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2022 Laparoscopic Isthmocele Repair with Hysteroscopic Assistance
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
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Patients or Participants: Thirty-three obstetrician-gynecologic residents with no background on laparoscopy but assisting and performing gynecological laparotomy cases. Patients were female with age ranged of 20 to 55 years old, history of sexual contact, scheduled for elective total laparoscopic hysterectomy and adnexectomy for benign uterine or ovarian pathologies. Interventions: The residents were randomly grouped into two. Group A consisted of sixteen residents who underwent uterine manipulation training using the pelvic trainer box and Group B consisted of seventeen residents who did not undergo training. Group A was given PST which were performed in 5 repetitions in one session. One set of tasks commanded to perform in this order were antevert uterus, uterus to the patient’s left, uterus to the patient’s right, push uterus cephalad, pull uterus caudally and retrovert uterus. One session consisted of 5 sets. After a week, both groups were asked to scrub-in on actual procedure with the same instructor commanding the tasks and recording the time to perform the tasks. Measurements and Main Results: Group A performed the procedurespecific tasks correctly with a significantly shorter time than Group B (pvalue of 0.000). The senior residents did not perform the PST better than the junior residents (correlation coefficient was significant with p-value of 0.023 and a negative correlation coefficient of -0.200, this means that as the negative time difference to perform from the first to the fifth specific tasks increases, the actual time decreases). Conclusion: We have shown that uterine manipulation exercises in the pelvic trainer box is effective in the proper performance of residents as bottom person for uterine manipulation during TLH.
Design: Retrospective review of patients undergoing fibroid surgery from November 26, 2014 through February 28, 2019. Setting: Minimally Invasive Gynecologic Surgery private practice. Patients or Participants: Women with fibroids whose surgery involved morcellation. Interventions: Each patient was offered a fibroid procedure with contained(in bag) or non-contained morcellation with a scalpel. The incidence of leiomyosarcoma was quoted as 1-2 per 1,000 from 11/26/14 − 2/1/18 and then 1 per 1,000 thereafter. Measurements and Main Results: 260 charts were available for review. After excluding 43 that left 217. 105 had Laparoscopic Intrafascial hysterectomy(LIH) and 112 had Laparoscopic myomectomy(L/SM). Ten women(5%) elected contained morcellation(LIH, 3; L/SM, 7). Conclusion: When given a 99.8-99.9% probability of benign disease 95% of the patients elected to treat the fibroid(s) as benign and have the smallest incisions possible for their surgery. Outcomes and complications will be discussed in detail along with a hospital system change in policy following one complication.
Virtual Poster Session 1: Laparoscopy (10:10 AM — 10:20 AM) 10:10 AM: STATION R 2022 Laparoscopic Isthmocele Repair with Hysteroscopic Assistance Gallego-Muneton DE,1,* De Los Rios JF,2 Arango A.M.3. 1Gynecological Endoscopy Unit, Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS) AAGL, Clınica del Prado, Medellın, Colombia; 2Gynecological Endoscopy Unit, Clınica del Prado, Medellın, Colombia; 3Gynecology, CES University, Medellın, Colombia *Corresponding author. Video Objective: To demonstrate the surgical technique of the laparoscopic isthmocele repair. Setting: A 35-year-old woman with a previous caesarean refers secondary infertility of 1 year of evolution and abnormal uterine bleeding. Salineinfused sonohysterography shows a normal size uterus and an Isthmocele in the Left side with a residual myometrium of 0 mm. Interventions: We describe the surgical technique for isthmocele correction by laparoscopy with the help of hysteroscopy to identify the area to be resected. Then, the abnormal tissue is resected with scissors and with a monopolar electrode. Finally the uterine wall is sutured. Conclusion: The laparoscopic isthmocele repair is an easily reproducible technique for the treatment of this disease. In most cases the improvement of symptoms such as abnormal uterine bleeding and infertility is achieved. Virtual Poster Session 1: Laparoscopy (10:10 AM — 10:20 AM) 10:10 AM: STATION S 2193 To Review Informed Patient Decisions Regarding Morcellation of Fibroids Since the FDA Guidance Statement of November 2014.Michael L Moore M.D., Advanced Womens Health Institute, Denver, CO Moore ML*. Advanced Womens Health Institute, Greenwood Village, CO *Corresponding author. Study Objective: To review informed patient decisions regarding morcellation of fibroids since the FDA guidance statement of November 2014.
Virtual Poster Session 1: Laparoscopy (10:10 AM — 10:20 AM) 10:10 AM: STATION T 1350 A Comprehensive Review of Laparoscopic Entry Techniques Chung MS,1 Walsh TM,2 Shields J2,*. 1Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX; 2Division of Minimally Invasive Gynecologic Surgery, UT Southwestern Medical Center, Dallas, TX *Corresponding author. Video Objective: The objective of this video is to present viewers with the most common laparoscopic entry techniques to improve comprehension and proficiency, reducing the risk of major surgical complications from abdominal entry. Setting: This video was recorded at a large academic institution. Interventions: N/A Conclusion: Clinicians performing laparoscopic surgery should be aware of their preferred method of entry but also recognize alternate entry sites and methods when the circumstances necessitate it. It is important to learn and demonstrate proficiency in each technique as up to half of major laparoscopic surgical complications occur during initial entry. Virtual Poster Session 1: Laparoscopy (10:20 AM — 10:30 AM) 10:20 AM: STATION A 1348 Caesarean Scar Ectopic Pregnancies: Tale of two Approaches Ma K,* Lim K, Edi-Osagie E, Majumder K. Gynaecology, Manchester Foundation Trust, Manchester, United Kingdom *Corresponding author. Study Objective: Demonstrate hysteroscopic and laparoscopic approaches to managing residual caesarean scar ectopic pregnancy tissue. Design: Case report discussion. Setting: Tertiary Referral Centre and University Teaching Hospital. Patients or Participants: Two cases of caesarean scar ectopic pregnancies. Interventions: Case 1) Hysteroscopic removal of residual trophoblastic tissue using hysteroscopic forceps. Case 2) Laparoscopic excision of residual trophoblstic tissue using ultrasonic device. Measurements and Main Results: Case 1) 32 year old Para 2 (two previous caesarean sections) presented at 8 weeks gestation with a caesarean scar ectopic pregnancy. Primary systemic methotrexate management was followed by surgical suction curettage 4 weeks later. The patient complained of persistent irregular intermenstrual bleeding and retained trophoblastic
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Patients or Participants: Thirty-three obstetrician-gynecologic residents with no background on laparoscopy but assisting and performing gynecological laparotomy cases. Patients were female with age ranged of 20 to 55 years old, history of sexual contact, scheduled for elective total laparoscopic hysterectomy and adnexectomy for benign uterine or ovarian pathologies. Interventions: The residents were randomly grouped into two. Group A consisted of sixteen residents who underwent uterine manipulation training using the pelvic trainer box and Group B consisted of seventeen residents who did not undergo training. Group A was given PST which were performed in 5 repetitions in one session. One set of tasks commanded to perform in this order were antevert uterus, uterus to the patient’s left, uterus to the patient’s right, push uterus cephalad, pull uterus caudally and retrovert uterus. One session consisted of 5 sets. After a week, both groups were asked to scrub-in on actual procedure with the same instructor commanding the tasks and recording the time to perform the tasks. Measurements and Main Results: Group A performed the procedurespecific tasks correctly with a significantly shorter time than Group B (pvalue of 0.000). The senior residents did not perform the PST better than the junior residents (correlation coefficient was significant with p-value of 0.023 and a negative correlation coefficient of -0.200, this means that as the negative time difference to perform from the first to the fifth specific tasks increases, the actual time decreases). Conclusion: We have shown that uterine manipulation exercises in the pelvic trainer box is effective in the proper performance of residents as bottom person for uterine manipulation during TLH.
Design: Retrospective review of patients undergoing fibroid surgery from November 26, 2014 through February 28, 2019. Setting: Minimally Invasive Gynecologic Surgery private practice. Patients or Participants: Women with fibroids whose surgery involved morcellation. Interventions: Each patient was offered a fibroid procedure with contained(in bag) or non-contained morcellation with a scalpel. The incidence of leiomyosarcoma was quoted as 1-2 per 1,000 from 11/26/14 − 2/1/18 and then 1 per 1,000 thereafter. Measurements and Main Results: 260 charts were available for review. After excluding 43 that left 217. 105 had Laparoscopic Intrafascial hysterectomy(LIH) and 112 had Laparoscopic myomectomy(L/SM). Ten women(5%) elected contained morcellation(LIH, 3; L/SM, 7). Conclusion: When given a 99.8-99.9% probability of benign disease 95% of the patients elected to treat the fibroid(s) as benign and have the smallest incisions possible for their surgery. Outcomes and complications will be discussed in detail along with a hospital system change in policy following one complication.
Virtual Poster Session 1: Laparoscopy (10:10 AM — 10:20 AM) 10:10 AM: STATION R 2022 Laparoscopic Isthmocele Repair with Hysteroscopic Assistance Gallego-Muneton DE,1,* De Los Rios JF,2 Arango A.M.3. 1Gynecological Endoscopy Unit, Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS) AAGL, Clınica del Prado, Medellın, Colombia; 2Gynecological Endoscopy Unit, Clınica del Prado, Medellın, Colombia; 3Gynecology, CES University, Medellın, Colombia *Corresponding author. Video Objective: To demonstrate the surgical technique of the laparoscopic isthmocele repair. Setting: A 35-year-old woman with a previous caesarean refers secondary infertility of 1 year of evolution and abnormal uterine bleeding. Salineinfused sonohysterography shows a normal size uterus and an Isthmocele in the Left side with a residual myometrium of 0 mm. Interventions: We describe the surgical technique for isthmocele correction by laparoscopy with the help of hysteroscopy to identify the area to be resected. Then, the abnormal tissue is resected with scissors and with a monopolar electrode. Finally the uterine wall is sutured. Conclusion: The laparoscopic isthmocele repair is an easily reproducible technique for the treatment of this disease. In most cases the improvement of symptoms such as abnormal uterine bleeding and infertility is achieved. Virtual Poster Session 1: Laparoscopy (10:10 AM — 10:20 AM) 10:10 AM: STATION S 2193 To Review Informed Patient Decisions Regarding Morcellation of Fibroids Since the FDA Guidance Statement of November 2014.Michael L Moore M.D., Advanced Womens Health Institute, Denver, CO Moore ML*. Advanced Womens Health Institute, Greenwood Village, CO *Corresponding author. Study Objective: To review informed patient decisions regarding morcellation of fibroids since the FDA guidance statement of November 2014.
Virtual Poster Session 1: Laparoscopy (10:10 AM — 10:20 AM) 10:10 AM: STATION T 1350 A Comprehensive Review of Laparoscopic Entry Techniques Chung MS,1 Walsh TM,2 Shields J2,*. 1Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX; 2Division of Minimally Invasive Gynecologic Surgery, UT Southwestern Medical Center, Dallas, TX *Corresponding author. Video Objective: The objective of this video is to present viewers with the most common laparoscopic entry techniques to improve comprehension and proficiency, reducing the risk of major surgical complications from abdominal entry. Setting: This video was recorded at a large academic institution. Interventions: N/A Conclusion: Clinicians performing laparoscopic surgery should be aware of their preferred method of entry but also recognize alternate entry sites and methods when the circumstances necessitate it. It is important to learn and demonstrate proficiency in each technique as up to half of major laparoscopic surgical complications occur during initial entry. Virtual Poster Session 1: Laparoscopy (10:20 AM — 10:30 AM) 10:20 AM: STATION A 1348 Caesarean Scar Ectopic Pregnancies: Tale of two Approaches Ma K,* Lim K, Edi-Osagie E, Majumder K. Gynaecology, Manchester Foundation Trust, Manchester, United Kingdom *Corresponding author. Study Objective: Demonstrate hysteroscopic and laparoscopic approaches to managing residual caesarean scar ectopic pregnancy tissue. Design: Case report discussion. Setting: Tertiary Referral Centre and University Teaching Hospital. Patients or Participants: Two cases of caesarean scar ectopic pregnancies. Interventions: Case 1) Hysteroscopic removal of residual trophoblastic tissue using hysteroscopic forceps. Case 2) Laparoscopic excision of residual trophoblstic tissue using ultrasonic device. Measurements and Main Results: Case 1) 32 year old Para 2 (two previous caesarean sections) presented at 8 weeks gestation with a caesarean scar ectopic pregnancy. Primary systemic methotrexate management was followed by surgical suction curettage 4 weeks later. The patient complained of persistent irregular intermenstrual bleeding and retained trophoblastic