- Email: [email protected]
2878 Posterior Approach to Uterine Artery Ligation
S216
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Meridian Health, Neptune, NJ; 2Obstetrics and Gynecology, Hackensack Meridian Health, Neptune, NJ; 3Gynecologic Oncology, Hackensack Meridian Health, Neptune, NJ *Corresponding author.
Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM)
Video Objective: To Demonstrate Robot-assisted total laparoscopic hysterectomy, bilateral salpingo-oopherectomy (TLHBSO) using 3 arms and a uterine manipulator Setting: The da Vinci XI Platform is used to perform a simple extrafascial TLHBSO Interventions: A step-by-step choreography demonstrates 5 main exercises of a robot-assisted TLHBSO mainly; 1- The posterior dissection, 2- The anterior dissection, 3- The lateral dissection, 4- The colpotomy, 5- The cuff closure and suspension. Attention is drawn to the position of the uterus and the direction of counter-traction necessary to complete each step. The function of the third arm is emphasized. Relevant anatomy shown. Necessary laparoscopic surgical techniques demonstrated. Conclusion: The principles of this step-by-step choreographed method can be reproducible with every platform, docking preference, and surgeon handedness. The 5 exercises break down the procedure for the trainee as specific tasks to complete and master separately. This facilitates the learning process and maintains operating room efficiency. Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM) 1:20 PM: STATION A 2529 Increased Surgical Site Infections in Robotic Hysterectomies in a Large Health System Mandelberger A,1,* Neal KL,1 Bueser R,1 Nimaroff ML2. 1OB/GYN, Northwell Health, Manhasset, NY; 2Minimally Invasive Gynecologic Surgery, North Shore University Hospital, Manhasset, NY *Corresponding author. Study Objective: To describe cases of surgical site infection (SSI) after hysterectomy in a large health system and investigate adherence to infection prevention guidelines Design: Retrospective observational study Setting: 6 hospitals in New York, both community and academic centers Patients or Participants: Patients with surgical site infections as defined by CDC after hysterectomy in 2016 and 2017 Interventions: n/a Measurements and Main Results: Available data from 6 hospitals across a large health system in New York were analyzed. A total of 4589 inpatient open, robotic, and laparoscopic hysterectomies were performed in 2016 and 2017 of which 48 cases of surgical site infection were identified and reviewed. Overall SSI incidence was found to be 1.05%. Mean age of SSI cases was 53.5, and mean BMI 33.7. Among the SSI cases, 20 (41.7%) originated from a robotic approach, 1 (2.1%) straight laparoscopic, and 27 (56.2%) were open. This gave an SSI incidence of 1.98% for robotic, 0.13% for straight laparoscopic, and 0.97% for open approach. 41 (85.4%) SSI cases had total hysterectomies vs 7 (14.6%) supracervical. 34 (70.8%) of cases had a history of prior abdominal surgery. The most common infection type was intraabdominal at 19 cases (39.6%). Incisional infections accounted for 11 cases (22.9%), and vaginal cuff infection accounted for 4 (8.3%). The most common pathogens encountered were bacteroides fragilis (16.2%) and staphylococcus aureus (16.2%). Of 10 cases that used second-line antibiotics, 70% did not adhere to system protocol for dosing or antibiotic choice. Conclusion: A review of cases reveals robotic hysterectomies as having the largest rate of SSI in the 6 hospitals examined at 1.98% as compared to laparoscopic hysterectomies with an SSI rate of 0.13% over 2 years. Further research is needed to validate these findings over time and geographic location, and examine reasons why robotic surgery may confirm a higher infection rate than laparoscopic in these locations.
1:20 PM: STATION B 2026 Robot-Assisted Laparoscopic Adenomyomectomy is a Feasible Option of Uterus-Sparing Surgery: Adenomyomectomy Cohort Study Kang HJ,1,* Chung YJ2. 1Obstetrics & Gynecology, Seoul St. Mary’s Hospital, The Catholic university of Korea, Seoul, Korea, Republic of (South); 2Department of Obstetrics and Gynecology, Seoul Saint Mary’s Hospital, The Catholic University of Korea, Seoul, Korea, Republic of (South) *Corresponding author. Study Objective: To compare surgical outcomes of open adenomyomectomy and robot-assisted laparoscopic adenomyomectomy. Design: Cohort study. Setting: Fibroid Center of tertiary university hospital. Patients or Participants: Among adenomyomectomy cohort, forty-two patients who underwent robot-assisted laparoscopic adenomyomectomy and 16 patients who underwent open adenomyomectomy. Interventions: N/A Measurements and Main Results: All 58 patients with severe secondary dysmenorrhea and pelvic pain visited Seoul St. Mary’s hospital between 2012 and 2017. Eighty-one percent of patients were nulliparous woman (47 patients among 58 patients). Adenomyosis was diagnosed by pelvic ultrasonography. To determine the exact location and size of the lesion and its relation to the uterine cavity, pelvic MRI was performed in all patients. Their mean age, pre-operative CA-125 level, hemoglobin changes after surgery, estimated blood loss were comparable between two groups. The size of adenomyosis was larger in open than robot surgery group. Operation time was longer in robot than open surgery group (open vs robot 244.8§44.2 vs 281.8§77.1 min). Percentage of packed RBC transfusion during surgery was higher in open than robot surgery group (open vs robot 50% vs 14.3%). Hospital stay was shorter in robot than open surgery group (open vs robot 6.1§1.1 vs 2.7§0.7 days). All patients discharged without major complication. Conclusion: Adenomyosis is a common benign gynecologic disease, however, conservative surgical option for preserving fertility is challenging. Adenomyomectomy is a conservative surgical option for preserving fertility. Comparing with open surgery, robot-assisted laparoscopic adenomyomectomy is a feasible option of uterus-sparing surgery using minimally invasive approach.
Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM) 1:20 PM: STATION C 2878 Posterior Approach to Uterine Artery Ligation Fiori C,1,* Patel NR,2 Namaky DD1. 1OB/GYN, TriHealth, Cincinnati, OH; 2Medical Education, OB/GYN, TriHealth/Good Samaritan Hospital, Cincinnati, OH *Corresponding author. Video Objective: This video demonstrates an alternative approach to uterine artery ligation during a Robotic Assisted Total Laparoscopic Hysterectomy in the setting of an obliterated anterior cul-de-sac. Setting: This a case of a 29 year old with two prior cesarean sections presenting for Robotic Assisted Total Laparoscopic Hysterectomy for abnormal uterine bleeding. Upon entry, the uterus is found to be densely adherent to the anterior abdominal wall. Interventions: The uterine arteries were dissected out, desiccated, and transected from the posterior aspect of the uterus due to the limited access anteriorly secondary to bladder adhesions.
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
S217
Conclusion: In conclusion, an obliterated anterior cul-de-sac due to previous surgeries makes it difficult to access the uterine arteries secondary to poor visualization. By approaching uterine artery ligation from the posterior aspect, one may avoid inadvertent injury to vasculature or the bladder and reduce the amount of bleeding during the bladder dissection.
procedure performed. Patients undergoing robotic assisted hysterectomies and laparoscopic hysterectomies were placed in the dorsal lithotomy position with trendelenberg. Those undergoing abdominal hysterectomies were placed in the dorsal supine position. Patients or Participants: The study included 288 women who underwent benign hysterectomy by any method at Saint Peters University Hospital from March 2017 to Dec 2018. 86 (40.4%) patients underwent a robotic assisted laparoscopic hysterectomy, 60 (28.0%) underwent a laparoscopic hysterectomy, and 68 (31.7%) underwent an abdominal hysterectomy. Interventions: All patients received a hysterectomy in one of the three following methods: robotic assisted laparoscopic hysterectomy, laparoscopic hysterectomy, and abdominal hysterectomy. Concomitant procedures of a salpingo-oophrectomy and/or cystoscopy were performed if indicated. Measurements and Main Results: A retrospective chart review was performed for all benign hysterectomies from March 2017 to December 2018 using student t test and a multivariate regression analysis. The primary outcome was the direct total cost of the patient’s hospitalization related to their hysterectomy. Secondary outcomes included estimated blood loss, surgery time, days in the hospital postoperatively, and complications postoperatively. Mean total costs of robotically assisted hysterectomies were $26,452 less than abdominal hysterectomies (p<0.001) and $10,401 less than laparoscopic hysterectomies (p<0.001). These savings held true even after controlling for age, prior surgery, and uterine weight. Conclusion: Overall, total cost was significantly influenced by the mode of hysterectomy, with robotic assisted hysterectomies being the most cost effective.
Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM) 1:20 PM: STATION D 2180 Experience of Centro Medico Nacional “20 De Noviembre“ in Robotic-assisted Hysterectomy for Large Uteri: A Case Series of 20 Women Cortes AL,1,* Cortes Vazquez A,1 Gallardo Valencia LE Sr,1 Gongora Rodriguez A,2 Reyes Santillan VN,1 Goitia GA1. 1Laparoscopic and Robotic Surgery, Centro M edico Nacional 20 de Noviembre, Mexico City, DF, Mexico; 2Reproductive Endocrinology, Centro M edico Nacional 20 de Noviembre, Mexico City, DF, Mexico *Corresponding author. Study Objective: To determine the outcomes of robotic-assisted laparoscopic hysterectomy for benign conditions in women with large uteri. Design: A prospective and recruting cases for robotic-assisted laparoscopic hysterectomy for benign indications at Centro Medico Nacional “20 de Noviembre” by one surgeon with trainning in minimally invasive and Robotic surgery between May 2016 to August 2018. Setting: Centro Medico Nacional “20 de Noviembre” ISSSTE. Patients or Participants: Only women with large uteri (defined as greater than 750g) were included in this study. Interventions: Robotic hysterectomy. Measurements and Main Results: A total of 20 women were included in the analysis: 11 patients had uterine weights 750-999g and 9 had uterine weights greater than 1000g with the largest being 1,450g. The average surgical times were 131 min (53-301 min) and 156 min (82-338 min), respectively. The average estimated blood loss was 50cc; no blood transfusions were required. There were no intra- operative conversions. There were none major intraoperative complications. There were 2 minor postoperative complications (acute urinary retention and a wound dehiscence of an umbilical port site); both were in the 750-999g group. All patients in both groups were hospitalized 0-1 days. Conclusion: In skilled hands, robotic-assisted laparoscopic hysterectomy in women with large uteri is an acceptable option, associated with minimal complications. Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM) 1:20 PM: STATION E 1369 Cost and Outcomes Analysis of Robotic, Laparoscopic, and Abdominal Hysterectomy for Benign Disease in a Community Hospital Setting Yoo N,* Cernadas M, Perisic D. Saint Peters University Hospital, New Brunswick, NJ *Corresponding author. Study Objective: To compare overall costs and quality measures of various methods of benign hysterectomies at a community based hospital system Design: A retrospective review of all hysterectomies for benign indications at Saint Peters University Hospital between March 2017 to Dec 2018. Robotic assisted laparoscopic hysterectomies, laparoscopic hysterectomies, and abdominal hysterectomies were compared. Setting: Data was collected from admission to discharge. In the OR, all patients were in comparable sized OR rooms and staff were trained in the
Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM) 1:20 PM: STATION F 2751 A New Approach to the 4-Point Transversus Abdominis Plane Block Ladanyi C,1,* Mohling S2. 1Minimally Invasive Gynecologic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; 2Obstetrics and Gynecology, Minimally Invasive Gynecology, University of Tennessee, College of Medicine, Chattanooga, TN *Corresponding author. Study Objective: To educate gynecologic surgeons on the background, indications, technique, and outcomes of a four-point transversus abdominis plane (TAP) block delivered under laparoscopic guidance. Design: We devised a technique for a laparoscopic assisted four-point TAP block. We have described the indications, supplies needed, and medications administered. We performed a cadaveric dissection of the anteriorlateral abdominal wall to identify the neurovascular plane used for anesthetic injection. To the best of our knowledge, we are the first to perform a four-point TAP block at the subcostal and lateral positions, under laparoscopic visualization, for robotic-assisted gynecologic procedures including hysterectomies. Setting: Academic community hospital setting and institutional cadaver lab. Patients or Participants: N/A Interventions: We perform laparoscopic assisted four-point TAP blocks on all robotic-assisted gynecologic procedures unless there is a contraindication. Blocks are placed by the surgeon after insertion of the laparoscope. For the subcostal injection the lower costal margin is palpated, and the injection site is identified two centimeters inferior and medial to the midaxillary line. For the inferior injection the anterior superior iliac spine is palpated, and the injection is two centimeters superior and medial to the mid-axillary line. Introduction of a regional anesthesia needle is simultaneously observed externally and laparoscopically. This method along with detailed anatomical landmarks are described in our technique paper. Measurements and Main Results: N/A Conclusion: A four-point TAP block is a safe, efficacious, yet simple procedure which can be performed by the surgeon under laparoscopic visualization.
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Meridian Health, Neptune, NJ; 2Obstetrics and Gynecology, Hackensack Meridian Health, Neptune, NJ; 3Gynecologic Oncology, Hackensack Meridian Health, Neptune, NJ *Corresponding author.
Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM)
Video Objective: To Demonstrate Robot-assisted total laparoscopic hysterectomy, bilateral salpingo-oopherectomy (TLHBSO) using 3 arms and a uterine manipulator Setting: The da Vinci XI Platform is used to perform a simple extrafascial TLHBSO Interventions: A step-by-step choreography demonstrates 5 main exercises of a robot-assisted TLHBSO mainly; 1- The posterior dissection, 2- The anterior dissection, 3- The lateral dissection, 4- The colpotomy, 5- The cuff closure and suspension. Attention is drawn to the position of the uterus and the direction of counter-traction necessary to complete each step. The function of the third arm is emphasized. Relevant anatomy shown. Necessary laparoscopic surgical techniques demonstrated. Conclusion: The principles of this step-by-step choreographed method can be reproducible with every platform, docking preference, and surgeon handedness. The 5 exercises break down the procedure for the trainee as specific tasks to complete and master separately. This facilitates the learning process and maintains operating room efficiency. Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM) 1:20 PM: STATION A 2529 Increased Surgical Site Infections in Robotic Hysterectomies in a Large Health System Mandelberger A,1,* Neal KL,1 Bueser R,1 Nimaroff ML2. 1OB/GYN, Northwell Health, Manhasset, NY; 2Minimally Invasive Gynecologic Surgery, North Shore University Hospital, Manhasset, NY *Corresponding author. Study Objective: To describe cases of surgical site infection (SSI) after hysterectomy in a large health system and investigate adherence to infection prevention guidelines Design: Retrospective observational study Setting: 6 hospitals in New York, both community and academic centers Patients or Participants: Patients with surgical site infections as defined by CDC after hysterectomy in 2016 and 2017 Interventions: n/a Measurements and Main Results: Available data from 6 hospitals across a large health system in New York were analyzed. A total of 4589 inpatient open, robotic, and laparoscopic hysterectomies were performed in 2016 and 2017 of which 48 cases of surgical site infection were identified and reviewed. Overall SSI incidence was found to be 1.05%. Mean age of SSI cases was 53.5, and mean BMI 33.7. Among the SSI cases, 20 (41.7%) originated from a robotic approach, 1 (2.1%) straight laparoscopic, and 27 (56.2%) were open. This gave an SSI incidence of 1.98% for robotic, 0.13% for straight laparoscopic, and 0.97% for open approach. 41 (85.4%) SSI cases had total hysterectomies vs 7 (14.6%) supracervical. 34 (70.8%) of cases had a history of prior abdominal surgery. The most common infection type was intraabdominal at 19 cases (39.6%). Incisional infections accounted for 11 cases (22.9%), and vaginal cuff infection accounted for 4 (8.3%). The most common pathogens encountered were bacteroides fragilis (16.2%) and staphylococcus aureus (16.2%). Of 10 cases that used second-line antibiotics, 70% did not adhere to system protocol for dosing or antibiotic choice. Conclusion: A review of cases reveals robotic hysterectomies as having the largest rate of SSI in the 6 hospitals examined at 1.98% as compared to laparoscopic hysterectomies with an SSI rate of 0.13% over 2 years. Further research is needed to validate these findings over time and geographic location, and examine reasons why robotic surgery may confirm a higher infection rate than laparoscopic in these locations.
1:20 PM: STATION B 2026 Robot-Assisted Laparoscopic Adenomyomectomy is a Feasible Option of Uterus-Sparing Surgery: Adenomyomectomy Cohort Study Kang HJ,1,* Chung YJ2. 1Obstetrics & Gynecology, Seoul St. Mary’s Hospital, The Catholic university of Korea, Seoul, Korea, Republic of (South); 2Department of Obstetrics and Gynecology, Seoul Saint Mary’s Hospital, The Catholic University of Korea, Seoul, Korea, Republic of (South) *Corresponding author. Study Objective: To compare surgical outcomes of open adenomyomectomy and robot-assisted laparoscopic adenomyomectomy. Design: Cohort study. Setting: Fibroid Center of tertiary university hospital. Patients or Participants: Among adenomyomectomy cohort, forty-two patients who underwent robot-assisted laparoscopic adenomyomectomy and 16 patients who underwent open adenomyomectomy. Interventions: N/A Measurements and Main Results: All 58 patients with severe secondary dysmenorrhea and pelvic pain visited Seoul St. Mary’s hospital between 2012 and 2017. Eighty-one percent of patients were nulliparous woman (47 patients among 58 patients). Adenomyosis was diagnosed by pelvic ultrasonography. To determine the exact location and size of the lesion and its relation to the uterine cavity, pelvic MRI was performed in all patients. Their mean age, pre-operative CA-125 level, hemoglobin changes after surgery, estimated blood loss were comparable between two groups. The size of adenomyosis was larger in open than robot surgery group. Operation time was longer in robot than open surgery group (open vs robot 244.8§44.2 vs 281.8§77.1 min). Percentage of packed RBC transfusion during surgery was higher in open than robot surgery group (open vs robot 50% vs 14.3%). Hospital stay was shorter in robot than open surgery group (open vs robot 6.1§1.1 vs 2.7§0.7 days). All patients discharged without major complication. Conclusion: Adenomyosis is a common benign gynecologic disease, however, conservative surgical option for preserving fertility is challenging. Adenomyomectomy is a conservative surgical option for preserving fertility. Comparing with open surgery, robot-assisted laparoscopic adenomyomectomy is a feasible option of uterus-sparing surgery using minimally invasive approach.
Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM) 1:20 PM: STATION C 2878 Posterior Approach to Uterine Artery Ligation Fiori C,1,* Patel NR,2 Namaky DD1. 1OB/GYN, TriHealth, Cincinnati, OH; 2Medical Education, OB/GYN, TriHealth/Good Samaritan Hospital, Cincinnati, OH *Corresponding author. Video Objective: This video demonstrates an alternative approach to uterine artery ligation during a Robotic Assisted Total Laparoscopic Hysterectomy in the setting of an obliterated anterior cul-de-sac. Setting: This a case of a 29 year old with two prior cesarean sections presenting for Robotic Assisted Total Laparoscopic Hysterectomy for abnormal uterine bleeding. Upon entry, the uterus is found to be densely adherent to the anterior abdominal wall. Interventions: The uterine arteries were dissected out, desiccated, and transected from the posterior aspect of the uterus due to the limited access anteriorly secondary to bladder adhesions.
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
S217
Conclusion: In conclusion, an obliterated anterior cul-de-sac due to previous surgeries makes it difficult to access the uterine arteries secondary to poor visualization. By approaching uterine artery ligation from the posterior aspect, one may avoid inadvertent injury to vasculature or the bladder and reduce the amount of bleeding during the bladder dissection.
procedure performed. Patients undergoing robotic assisted hysterectomies and laparoscopic hysterectomies were placed in the dorsal lithotomy position with trendelenberg. Those undergoing abdominal hysterectomies were placed in the dorsal supine position. Patients or Participants: The study included 288 women who underwent benign hysterectomy by any method at Saint Peters University Hospital from March 2017 to Dec 2018. 86 (40.4%) patients underwent a robotic assisted laparoscopic hysterectomy, 60 (28.0%) underwent a laparoscopic hysterectomy, and 68 (31.7%) underwent an abdominal hysterectomy. Interventions: All patients received a hysterectomy in one of the three following methods: robotic assisted laparoscopic hysterectomy, laparoscopic hysterectomy, and abdominal hysterectomy. Concomitant procedures of a salpingo-oophrectomy and/or cystoscopy were performed if indicated. Measurements and Main Results: A retrospective chart review was performed for all benign hysterectomies from March 2017 to December 2018 using student t test and a multivariate regression analysis. The primary outcome was the direct total cost of the patient’s hospitalization related to their hysterectomy. Secondary outcomes included estimated blood loss, surgery time, days in the hospital postoperatively, and complications postoperatively. Mean total costs of robotically assisted hysterectomies were $26,452 less than abdominal hysterectomies (p<0.001) and $10,401 less than laparoscopic hysterectomies (p<0.001). These savings held true even after controlling for age, prior surgery, and uterine weight. Conclusion: Overall, total cost was significantly influenced by the mode of hysterectomy, with robotic assisted hysterectomies being the most cost effective.
Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM) 1:20 PM: STATION D 2180 Experience of Centro Medico Nacional “20 De Noviembre“ in Robotic-assisted Hysterectomy for Large Uteri: A Case Series of 20 Women Cortes AL,1,* Cortes Vazquez A,1 Gallardo Valencia LE Sr,1 Gongora Rodriguez A,2 Reyes Santillan VN,1 Goitia GA1. 1Laparoscopic and Robotic Surgery, Centro M edico Nacional 20 de Noviembre, Mexico City, DF, Mexico; 2Reproductive Endocrinology, Centro M edico Nacional 20 de Noviembre, Mexico City, DF, Mexico *Corresponding author. Study Objective: To determine the outcomes of robotic-assisted laparoscopic hysterectomy for benign conditions in women with large uteri. Design: A prospective and recruting cases for robotic-assisted laparoscopic hysterectomy for benign indications at Centro Medico Nacional “20 de Noviembre” by one surgeon with trainning in minimally invasive and Robotic surgery between May 2016 to August 2018. Setting: Centro Medico Nacional “20 de Noviembre” ISSSTE. Patients or Participants: Only women with large uteri (defined as greater than 750g) were included in this study. Interventions: Robotic hysterectomy. Measurements and Main Results: A total of 20 women were included in the analysis: 11 patients had uterine weights 750-999g and 9 had uterine weights greater than 1000g with the largest being 1,450g. The average surgical times were 131 min (53-301 min) and 156 min (82-338 min), respectively. The average estimated blood loss was 50cc; no blood transfusions were required. There were no intra- operative conversions. There were none major intraoperative complications. There were 2 minor postoperative complications (acute urinary retention and a wound dehiscence of an umbilical port site); both were in the 750-999g group. All patients in both groups were hospitalized 0-1 days. Conclusion: In skilled hands, robotic-assisted laparoscopic hysterectomy in women with large uteri is an acceptable option, associated with minimal complications. Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM) 1:20 PM: STATION E 1369 Cost and Outcomes Analysis of Robotic, Laparoscopic, and Abdominal Hysterectomy for Benign Disease in a Community Hospital Setting Yoo N,* Cernadas M, Perisic D. Saint Peters University Hospital, New Brunswick, NJ *Corresponding author. Study Objective: To compare overall costs and quality measures of various methods of benign hysterectomies at a community based hospital system Design: A retrospective review of all hysterectomies for benign indications at Saint Peters University Hospital between March 2017 to Dec 2018. Robotic assisted laparoscopic hysterectomies, laparoscopic hysterectomies, and abdominal hysterectomies were compared. Setting: Data was collected from admission to discharge. In the OR, all patients were in comparable sized OR rooms and staff were trained in the
Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM) 1:20 PM: STATION F 2751 A New Approach to the 4-Point Transversus Abdominis Plane Block Ladanyi C,1,* Mohling S2. 1Minimally Invasive Gynecologic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; 2Obstetrics and Gynecology, Minimally Invasive Gynecology, University of Tennessee, College of Medicine, Chattanooga, TN *Corresponding author. Study Objective: To educate gynecologic surgeons on the background, indications, technique, and outcomes of a four-point transversus abdominis plane (TAP) block delivered under laparoscopic guidance. Design: We devised a technique for a laparoscopic assisted four-point TAP block. We have described the indications, supplies needed, and medications administered. We performed a cadaveric dissection of the anteriorlateral abdominal wall to identify the neurovascular plane used for anesthetic injection. To the best of our knowledge, we are the first to perform a four-point TAP block at the subcostal and lateral positions, under laparoscopic visualization, for robotic-assisted gynecologic procedures including hysterectomies. Setting: Academic community hospital setting and institutional cadaver lab. Patients or Participants: N/A Interventions: We perform laparoscopic assisted four-point TAP blocks on all robotic-assisted gynecologic procedures unless there is a contraindication. Blocks are placed by the surgeon after insertion of the laparoscope. For the subcostal injection the lower costal margin is palpated, and the injection site is identified two centimeters inferior and medial to the midaxillary line. For the inferior injection the anterior superior iliac spine is palpated, and the injection is two centimeters superior and medial to the mid-axillary line. Introduction of a regional anesthesia needle is simultaneously observed externally and laparoscopically. This method along with detailed anatomical landmarks are described in our technique paper. Measurements and Main Results: N/A Conclusion: A four-point TAP block is a safe, efficacious, yet simple procedure which can be performed by the surgeon under laparoscopic visualization.