, fetal heart (+), the sac locates on the cesarean scar. 2.MRI: the thickness of cesarean scar is less than 2mm. 3.HCG:103722mIU/ml. Diagnosis: Cesarean scar pregnancy(CSP Type II) Interventions: Laparoscopy combined with hysteroscopy to remove the CSP and repair the uterine,the innovative point is to temporary interrup the bloodstream by knotting a slipknot around both uterina arterys during the operation and remove the knots at last of the operation. Conclusion: The removal the CSP and repair the uterine through laparoscopy combined with hysteroscopy is a minimally invasive surgery which will help patient to recover rapidly.Temporary interrup the bloodstream by knotting a slipknot around both uterina arterys during the operation and remove the knots at last of the operation that will reduce the bleeding during the operation effectively.This kind of surgery is expected to be a good way to treat CSP type II and type III. Virtual Poster Session 1: Laparoscopy (10:30 AM — 10:40 AM) 10:30 AM: STATION L 2088 The Comparison of Total Laparoscopic Hysterectomy With 2-Dimensionalversus 3-Dimensional Laparoscopic Surgical Systems In Benign Uterine Diseases Park S*. Obstetrics and Gynecology, Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea, Republic of (South) *Corresponding author. Study Objective: Three-dimensional (3D) laparoscopic surgical systems have been developed to account for the lack of depth perception, a known disadvantage of conventional 2-dimensional (2D) laparoscopic system. Design: We retrospectively compared the outcomes of total laparoscopic hysterectomy (TLH) with 3D versus conventional 2D laparoscopy. From September 2017, when we began using a 3D laparoscopic system at Kangnam Sacred Heart hospital, Hallym University, to December 2018, 60 TLH procedures were performed using a 3D laparoscopic system (3D-TLH). Setting: Under general anesthesia, TLH with 3D laparoscopy was perfomed with same method of TLH with 2D laparoscopy. Patients or Participants: In this study, Sixty patients with benign uterine diseases were included. Interventions: Total laparoscopic hysterectomy with 3D laparosopy were performed for patients with benign uterine diseases. Measurements and Main Results: The surgical outcomes of 3D-TLH were compared with the surgical outcomes of TLH using the conventional 2D laparoscopic system (2D-TLH) performed just before the introduction of the 3D system. The 3D-TLH group had a statistically significantly