2088 The Comparison of Total Laparoscopic Hysterectomy With 2-Dimensionalversus 3-Dimensional Laparoscopic Surgical Systems In Benign Uterine Diseases

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

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Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231

shorter mean operative time than the 2D-TLH group (105§18vs. 128§14 min), whereas the mean weight of the resected uterus and mean intraoperative blood loss were not statistically different. When we compared the outcomes for 40 cases in each group, using the same energy sealing device in a short period of time,only mean operative time was statistically different between the 3D-TLH and 2D-TLH groups(98§19 vs. 118§21 min). During the observation period, there were no differences in postoperative peritonitis, occurrence of vaginal cuff dehiscence, hospital stay and postoperative transfusion rate between two groups. The surgeon and assistants did not report any symptoms attributable to the 3D imaging system such as dizziness, eyestrain, nausea, and headache. Conclusion: We conclude that the 3D laparoscopic system could be safe and efficient laparoscopic system for 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 consenting to laparoscopic fibroid surgery involving morcellation. Interventions: Diamond pattern operative laparoscopy using 5 mm X 3 and midline 12 mm trocar. Each patient was offered bag contained morcellation through a 5 cm minilap or non-contained morcellation with a # 10 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 99.8-99.9% probability of no leiomyosarcoma, 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 along with a hospital system change in policy following one complication.

Virtual Poster Session 1: Laparoscopy (10:30 AM — 10:40 AM) 10:30 AM: STATION M 2219 Laparoscopic Resection of Bulky Para-Aortic Lymph Node Metastasis Choi JS,* Bae J, Lee WM, Jung U.S., Eom JM, Lee H. Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Korea, Republic of (South) *Corresponding author. Video Objective: To present of laparoscopic resection of bulky para-aortic lymph node metastasis discovered during laparoscopic restaging surgery for unexpected ovarian malignancy. Design: Case study. Setting: University hospital in Korea. Patients: A 45-year-old Korean woman with prior laparoscopic bilateral salpingo-oophorecetomy, presented to our department with unexpected ovarian malignancy which was resulted from the high grade serous carcinoma. Preoperative PET CT scan shows enlarged lymph node in aorto-caval area and no abnormal finding in peritoneal cavity and previous operative site. Interventions: We planned to perform laparoscopic restaging surgery to obtain knowledge about the stage on February 19, 2019. Laparoscopic restaging surgery included peritoneal washing cytology, LAVH, pelvic lymphadenectomy, para-aortic lymphadenectomy, omentectomy, appendectomy, and multiple peritoneal biopsies. We encountered about 6cm sized Isolated huge para-aortic lymph node metastasis just before the paraaortic lymphadenectomy. Peritoneal incision was made from right common iliac artery to the duodenum. The bulky nodes were encased and severely densely adhered to important aorta and inferior vena cava. We detached peri-nodal tissue from the vessels meticulously not to rupture of metastatic nodal capsule. Resected nodal specimen carried in the endo pouch was extracted though the opened vaginal vault. The final histopathological results showed lymph node metastases of 4 out of 44 para-aortic lymph nodes and the other of resected tissues were tumor-free. The final diagnosis was FIGO stage ⅢC of ovarian serous carcinoma. She is receiving chemotherapy at this time and healthy since then. Conclusion: Our experience indicate that laparoscopy is a feasible and safe approach to resection of bulky para-aortic lymph node metastasis during laparoscopic debulking surgery for gynecologic malignancies.

Virtual Poster Session 1: Laparoscopy (10:30 AM — 10:40 AM) 10:30 AM: STATION O 2285 Laparoscopic Primary Repair after the Diaphragmatic Endometriosis Resection Eom JM,* Choi JS, Bae J, Lee WM, Jung U.S.. Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Korea, Republic of (South) *Corresponding author. Video Objective: In approximately 0.6 % of cases, ectopic endometrium has been found in extrapelvic sites, such as the umbilicus, skin, upper abdominal peritoneum and organs (liver, spleen), diaphragm, pleural cavity, lungs, and pericardium. The prevalence of diaphragmatic endometriosis has been reported in up to 0.19 % of lesions. No guidelines exist about treatment of diaphragmatic endometriosis, and this rare condition is still a matter of debate because it raises several diagnostic and treatment challenges. We present a case of patient affected by diaphragmatic endometriosis who was treated by laparoscopy. Setting: Case study, University hospital in Korea. Interventions: A 41-year-old woman was referred to our department because of dyspareunia and dysmenorrhea. Laparoscopic finding showed left ovarian cyst adherent to peritoneum, cul-de-sac partial obliteration and endometriotic nodule on right diaphragm. We performed laparoscopic adhesiolysis, right ureter peritonectomy and diaphragmatic resection of endometriosis. An accidental diaphragmatic injury was occurred during the laparoscopic diaphragmatic resection. We performed successful laparoscopic primary repair of diaphragm and then chest tube was also inserted. The patient was uneventfully discharged home 4 days later. Conclusion: Laparoscopic primary repair after resection of diaphragmatic endometriosis is feasible.

Virtual Poster Session 1: Laparoscopy (10:30 AM — 10:40 AM)

Virtual Poster Session 1: Laparoscopy (10:30 AM — 10:40 AM)

10:30 AM: STATION N

10:30 AM: STATION P

2271 Patient Informed Decision in Minimally Invasive Surgery for Fibroids and Morcellation Moore ML*. Advanced Womens Health Institute, Greenwood Village, CO *Corresponding author.

2544 Minilaparoscopic Assisted Vaginal Myomectomy: A Novel Technique, Preliminary Study Tsivyan BL,1,* Vardanyan S,1 Onegova S,2 Konstantinova E2. 1Gyn Department, City Hospital 40, North-Western Medical Academy n.a. II Mechnikov, Saint-Petersburg, Russian Federation; 2Gyn Department, City Hospital 40, Saint-Petersburg, Russian Federation *Corresponding author.

Study Objective: To review informed patient decisions regarding morcellation of fibroids since the FDA guidance statement of November 2014.