2859 Single-Port Laparoscopic Hysterectomy in Patients with Myoma Uteri

Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231 Video Objective: To demonstrate the importance of total salpingectomy when surgical management of ectopic pregnancy is warranted. Setting: The patient is a 41 year old G6P4014 at 6 weeks gestation who presented with abdominal pain and vaginal bleeding. She underwent an initial dilation and curettage and bilateral salpingectomy for pregnancy of unknown location (PUL). Pathology returned without evidence of pregnancy tissue. Interventions: The patient required additional imaging including a transvaginal ultrasound and magnetic resonance imaging scan. She underwent repeat surgical intervention with removal of the remaining portion of the right fallopian tube and intra-operative frozen pathology to confirm the diagnosis and definitive treatment of the ectopic pregnancy. Conclusion: This is a unique case where initial surgical management failed to identify a pregnancy of unknown location. In the setting of a suspected tubal ectopic pregnancy requiring salpingectomy, performing a complete salpingectomy is essential. Additionally, the use of intra-operative frozen pathology can aid in confirming the diagnosis and successful treatment of a PUL. Virtual Poster Session 1: Laparoscopy (9:50 AM — 10:00 AM) 9:50 AM: STATION Q 2937 Robotic Single-Site Surgery as a Feasible Method in Managing all Stages of Endometriosis with Chronic Pelvic Pain Huang Y,1 Guan Z,2 Rezai S,3 Bardawil E,4 Liu J,2 Guan X3,*. 1OBGYN, Nanhai Hospital Affiliated to Southern Medical University, Foshan, China; 2Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; 3Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; 4Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX *Corresponding author. Study Objective: To investigate the safety and feasibility of robotic single-site for surgical resection of stage I to IV endometriosis in chronic pelvic pain patients. Design: A retrospective cohort study via chart review collected data. All procedures were performed by a single surgeon between January 2015 and April 2019. Setting: An academic university hospital. Patients or Participants: A total of 272 patients with chronic pelvic pain and pathology confirmed endometriosis were managed with surgical resection via the robotic single-site laparoscopy. All of the patients were chronic pelvic pain who incurred symptoms of dysmenorrhea, menorrhagia, deep dyspareunia, although other symptoms may be present such as dysphasia, lower back pain, urinary, or intestinal symptoms. Interventions: All procedures were completed successfully with robotic single-site resection; however, an additional port was added in fourteen cases due to deep infiltrating endometriosis with colorectal, urinary tract involvement and extensive pelvic adhesion. Measurements and Main Results: The median operative time was 110 min (range, 45-480 min), and the median blood loss was 50 mL (range, 15-300 mL). The length of hospital stay was less than 24 hours for 90.8% of patients (247/272). The incidence of complication was 5.9% (16/ 272). All but two surgeries had no severe complications, which included eight wound infection, one vaginal cuff dehiscence, four urinary tract infection and pelvic abscess. One patient with symptomatic bowel endometriosis nodule developed in the right abdominal wall and perineal hematoma after lower anterior bowel resection. The other patient, who had undergone a double ureteral malformation, ureteral endometriosis, and severe adhesion, had injured the left ureteral ten days after extensive pelvic and bladder nodule endometriosis resection. Conclusion: Robotic single-site laparoscopic resection of endometriosis surgery appears to be a reasonably safe and feasible method for the surgical management of women with endometriosis. Adding a port is a good alternative if challenging cases encountered.

S103 Virtual Poster Session 1: Laparoscopy (9:50 AM — 10:00 AM) 9:50 AM: STATION R 2168 Cavernous Lymphangioma of the Fallopian Tube De La O O, Gami~ no Sanchez LS,* P erez CA. Reproductive Medicine, IMSS, Monterrey, NL, Mexico *Corresponding author. Video Objective: Describe an uncommon tumor of the lymphatic system in the fallopian tube Fertility preserving laparoscopic surgery. Setting: 34 years old female. G1P1 Presenting with secundary infertility and pelvic tumor. Recurrent episodes of severe left lower quadrant pain. Undergoing diagnoses laparoscopy finding a rare tumor. Interventions: Operative laparoscopy. Complete resection of the tumor as well as fallopian tube and ovary. Conclusion: Lymphangiomas are rare, usually benign lesions of the lymphatic system. Laparatomy or laparoscopy both are acceptable routes of surgery for treatment. The prognosis with laparoscopic treatment is usually excellent. It has inherent advantages in the form of less intra- operative blood loss, early recovery, less morbidity, and low complication rate compared with laparotomy. Preserving fertility surgery. Virtual Poster Session 1: Laparoscopy (9:50 AM — 10:00 AM) 9:50 AM: STATION S 2824 Laparoscopic Tips and Tricks for Temporary Oophoropexy During Pelvic Surgery Barnes WA,1,* Hazen ND,2 Robinson JK III3. 1Minimally Invasive Surgery, Medstar Georgetown University-Washington Hospital Center, Washington, DC; 2MIGS - National Center for Advanced Pelvic Surgery, Medstar Washington Hospital Center, Washington, DC; 3MIGS - National Center for Advanced Pelvic Surgery, Medstar Washington Hospital Center, WASHINGTON, DC *Corresponding author. Video Objective: To demonstrate minimally invasive surgical techniques that can be employed for temporary suspension of pelvic anatomy, specifically the ovaries, for improved visualization during complex laparoscopic pelvic surgery. Setting: Operating room. Interventions: Suboptimal visualization of the pelvis during laparoscopic surgery can arise from normal anatomic structures blocking clear line of sight of the laparoscope or due to comorbid conditions that limit trendelenburg each of which can negatively impact surgical efficiency. This instructional video demonstrates techniques of oophoropexy to facilitate better visualization of pelvic anatomy, and aid in retroperitoneal dissection. These techniques can replace the need for additional ports and allow surgical assistants to perform other more active tasks than retracting. Conclusion: The techniques demonstrated already exist within the skill set of most laparoscopically trained gynecological surgeons. Employing these simple techniques can increase efficiency, replace need for additional laparoscopic ports, and allow surgical assistants to perform alternative tasks besides anatomical retraction to improve the safety of and operator comfort completing complex pelvic surgery, and well as provide physical space following a dissection to avoid adhesion formation. Virtual Poster Session 1: Laparoscopy (9:50 AM — 10:00 AM) 9:50 AM: STATION T 2859 Single-Port Laparoscopic Hysterectomy in Patients with Myoma Uteri

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.