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2366 Laparoscopic Repair of Intraoperative Cystotomy
S118
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Interventions: “Chopstick technique” was performed in LESS-RH and pelvic lymph node dissection. The demographic characteristics and perioperative efficacy of the patients were summarized and analyzed. Measurements and Main Results: LESS-RH was attempted in 84 patients, and 83 (98%) patients underwent the procedure successfully. One patient underwent conversion to traditional laproscopic surgery secondary to phase IV endometriosis. “Chopstick technique” was used in all the 83 cases, wherein 40 cases used the single-incision three-channel laparoscopy platform, and 43 used the multichannel-tipped single port laparoscopy platform (HangT Port). The average operation time was 225.0§50.2min and the median intraoperative blood loss was 100mL. During the operations in the first 20 cases, 2 patients had intraoperative vascular injuries and 1 patient had bladder injury, and all were repaired under LESS. One case had ureterovaginal fistula 14 days after operation, and was successfully repaired by ureteroneocystostomy. The average number of pelvic lymph node dissections was 21, and the pathological examination of incisal edge was negative. Deep stromal invasion in 43 cases, LVSI in 16 cases,positive parametrium in 1 case, positive pelvic nodes in 15 cases. 33 patients were treated with postoperative chemotherapy and radiotherapy and 19 patients with intermediate risk factors were treated with radiotherapy postoperatively. Conclusion: “Chopstick technique” under LESS was considered feasible for treating cervical cancer.
Virtual Poster Session 1: Laparoscopy (10:20 AM — 10:30 AM)
Virtual Poster Session 1: Laparoscopy (10:20 AM — 10:30 AM) 10:20 AM: STATION H 2287 Cystoscopy with Laparoscope Lens of 5 MM after Laparoscopic Hysterectomy, Experience in a Third Level Hospital Garcia Rodriguez LF,1 Villegas-Cruz C,2 Berlanga-Narro SM,2,* Garza-Ayala M,3 Alvarez-Rosales A,4 Lara Esqueda J2. 1Fellowship Director MIGs, Tecnologico de Monterrey, Monterrey, NL, Mexico; 2 Tecnologico de Monterrey, Monterrey, NL, Mexico; 31° year Fellow MIGS, Tecnologico de Monterrey, Monterrey, NL, Mexico; 42° year Fellow MIGS, Tecnologico de Monterrey, Monterrey, NL, Mexico *Corresponding author. Study Objective: Evaluate the detection of ureteral injuries with the use of laparoscopic lens of 5 mm and 30˚ for cystoscopy after total laparoscopic hysterectomy. Design: Retrospective, descriptive, observational. Setting: Third level hospital in the north of Mexico. Patients or Participants: 135 patients scheduled for laparoscopic hysterectomy between march 2018 to march 2019, in a third level hospital in the north of Mexico. In four cases, laparoscopic surgery was converted to laparotomy due to bleeding, non-diagnosed ovarian malignancy, failure in the equipment, and patient’s condition. Interventions: No intervention. Measurements and Main Results: Retrospective study of 131 patients who underwent a total laparoscopic hysterectomy, in which routinary diagnostic transoperative cystoscopy was made with a laparoscopic lens of 5 mm and 30˚. The detection of 1 case of ureteral kinking was detected during the cystoscopies and one patient had an ureterovaginal fistula detected 7 days after de surgery. The results of cystoscopy after a laparoscopic hysterectomy has a sensibility of 50%, specificity of 100% and False Positive Ratio 0% and False Negatives Ratio 50% in identifying ureteral injuries. Conclusion: The use of routinary cystoscopy during total laparoscopic hysterectomy has been debated previously. The detection rate in other studies reported that twice the injuries were detected during cystoscopy immediately after hysterectomy and delayed detection of ureteral injury decreased seven fold. Our study justifies the use of cystoscopy as a cost effective test, using only the 5 mm lens as the additional equipment required.
10:20 AM: STATION I 2366 Laparoscopic Repair of Intraoperative Cystotomy Moore K,1,* Ahluwalia P2. 1Obstetrics and Gynecology, Saint Elizabeth Medical Center, Utica, NY; 24401 Middle Settlement Rd, 4401 Middle Settlement Rd, New Hartford, NY *Corresponding author. Video Objective: The purpose of this video is to demonstrate the technique for laparoscopic repair of an intraoperative cystotomy, at the time of total laparoscopic hysterectomy. Setting: In the particular case presented in this video, a large paracervical fibroid distorts the anatomy of the lower uterine segment. While developing the bladder flap, an inadvertent cystotomy 4 centimeters in diameter is created, immediately identified, and subsequently repaired laparoscopically by standard surgical guidelines. The risk of a urinary tract injury during laparoscopic hysterectomy ranges from 0.735-1.8%; the risk of a bladder injury is three times more likely than that of a ureteral injury. A number of patient characteristics increase the risk of an injury, including endometriosis, a history of cesarean sections, and large fibroids that distort uterine anatomy. Urinary tract injuries that go unrecognized at the time of surgery are associated with increased postoperative morbidities, specifically hospital readmission, sepsis, and fistula formation. Interventions: The cystotomy repair is demonstrated in standard fashion after completion of the hysterectomy and confirming the injury does not involve the trigone. Bladder dome injuries greater than 1 centimeter require primary repair, which should be completed in 2 layers with delayed absorbable suture. The first layer opposes the edges of the bladder mucosa and muscularis and the second layer closes the bladder serosa. Following repair, the bladder is retro filled with normal saline to ensure a watertight closure. Imbricating sutures can be utilized on the serosa to enhance closure as necessary. A cystoscopy confirms intact repair and bilateral ureteral efflux. An indwelling foley catheter is maintained for 1-2 weeks postoperatively. Conclusion: Recognition and repair of a bladder injury at the time of original surgery optimizes patient outcomes. A two layer closure using excellent tissue reapproximation is essential for ideal wound healing. Virtual Poster Session 1: Laparoscopy (10:20 AM — 10:30 AM) 10:20 AM: STATION J 2561 Should Placental Abnormality be Expected in Subsequent Pregnancy after Myomectomy? Mohr-Sasson A,1,2,* Timor I,1 Meir R,1,2 Stockheim D,1,2 Goldenberg M,1,2 Mashiach R1,2. 1Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, Israel; 2Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel *Corresponding author. Study Objective: To compare the incidence of placental abnormalities in subsequent pregnancy after myomectomy performed by laparoscopy, laparotomy and hysteroscopy. Design: A retrospective cohort study, conducted from February 2011 to November 2018. Setting: A single tertiary care center. Patients or Participants: All women after myomectomy that gave birth. Interventions: Data was collected from patients’ medical files. Groups were compared for women demographics, fibroids characteristics, operative management, post-operative placental evaluation and delivery characteristics. Primary outcome was defined as the need for any intervention for placental separation during the third phase of the delivery. Non-parametric statistics were used for analysis.
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Interventions: “Chopstick technique” was performed in LESS-RH and pelvic lymph node dissection. The demographic characteristics and perioperative efficacy of the patients were summarized and analyzed. Measurements and Main Results: LESS-RH was attempted in 84 patients, and 83 (98%) patients underwent the procedure successfully. One patient underwent conversion to traditional laproscopic surgery secondary to phase IV endometriosis. “Chopstick technique” was used in all the 83 cases, wherein 40 cases used the single-incision three-channel laparoscopy platform, and 43 used the multichannel-tipped single port laparoscopy platform (HangT Port). The average operation time was 225.0§50.2min and the median intraoperative blood loss was 100mL. During the operations in the first 20 cases, 2 patients had intraoperative vascular injuries and 1 patient had bladder injury, and all were repaired under LESS. One case had ureterovaginal fistula 14 days after operation, and was successfully repaired by ureteroneocystostomy. The average number of pelvic lymph node dissections was 21, and the pathological examination of incisal edge was negative. Deep stromal invasion in 43 cases, LVSI in 16 cases,positive parametrium in 1 case, positive pelvic nodes in 15 cases. 33 patients were treated with postoperative chemotherapy and radiotherapy and 19 patients with intermediate risk factors were treated with radiotherapy postoperatively. Conclusion: “Chopstick technique” under LESS was considered feasible for treating cervical cancer.
Virtual Poster Session 1: Laparoscopy (10:20 AM — 10:30 AM)
Virtual Poster Session 1: Laparoscopy (10:20 AM — 10:30 AM) 10:20 AM: STATION H 2287 Cystoscopy with Laparoscope Lens of 5 MM after Laparoscopic Hysterectomy, Experience in a Third Level Hospital Garcia Rodriguez LF,1 Villegas-Cruz C,2 Berlanga-Narro SM,2,* Garza-Ayala M,3 Alvarez-Rosales A,4 Lara Esqueda J2. 1Fellowship Director MIGs, Tecnologico de Monterrey, Monterrey, NL, Mexico; 2 Tecnologico de Monterrey, Monterrey, NL, Mexico; 31° year Fellow MIGS, Tecnologico de Monterrey, Monterrey, NL, Mexico; 42° year Fellow MIGS, Tecnologico de Monterrey, Monterrey, NL, Mexico *Corresponding author. Study Objective: Evaluate the detection of ureteral injuries with the use of laparoscopic lens of 5 mm and 30˚ for cystoscopy after total laparoscopic hysterectomy. Design: Retrospective, descriptive, observational. Setting: Third level hospital in the north of Mexico. Patients or Participants: 135 patients scheduled for laparoscopic hysterectomy between march 2018 to march 2019, in a third level hospital in the north of Mexico. In four cases, laparoscopic surgery was converted to laparotomy due to bleeding, non-diagnosed ovarian malignancy, failure in the equipment, and patient’s condition. Interventions: No intervention. Measurements and Main Results: Retrospective study of 131 patients who underwent a total laparoscopic hysterectomy, in which routinary diagnostic transoperative cystoscopy was made with a laparoscopic lens of 5 mm and 30˚. The detection of 1 case of ureteral kinking was detected during the cystoscopies and one patient had an ureterovaginal fistula detected 7 days after de surgery. The results of cystoscopy after a laparoscopic hysterectomy has a sensibility of 50%, specificity of 100% and False Positive Ratio 0% and False Negatives Ratio 50% in identifying ureteral injuries. Conclusion: The use of routinary cystoscopy during total laparoscopic hysterectomy has been debated previously. The detection rate in other studies reported that twice the injuries were detected during cystoscopy immediately after hysterectomy and delayed detection of ureteral injury decreased seven fold. Our study justifies the use of cystoscopy as a cost effective test, using only the 5 mm lens as the additional equipment required.
10:20 AM: STATION I 2366 Laparoscopic Repair of Intraoperative Cystotomy Moore K,1,* Ahluwalia P2. 1Obstetrics and Gynecology, Saint Elizabeth Medical Center, Utica, NY; 24401 Middle Settlement Rd, 4401 Middle Settlement Rd, New Hartford, NY *Corresponding author. Video Objective: The purpose of this video is to demonstrate the technique for laparoscopic repair of an intraoperative cystotomy, at the time of total laparoscopic hysterectomy. Setting: In the particular case presented in this video, a large paracervical fibroid distorts the anatomy of the lower uterine segment. While developing the bladder flap, an inadvertent cystotomy 4 centimeters in diameter is created, immediately identified, and subsequently repaired laparoscopically by standard surgical guidelines. The risk of a urinary tract injury during laparoscopic hysterectomy ranges from 0.735-1.8%; the risk of a bladder injury is three times more likely than that of a ureteral injury. A number of patient characteristics increase the risk of an injury, including endometriosis, a history of cesarean sections, and large fibroids that distort uterine anatomy. Urinary tract injuries that go unrecognized at the time of surgery are associated with increased postoperative morbidities, specifically hospital readmission, sepsis, and fistula formation. Interventions: The cystotomy repair is demonstrated in standard fashion after completion of the hysterectomy and confirming the injury does not involve the trigone. Bladder dome injuries greater than 1 centimeter require primary repair, which should be completed in 2 layers with delayed absorbable suture. The first layer opposes the edges of the bladder mucosa and muscularis and the second layer closes the bladder serosa. Following repair, the bladder is retro filled with normal saline to ensure a watertight closure. Imbricating sutures can be utilized on the serosa to enhance closure as necessary. A cystoscopy confirms intact repair and bilateral ureteral efflux. An indwelling foley catheter is maintained for 1-2 weeks postoperatively. Conclusion: Recognition and repair of a bladder injury at the time of original surgery optimizes patient outcomes. A two layer closure using excellent tissue reapproximation is essential for ideal wound healing. Virtual Poster Session 1: Laparoscopy (10:20 AM — 10:30 AM) 10:20 AM: STATION J 2561 Should Placental Abnormality be Expected in Subsequent Pregnancy after Myomectomy? Mohr-Sasson A,1,2,* Timor I,1 Meir R,1,2 Stockheim D,1,2 Goldenberg M,1,2 Mashiach R1,2. 1Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, Israel; 2Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel *Corresponding author. Study Objective: To compare the incidence of placental abnormalities in subsequent pregnancy after myomectomy performed by laparoscopy, laparotomy and hysteroscopy. Design: A retrospective cohort study, conducted from February 2011 to November 2018. Setting: A single tertiary care center. Patients or Participants: All women after myomectomy that gave birth. Interventions: Data was collected from patients’ medical files. Groups were compared for women demographics, fibroids characteristics, operative management, post-operative placental evaluation and delivery characteristics. Primary outcome was defined as the need for any intervention for placental separation during the third phase of the delivery. Non-parametric statistics were used for analysis.