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2219 Laparoscopic Resection of Bulky Para-Aortic Lymph Node Metastasis
S126
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.
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.