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2363 Laparoscopic Management of Heterotopic Cornual Pregnancy - Tips & Tricks
S104
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Tsivyan BL,1,* Puchkov K,2 Konstantinova E,3 Vardanyan S1. 1Gyn department, City Hospital 40, North-Western Medical Academy n.a. II Mechnikov, Saint-Petersburg, Russian Federation; 2Surgical department, Swiss University Clinic, Moscow, Russian Federation; 3Gyn department, City Hospital 40, Saint-Petersburg, Russian Federation *Corresponding author.
7 morcellators (Q1-Q3: 1.25-15.75) used per annum. A median of 10 (Q1Q3: 2.0-15.0) laparoscopic hysterectomies and 5 (Q1-Q3: 0.5-9.0) myomectomies requiring morcellation were performed per annum. Almost, a third of trust did not perform an endometrial biopsy or MRI. 79.7% (47) of trusts consented for power morcellation and 76%, (46) explained risk of inadvertent leiomyosarcoma.83.3%, (50) had no patient literature and almost half had no audit process 45%, (27). Conclusion: Current UK practice does not reflect recommendations from the AAGL or BSGE. Deficiencies were identified in pre-operative evaluation, local governance procedures, and consenting practices regarding use of a power morcellator and risk of occult leiomyosarcoma.
Study Objective: The aim of this study is to compare surgical outcomes of single − port laparoscopic hysterectomy (SPL-H), conventional laparoscopic hysterectomy (LH) and robot-assisted hysterectomy (RH) in patients with uterine fibroids. Design: Retro and prospective study. Setting: City Hospital #40, The Swiss University clinic. Patients or Participants: 117 patients entered the study between 2012 and 2018. 39 patients had single − port laparoscopic hysterectomy (SPL-H), 41 patients - conventional laparoscopic hysterectomy (LH), and 37 patients robot-assisted hysterectomy (RH) for myoma uteri. Interventions: single − port laparoscopic hysterectomy (SPL-H), conventional laparoscopic hysterectomy (LH), robot-assisted hysterectomy (RH). Measurements and Main Results: Patient characteristics, operating time, estimated blood loss, length of hospital stay, rate of complications, postoperative pain scores and cosmesis were compared. Mean operating time (min) in the group of SPL-H was 109,1§24,8 (95% CI: 101,1-117,2 min), in comparison with LH -104,8§26,2 min (95% CI: 96,5-113,0 min), p=0,847. The total duration of surgery in the group of robot-assisted laparoscopy was 185.1§50.5 min. Estimated blood loss (ml) did not differ statistically in the group of single - port and conventional laparoscopic hysterectomy (Me 80 ml, p=0,083). The hospital stay (days) in a group of SPL-H was significantly lower compared to both groups robotic and conventional laparoscopy (p=0.018 and p=0.034, respectively), while the differences in this two groups were insignificant (p=0.777). There were no conversions to abdominal hysterectomy. In one case of single-port hysterectomy (2.56%), an additional trocar was required due to the atypical localization of the myoma. There were 2 cases with complications in the group of SPL-H who had required relaparoscopy, in the group of RH - 1 case. In the group of traditional laparoscopy there were no complications. All complications in SPLH group were at the stage of development of the method. Conclusion: Single-port hysterectomy is a feasible and safe technique, with no major complications compared to conventional and robotic access. Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM)
Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION B 2363 Laparoscopic Management of Heterotopic Cornual Pregnancy - Tips & Tricks Weng C,* Chen LH, Chao AS, Wang CJ. Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan *Corresponding author. Video Objective: To provide practical tips and tricks on laparoscopic management of a heterotopic cornual pregnancy. Setting: This video presents a 38-year-old nulliparous female patient who received bilateral salpingectomy and then underwent in vitro fertilization. Heterotopic pregnancy was found at 8 weeks of gestation. We arranged fetal reduction by ultrasound-guided potassium chloride injection. Two weeks after the procedure, severe lower abdominal pain developed. Due to massive hemoperitoneum with suspected left cornual rupture, she was admitted for laparoscopic intervention. Interventions: Laparoscopic surgery was arranged. Left cornual pregnancy with necrosis and oozing were seen upon entry into the abdominal cavity. Estimated internal bleeding was about 3000 ml. Laparoscopic management was carried out in five steps: identification of the cornual protruding mass; control of bleeding via a loop ligation; incision of the cornus precisely with complete removal of the ectopic gestational tissue; closure of the defect of the cornus; and hemostasis using Floseal matrix. Conclusion: The surgery was done smoothly and the patient recovered well with ongoing pregnancy. However, the patient underwent termination of pregnancy at 23 weeks of gestation due to fetal hydrocephalus. Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM)
10:00 AM: STATION A 1668 A National Survey: Evaluating Current Practice and Risk Assessment in Morcellation Amongst Gynecologists in the United Kingdom Ghai V,* Jan H. Gynaecology, Epsom and St Helier’s University Hospitals NHS Trust, London, United Kingdom *Corresponding author. Study Objective: To evaluate current practice and adherence to AAGL and BSGE power morcellation guidelines. Design: Multiple-choice questionnaire. Setting: United Kingdom. Patients or Participants: 157 NHS hospitals offering gynaecological services. Interventions: n/a. Measurements and Main Results: Power morcellation practice patterns, informed consent processes and outcomes over the last 12 months. We received 136 responses (87% response rate). Power morcellation was performed by a third (59, 37.6%) of all UK hospitals. The median number of gynecologists performing morcellation per organisation was 2 (Q1-Q3: 2-4). A median of 7 morcellators (Q1-Q3: 0-17) were purchased and
10:00 AM: STATION C 2166 Transvaginal Single-Port Laparoscopic Ovarian Cystectomy for a Giant Ovarian Benign Tumor Wang X,1,* Chen Y2. 1Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; 2Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China *Corresponding author. Video Objective: To demonstrate the transvaginal single-port laparoscopic oophorocystectomy for a giant ovarian benign tumor. Setting: Academic tertiary care hospital Patient: A 44-year-old woman. Interventions: Transvaginal single-port laparoscopic oophorocystectomy. Measurements and Main Results: A 44-year-old woman (gravida 2 para 1) had a gradually abdominal distension and discomfort over two years. A preoperative magnetic resonance imaging showed ovarian cyst (the ovarian cyst is as large as 5 months pregnancy). Transvaginal single-port laparoscopic oophorocystectomy was performed. An intraoperative pathologic examination showed endometrial cyst of the ovary. The operation took roughly 80 minutes, and total blood loss was aprroximately 100ml. The patient recovered well and was discharged 2 days after surgery.
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Tsivyan BL,1,* Puchkov K,2 Konstantinova E,3 Vardanyan S1. 1Gyn department, City Hospital 40, North-Western Medical Academy n.a. II Mechnikov, Saint-Petersburg, Russian Federation; 2Surgical department, Swiss University Clinic, Moscow, Russian Federation; 3Gyn department, City Hospital 40, Saint-Petersburg, Russian Federation *Corresponding author.
7 morcellators (Q1-Q3: 1.25-15.75) used per annum. A median of 10 (Q1Q3: 2.0-15.0) laparoscopic hysterectomies and 5 (Q1-Q3: 0.5-9.0) myomectomies requiring morcellation were performed per annum. Almost, a third of trust did not perform an endometrial biopsy or MRI. 79.7% (47) of trusts consented for power morcellation and 76%, (46) explained risk of inadvertent leiomyosarcoma.83.3%, (50) had no patient literature and almost half had no audit process 45%, (27). Conclusion: Current UK practice does not reflect recommendations from the AAGL or BSGE. Deficiencies were identified in pre-operative evaluation, local governance procedures, and consenting practices regarding use of a power morcellator and risk of occult leiomyosarcoma.
Study Objective: The aim of this study is to compare surgical outcomes of single − port laparoscopic hysterectomy (SPL-H), conventional laparoscopic hysterectomy (LH) and robot-assisted hysterectomy (RH) in patients with uterine fibroids. Design: Retro and prospective study. Setting: City Hospital #40, The Swiss University clinic. Patients or Participants: 117 patients entered the study between 2012 and 2018. 39 patients had single − port laparoscopic hysterectomy (SPL-H), 41 patients - conventional laparoscopic hysterectomy (LH), and 37 patients robot-assisted hysterectomy (RH) for myoma uteri. Interventions: single − port laparoscopic hysterectomy (SPL-H), conventional laparoscopic hysterectomy (LH), robot-assisted hysterectomy (RH). Measurements and Main Results: Patient characteristics, operating time, estimated blood loss, length of hospital stay, rate of complications, postoperative pain scores and cosmesis were compared. Mean operating time (min) in the group of SPL-H was 109,1§24,8 (95% CI: 101,1-117,2 min), in comparison with LH -104,8§26,2 min (95% CI: 96,5-113,0 min), p=0,847. The total duration of surgery in the group of robot-assisted laparoscopy was 185.1§50.5 min. Estimated blood loss (ml) did not differ statistically in the group of single - port and conventional laparoscopic hysterectomy (Me 80 ml, p=0,083). The hospital stay (days) in a group of SPL-H was significantly lower compared to both groups robotic and conventional laparoscopy (p=0.018 and p=0.034, respectively), while the differences in this two groups were insignificant (p=0.777). There were no conversions to abdominal hysterectomy. In one case of single-port hysterectomy (2.56%), an additional trocar was required due to the atypical localization of the myoma. There were 2 cases with complications in the group of SPL-H who had required relaparoscopy, in the group of RH - 1 case. In the group of traditional laparoscopy there were no complications. All complications in SPLH group were at the stage of development of the method. Conclusion: Single-port hysterectomy is a feasible and safe technique, with no major complications compared to conventional and robotic access. Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM)
Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION B 2363 Laparoscopic Management of Heterotopic Cornual Pregnancy - Tips & Tricks Weng C,* Chen LH, Chao AS, Wang CJ. Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan *Corresponding author. Video Objective: To provide practical tips and tricks on laparoscopic management of a heterotopic cornual pregnancy. Setting: This video presents a 38-year-old nulliparous female patient who received bilateral salpingectomy and then underwent in vitro fertilization. Heterotopic pregnancy was found at 8 weeks of gestation. We arranged fetal reduction by ultrasound-guided potassium chloride injection. Two weeks after the procedure, severe lower abdominal pain developed. Due to massive hemoperitoneum with suspected left cornual rupture, she was admitted for laparoscopic intervention. Interventions: Laparoscopic surgery was arranged. Left cornual pregnancy with necrosis and oozing were seen upon entry into the abdominal cavity. Estimated internal bleeding was about 3000 ml. Laparoscopic management was carried out in five steps: identification of the cornual protruding mass; control of bleeding via a loop ligation; incision of the cornus precisely with complete removal of the ectopic gestational tissue; closure of the defect of the cornus; and hemostasis using Floseal matrix. Conclusion: The surgery was done smoothly and the patient recovered well with ongoing pregnancy. However, the patient underwent termination of pregnancy at 23 weeks of gestation due to fetal hydrocephalus. Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM)
10:00 AM: STATION A 1668 A National Survey: Evaluating Current Practice and Risk Assessment in Morcellation Amongst Gynecologists in the United Kingdom Ghai V,* Jan H. Gynaecology, Epsom and St Helier’s University Hospitals NHS Trust, London, United Kingdom *Corresponding author. Study Objective: To evaluate current practice and adherence to AAGL and BSGE power morcellation guidelines. Design: Multiple-choice questionnaire. Setting: United Kingdom. Patients or Participants: 157 NHS hospitals offering gynaecological services. Interventions: n/a. Measurements and Main Results: Power morcellation practice patterns, informed consent processes and outcomes over the last 12 months. We received 136 responses (87% response rate). Power morcellation was performed by a third (59, 37.6%) of all UK hospitals. The median number of gynecologists performing morcellation per organisation was 2 (Q1-Q3: 2-4). A median of 7 morcellators (Q1-Q3: 0-17) were purchased and
10:00 AM: STATION C 2166 Transvaginal Single-Port Laparoscopic Ovarian Cystectomy for a Giant Ovarian Benign Tumor Wang X,1,* Chen Y2. 1Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; 2Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China *Corresponding author. Video Objective: To demonstrate the transvaginal single-port laparoscopic oophorocystectomy for a giant ovarian benign tumor. Setting: Academic tertiary care hospital Patient: A 44-year-old woman. Interventions: Transvaginal single-port laparoscopic oophorocystectomy. Measurements and Main Results: A 44-year-old woman (gravida 2 para 1) had a gradually abdominal distension and discomfort over two years. A preoperative magnetic resonance imaging showed ovarian cyst (the ovarian cyst is as large as 5 months pregnancy). Transvaginal single-port laparoscopic oophorocystectomy was performed. An intraoperative pathologic examination showed endometrial cyst of the ovary. The operation took roughly 80 minutes, and total blood loss was aprroximately 100ml. The patient recovered well and was discharged 2 days after surgery.