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2274 Laparoscopic Primary Repair of Duodenal Perforation after Laparoscopic Para-Aortic Lymphadenectomy
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
S105
Conclusion: Transvaginal single-port laparoscopic skills allow the surgeon to accomplish oophorocystectomy for a giant ovarian benign tumor without abdominal incision, and let patient recover rapidly.
hysterectomy uses two 5-10 mm ports and requires transvaginal cuff closure. The benefit of smaller incisions and better triangulation comes at the expense of higher rates of cuff dehiscence associated with transvaginal cuff closure. Interventions: Two-port laparoscopic hysterectomy, salpingo-oophorectomy, and laparoscopic cuff closure using a 10 mm operative scope plus one additional 5 mm suprapubic port. Conclusion: While we acknowledge that vaginal hysterectomy remains the most minimally invasive route of surgery; a two-port hysterectomy would better serve a number of patients with limited vaginal access, or whose indication for surgery is pelvic pain if the initial survey reveals limited pathology. The novel technique we describe combines the benefit of smaller incisions, better triangulation, and laparoscopic cuff closure. To our knowledge, our group is the first to describe that procedure.
Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION D 2197 Strategies for Laparoscopic Entry in Complex Patients Ulrich AP,1,* Plewniak KM,1 Plummer M,2 Shreck E,3 Pacis M1. 1OB/GYN (Minimally Invasive Gynecologic Surgery), Montefiore Hospital/Albert Einstein College of Medicine, Bronx, NY; 2Albert Einstein College of Medicine, Bronx, NY; 3Urology, Montefiore Hospital/Albert Einstein College of Medicine, Bronx, NY *Corresponding author. Video Objective: There are three general techniques for laparoscopic entry, all of which are considered safe and effective. These include the use of a veress needle, an optical trocar, and an open approach. Twentyfive percent of all injuries during laparoscopic surgery occur with initial entry. Therefore, a thoughtful approach to port placement is critical to ensure optimal performance and patient safety with entry. Certain patient factors that may increase the rate of injury or complicate entry include obesity, prior abdominal surgeries, large uterine size, and the small stature and short torso of the pediatric patient. We created a video to describe laparoscopic entry techniques in patients with co-morbid conditions in order to improve surgical planning and decrease the rate of injury. Setting: We selected six patient scenarios that posed various challenges to safe laparoscopic entry at our large academic institution nested in an underserved urban environment. These scenarios included: morbid obesity, a large bulky uterus, previous abdominal surgeries, umbilical mesh from a herniorrhaphy, prior abdominoplasty, and the pediatric patient. Interventions: We identified complexities of laparoscopic entry in surgical patients and then reviewed the literature to devise techniques to address these challenges. We present techniques for entry from an evidence-based literature review and expert opinion from minimally invasive gynecologic surgeons and general surgeons, for patients undergoing laparoscopic surgery in the aforementioned scenarios. Conclusion: This video uses audio and visual components to review safe and effective strategies for laparoscopic entry. Through illustrations and surgical cases we offer tips in complex scenarios. We hope this video can serve as a resource to surgeons, particularly trainees, and improve confidence and surgical planning to ultimately decrease injury. Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION E 2972 Two-Port Laparoscopic Hysterectomy and Cuff Closure without the use of a Multiport Channel Tyan P,1,* Louie M2. 1The University of North Carolina, Chapel Hill, NC; 2 Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC *Corresponding author. Video Objective: To demonstrate a novel technique for a two-port hysterectomy and laparoscopic cuff closure using an operative laparoscope. Setting: The previously described port-reducing, single-port or two-port hysterectomy techniques fall into two broad categories. The first employs the use of a multiport channel, which requires a larger fascial defect and is associated with more postoperative pain and higher risks of postoperative hernia formation. The multiport channel is also technically limited by the loss of triangulation and instrument collision. The second technique for port-reducing
Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION F 1891 A Prospective, Controlled Study Comparing Single Port Laparoscopic Sacrospinous Fixation and Transvaginal Sacrospinous Fixation in the Treatment of Pelvic Organ Prolapse Zhang W*. Department of Gynaecology, Zhongnan Hospital of Wuhan University, Wuhan, China *Corresponding author. Study Objective: The objective of the study was to compare operative time, intraoperative blood loss, recurrence and complication rates for single port laparoscopic sacrospinous fixation SSF and transvaginal (SSF) for the primary treatment of pelvic organ prolapse. Design: Patients undergoing surgery for pelvic organ prolapse were included in a randomized, controlled study comparing single port laparoscopic SSF or transvaginal sacrospinous fixation. The examination included operative time, intraoperative blood loss, operative complication, and pelvic organ prolapse quantification, urodynamics, ultrasound, and quality-of-life (QoL) questionnaires before and 3 and 12 months after surgery. Setting: trendelenburg. Patients or Participants: Of 20 randomized patients in Zhongnan Hospital of Wuhan University, from Jan.2018 to Mar.2019. Interventions: 10 patients underwent single port laparoscopic SSF and 10 patients underwent transvaginal SSF. Measurements and Main Results: All the operations were completed successfully. The operative time in the single port laparoscopic group (117.0§ 20.0 min) was longer than the transvaginal group (75.2§24.3 min). The intraoperative blood loss (54.9§24.1 ml) was less than the transvaginal group (87.6§12.3 min). The incidence of operative complications in the single port laparoscopic group (30.0%) was lower than transvaginal group (50.0%). There were no difference between the single port laparoscopic group and the transvaginal group in prolapse recurrence after 12 months occurred (P >0.05). No difference in QoL improvement as well as of de novo stress urinary incontinence and overactive bladder onset was found. Conclusion: Single port laparoscopic sacrospinous fixation is safe and feasible in the treatment of pelvic organ prolapse. Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION G 2274 Laparoscopic Primary Repair of Duodenal Perforation after Laparoscopic Para-Aortic Lymphadenectomy Choi JS,* Bae J, Lee WM, Jung US, Eom JM, Lee H. Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Korea, Republic of (South) *Corresponding author.
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Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Video Objective: To present of laparoscopic primary repair of duodenal perforation after laparoscopic paraaortic lymphadenectomy for the patient with endometrial carcinoma. Setting: Case study. University hospital in Korea. Interventions: A 78-year-old Korean woman with postmenopausal bleeding and thickened endometrium presented to our department. The histopathology of biopsied endometrium revealed grade 1 endometrioid adenocarcinoma. The preoperative MRI shows an about 5cm sized tumor within the endometrial cavity suspicious myometrial invasion. We perform the laparosco pic staging surgery on April 2, 2019. No intraoperative complications were recognized. However, on postoperative day 1, the color of intra-abdominal drainage change from serosanginous to dark green. We strongly suspected small bowel perforation and perform secondary laparoscopic surgery immediately. Peritoneum and prior operative site were tinged with bile. We scrutinized the small bowel and finally found the perforation site on duodenum. The perforation occurred at the horizontal part of duodenum ventrally vena cava. We carried out laparoscopic primary repair with 3-0 vicryl. Double layer closure was done by interrupted suture in first layer and Lambert suture for second layer. Then, we placed drainage into the duodenal repair site and traced the small bowel meticulously. We reviewed the video of primary surgery. But there was no definitive procedure related with duodenal perforation. We thought that the thermal injury was occurred by ultrasonic cutting and coagulating device during the lymphadenectomy in pre-caval area just below duodenum or mechanical micro-perforation is made during lifting the duodenum by dissecting forcep. After duodenal repair, endoscopically guided placement of nasogastric tube was performed. Gastrography did not show any leakage at the site of duodenal repair on postoperative day 3. Conclusion: Immediate laparoscopic primary repair of duodenal perforation after laparoscopic paraaortic lymphadenectomy is safe and feasible.
Study Objective: Heavy Menstrual Bleeding is the most common reason for gynaecological consultation in the United Kingdom. We aimed to identify factors that may contribute to failed ablation/resection of endometrium, to improve future patient selection and counselling. Design: Retrospective audit was performed for women who underwent hysterectomy, January 2012 - December 2018, following a Thermablate, NovaSure, or transcervical resection of endometrium (TCRE). Setting: Northern Health and Social Care Trust, Northern Ireland. Patients or Participants: 85 patients were identified by clinical coding department. Interventions: N/A. Measurements and Main Results: Mean age at hysterectomy was 43 years, Average body mass index (BMI) was 31.73 kg/m2. 87% underwent a pre-operative pelvic ultrasound scan, of these 32% had fibroids detected. 72% underwent endometrial ablation using Thermablate, 17% NovaSure, 2% Thermablate followed by NovaSure, 2% had Thermablate twice, performed nine months apart, and 7% patients had transcervical resection of the endometrium. 47% had a trial of Mirena IUS prior to ablation. Mean ablation to hysterectomy interval was 23 months. The main indication for hysterectomy was heavy menstrual bleeding (75%), followed by pelvic pain (13%), then both heavy menstrual bleeding and pelvic pain (11%). Mean specimen weight at hysterectomy was 183g. Abnormal pathology was confirmed in 70% of hysterectomy specimens (Fibroids 54%, adenomyosis 14% and combined pathology including fibroids, adenomyosis, simple hyperplasia and endometriosis in 32%. Dysmenorrhoea, parity, previous normal vaginal deliveries/caesarean section, BMI and type of ablation did not reach clinical significance in terms of predictive parameters. Conclusion: When ablation/ resection fails our results demonstrated that the pre-operative demographics above were a poor predictor. Associated identified pathologies particularly fibroids and adenomyosis suggests that pre-operative diagnosis of these would be valuable in optimizing patient selection and counselling.
Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION H 2332 Transient Uterine Artery Clipping in Complex Gynecologic Laparoscopy Heredia F,1,2,* Donetch G,3 Escalona JR,4 Hinostroza M2. 1Unidad de cirugıa mınimamente invasiva y rob otica, Clınica Universitaria de Concepci on, Concepci on, Chile; 2Departamento de Ginecologıa y Obstetricia, Universidad de Concepci on, Concepci on, Chile; 3Hospital 4 Las Higueras, Talcahuano, Chile; Departamento de Obstetricia y Ginecologia, Universidad de Concepcion, Concepci on, Chile *Corresponding author. Video Objective: To show diverse surgical procedures in which Transient Uterine Artery clipping may result in less bleeding throughout surgery. Setting: Three clinical cases in which this technique was used. Interventions: Uterine artery Clippping prior to a myomectomy, conrnuectomy and cesarean section scar pregnancy. Conclusion: We believe this simple step warrants less bleeding in complex laparoscopic gynecological surgery. Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION I 2887 Hysterectomy after Failed Endometrial Resection and Endometrial Ablation Techniques. Can We Work Out When It is Going to Fail? Skelly C,1,* Sheehan E,1 Niblock K,2 Johnston KM3. 1Obstetrics & Gynaecology, Antrim Area Hospital, Antrim, United Kingdom; 2Obstetrics & Gynaecology, Craigavon Area Hospital, Craigavon, United Kingdom; 3 Antrim Hospital, Antrim, United Kingdom *Corresponding author.
Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION J 1181 Laparoscopic Management of Hernia Uterus Inguinale with Associated Unicornuate Uterus: A Case Report Friedman J,1,* Hutchinson A,2 Milad MP1. 1Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL; 2 Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, IL *Corresponding author. Video Objective: This video demonstrates the laparoscopic management of a surgical emergency due a non-communicating herniated rudimentary uterine horn and ipsilateral torsed adnexa. Setting: NA. Interventions: This case is a 36-year-old healthy woman undergoing elective oocyte cryopreservation with normal baseline pelvic ultrasounds. On day 7 of oocyte stimulation, an enlarging inguinal mass was identified associated with severe inguinal pain; an incarcerated ovary was suspected. She was taken to the operating room for surgical management. The diagnosis of a M€ullerian anomaly was made laparoscopically, noting that she had a right unicornuate uterus with associated normal-appearing right adnexa and ureter. Notably, the left non-communicating rudimentary uterine horn was found herniated through the deep inguinal ring, drawing with it a portion of the left tube and ovary, torsed around its associated pedicle. A left ureter could not be visualized. After decompressing and de-torsing the left inguinal mass, the rudimentary horn, fallopian tube, and necrotic portion of the left ovary were excised using a bipolar sealing device; the inguinal hernia was repaired. The viable left ovarian tissue was retained. A postoperative renal ultrasound confirmed left renal agenesis. Two months later,
S105
Conclusion: Transvaginal single-port laparoscopic skills allow the surgeon to accomplish oophorocystectomy for a giant ovarian benign tumor without abdominal incision, and let patient recover rapidly.
hysterectomy uses two 5-10 mm ports and requires transvaginal cuff closure. The benefit of smaller incisions and better triangulation comes at the expense of higher rates of cuff dehiscence associated with transvaginal cuff closure. Interventions: Two-port laparoscopic hysterectomy, salpingo-oophorectomy, and laparoscopic cuff closure using a 10 mm operative scope plus one additional 5 mm suprapubic port. Conclusion: While we acknowledge that vaginal hysterectomy remains the most minimally invasive route of surgery; a two-port hysterectomy would better serve a number of patients with limited vaginal access, or whose indication for surgery is pelvic pain if the initial survey reveals limited pathology. The novel technique we describe combines the benefit of smaller incisions, better triangulation, and laparoscopic cuff closure. To our knowledge, our group is the first to describe that procedure.
Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION D 2197 Strategies for Laparoscopic Entry in Complex Patients Ulrich AP,1,* Plewniak KM,1 Plummer M,2 Shreck E,3 Pacis M1. 1OB/GYN (Minimally Invasive Gynecologic Surgery), Montefiore Hospital/Albert Einstein College of Medicine, Bronx, NY; 2Albert Einstein College of Medicine, Bronx, NY; 3Urology, Montefiore Hospital/Albert Einstein College of Medicine, Bronx, NY *Corresponding author. Video Objective: There are three general techniques for laparoscopic entry, all of which are considered safe and effective. These include the use of a veress needle, an optical trocar, and an open approach. Twentyfive percent of all injuries during laparoscopic surgery occur with initial entry. Therefore, a thoughtful approach to port placement is critical to ensure optimal performance and patient safety with entry. Certain patient factors that may increase the rate of injury or complicate entry include obesity, prior abdominal surgeries, large uterine size, and the small stature and short torso of the pediatric patient. We created a video to describe laparoscopic entry techniques in patients with co-morbid conditions in order to improve surgical planning and decrease the rate of injury. Setting: We selected six patient scenarios that posed various challenges to safe laparoscopic entry at our large academic institution nested in an underserved urban environment. These scenarios included: morbid obesity, a large bulky uterus, previous abdominal surgeries, umbilical mesh from a herniorrhaphy, prior abdominoplasty, and the pediatric patient. Interventions: We identified complexities of laparoscopic entry in surgical patients and then reviewed the literature to devise techniques to address these challenges. We present techniques for entry from an evidence-based literature review and expert opinion from minimally invasive gynecologic surgeons and general surgeons, for patients undergoing laparoscopic surgery in the aforementioned scenarios. Conclusion: This video uses audio and visual components to review safe and effective strategies for laparoscopic entry. Through illustrations and surgical cases we offer tips in complex scenarios. We hope this video can serve as a resource to surgeons, particularly trainees, and improve confidence and surgical planning to ultimately decrease injury. Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION E 2972 Two-Port Laparoscopic Hysterectomy and Cuff Closure without the use of a Multiport Channel Tyan P,1,* Louie M2. 1The University of North Carolina, Chapel Hill, NC; 2 Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC *Corresponding author. Video Objective: To demonstrate a novel technique for a two-port hysterectomy and laparoscopic cuff closure using an operative laparoscope. Setting: The previously described port-reducing, single-port or two-port hysterectomy techniques fall into two broad categories. The first employs the use of a multiport channel, which requires a larger fascial defect and is associated with more postoperative pain and higher risks of postoperative hernia formation. The multiport channel is also technically limited by the loss of triangulation and instrument collision. The second technique for port-reducing
Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION F 1891 A Prospective, Controlled Study Comparing Single Port Laparoscopic Sacrospinous Fixation and Transvaginal Sacrospinous Fixation in the Treatment of Pelvic Organ Prolapse Zhang W*. Department of Gynaecology, Zhongnan Hospital of Wuhan University, Wuhan, China *Corresponding author. Study Objective: The objective of the study was to compare operative time, intraoperative blood loss, recurrence and complication rates for single port laparoscopic sacrospinous fixation SSF and transvaginal (SSF) for the primary treatment of pelvic organ prolapse. Design: Patients undergoing surgery for pelvic organ prolapse were included in a randomized, controlled study comparing single port laparoscopic SSF or transvaginal sacrospinous fixation. The examination included operative time, intraoperative blood loss, operative complication, and pelvic organ prolapse quantification, urodynamics, ultrasound, and quality-of-life (QoL) questionnaires before and 3 and 12 months after surgery. Setting: trendelenburg. Patients or Participants: Of 20 randomized patients in Zhongnan Hospital of Wuhan University, from Jan.2018 to Mar.2019. Interventions: 10 patients underwent single port laparoscopic SSF and 10 patients underwent transvaginal SSF. Measurements and Main Results: All the operations were completed successfully. The operative time in the single port laparoscopic group (117.0§ 20.0 min) was longer than the transvaginal group (75.2§24.3 min). The intraoperative blood loss (54.9§24.1 ml) was less than the transvaginal group (87.6§12.3 min). The incidence of operative complications in the single port laparoscopic group (30.0%) was lower than transvaginal group (50.0%). There were no difference between the single port laparoscopic group and the transvaginal group in prolapse recurrence after 12 months occurred (P >0.05). No difference in QoL improvement as well as of de novo stress urinary incontinence and overactive bladder onset was found. Conclusion: Single port laparoscopic sacrospinous fixation is safe and feasible in the treatment of pelvic organ prolapse. Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION G 2274 Laparoscopic Primary Repair of Duodenal Perforation after Laparoscopic Para-Aortic Lymphadenectomy Choi JS,* Bae J, Lee WM, Jung US, Eom JM, Lee H. Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Korea, Republic of (South) *Corresponding author.
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Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Video Objective: To present of laparoscopic primary repair of duodenal perforation after laparoscopic paraaortic lymphadenectomy for the patient with endometrial carcinoma. Setting: Case study. University hospital in Korea. Interventions: A 78-year-old Korean woman with postmenopausal bleeding and thickened endometrium presented to our department. The histopathology of biopsied endometrium revealed grade 1 endometrioid adenocarcinoma. The preoperative MRI shows an about 5cm sized tumor within the endometrial cavity suspicious myometrial invasion. We perform the laparosco pic staging surgery on April 2, 2019. No intraoperative complications were recognized. However, on postoperative day 1, the color of intra-abdominal drainage change from serosanginous to dark green. We strongly suspected small bowel perforation and perform secondary laparoscopic surgery immediately. Peritoneum and prior operative site were tinged with bile. We scrutinized the small bowel and finally found the perforation site on duodenum. The perforation occurred at the horizontal part of duodenum ventrally vena cava. We carried out laparoscopic primary repair with 3-0 vicryl. Double layer closure was done by interrupted suture in first layer and Lambert suture for second layer. Then, we placed drainage into the duodenal repair site and traced the small bowel meticulously. We reviewed the video of primary surgery. But there was no definitive procedure related with duodenal perforation. We thought that the thermal injury was occurred by ultrasonic cutting and coagulating device during the lymphadenectomy in pre-caval area just below duodenum or mechanical micro-perforation is made during lifting the duodenum by dissecting forcep. After duodenal repair, endoscopically guided placement of nasogastric tube was performed. Gastrography did not show any leakage at the site of duodenal repair on postoperative day 3. Conclusion: Immediate laparoscopic primary repair of duodenal perforation after laparoscopic paraaortic lymphadenectomy is safe and feasible.
Study Objective: Heavy Menstrual Bleeding is the most common reason for gynaecological consultation in the United Kingdom. We aimed to identify factors that may contribute to failed ablation/resection of endometrium, to improve future patient selection and counselling. Design: Retrospective audit was performed for women who underwent hysterectomy, January 2012 - December 2018, following a Thermablate, NovaSure, or transcervical resection of endometrium (TCRE). Setting: Northern Health and Social Care Trust, Northern Ireland. Patients or Participants: 85 patients were identified by clinical coding department. Interventions: N/A. Measurements and Main Results: Mean age at hysterectomy was 43 years, Average body mass index (BMI) was 31.73 kg/m2. 87% underwent a pre-operative pelvic ultrasound scan, of these 32% had fibroids detected. 72% underwent endometrial ablation using Thermablate, 17% NovaSure, 2% Thermablate followed by NovaSure, 2% had Thermablate twice, performed nine months apart, and 7% patients had transcervical resection of the endometrium. 47% had a trial of Mirena IUS prior to ablation. Mean ablation to hysterectomy interval was 23 months. The main indication for hysterectomy was heavy menstrual bleeding (75%), followed by pelvic pain (13%), then both heavy menstrual bleeding and pelvic pain (11%). Mean specimen weight at hysterectomy was 183g. Abnormal pathology was confirmed in 70% of hysterectomy specimens (Fibroids 54%, adenomyosis 14% and combined pathology including fibroids, adenomyosis, simple hyperplasia and endometriosis in 32%. Dysmenorrhoea, parity, previous normal vaginal deliveries/caesarean section, BMI and type of ablation did not reach clinical significance in terms of predictive parameters. Conclusion: When ablation/ resection fails our results demonstrated that the pre-operative demographics above were a poor predictor. Associated identified pathologies particularly fibroids and adenomyosis suggests that pre-operative diagnosis of these would be valuable in optimizing patient selection and counselling.
Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION H 2332 Transient Uterine Artery Clipping in Complex Gynecologic Laparoscopy Heredia F,1,2,* Donetch G,3 Escalona JR,4 Hinostroza M2. 1Unidad de cirugıa mınimamente invasiva y rob otica, Clınica Universitaria de Concepci on, Concepci on, Chile; 2Departamento de Ginecologıa y Obstetricia, Universidad de Concepci on, Concepci on, Chile; 3Hospital 4 Las Higueras, Talcahuano, Chile; Departamento de Obstetricia y Ginecologia, Universidad de Concepcion, Concepci on, Chile *Corresponding author. Video Objective: To show diverse surgical procedures in which Transient Uterine Artery clipping may result in less bleeding throughout surgery. Setting: Three clinical cases in which this technique was used. Interventions: Uterine artery Clippping prior to a myomectomy, conrnuectomy and cesarean section scar pregnancy. Conclusion: We believe this simple step warrants less bleeding in complex laparoscopic gynecological surgery. Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION I 2887 Hysterectomy after Failed Endometrial Resection and Endometrial Ablation Techniques. Can We Work Out When It is Going to Fail? Skelly C,1,* Sheehan E,1 Niblock K,2 Johnston KM3. 1Obstetrics & Gynaecology, Antrim Area Hospital, Antrim, United Kingdom; 2Obstetrics & Gynaecology, Craigavon Area Hospital, Craigavon, United Kingdom; 3 Antrim Hospital, Antrim, United Kingdom *Corresponding author.
Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION J 1181 Laparoscopic Management of Hernia Uterus Inguinale with Associated Unicornuate Uterus: A Case Report Friedman J,1,* Hutchinson A,2 Milad MP1. 1Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL; 2 Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, IL *Corresponding author. Video Objective: This video demonstrates the laparoscopic management of a surgical emergency due a non-communicating herniated rudimentary uterine horn and ipsilateral torsed adnexa. Setting: NA. Interventions: This case is a 36-year-old healthy woman undergoing elective oocyte cryopreservation with normal baseline pelvic ultrasounds. On day 7 of oocyte stimulation, an enlarging inguinal mass was identified associated with severe inguinal pain; an incarcerated ovary was suspected. She was taken to the operating room for surgical management. The diagnosis of a M€ullerian anomaly was made laparoscopically, noting that she had a right unicornuate uterus with associated normal-appearing right adnexa and ureter. Notably, the left non-communicating rudimentary uterine horn was found herniated through the deep inguinal ring, drawing with it a portion of the left tube and ovary, torsed around its associated pedicle. A left ureter could not be visualized. After decompressing and de-torsing the left inguinal mass, the rudimentary horn, fallopian tube, and necrotic portion of the left ovary were excised using a bipolar sealing device; the inguinal hernia was repaired. The viable left ovarian tissue was retained. A postoperative renal ultrasound confirmed left renal agenesis. Two months later,