448: Anatomic Implications for the Treatment of Rudimentary Uterine Horn

DVD Presentations sacral ligaments and infundibulopelvic ligaments, and vaginal colpotomy. Conclusion: Total laparoscopic radical hysterectomy is safe and feasible in patients with early-stage cervical cancer. 447 Laparoscopic Rectocele Repair and Colpopexy With Graft Rardin CR, Erekson EA. Providence, Rhode Island This video demonstrates, with anatomic diagrams and surgical footage, a laparoscopic approach to rectocele repair and uterosacral colpopexy with xenograft. The technique involves dissection of the uterosacral ligaments and rectovaginal septum to the level of the perineum, and proximal and distal graft fixation. There are several potential advantages to the laparoscopic approach over the vaginal approach, which include: - enhanced safety to the ureter and rectum, thorough direct visualization - enhanced identification and tissue capture of proximal uterosacral ligaments through pelvic sidewall dissection - elimination of vaginal incisions and dissection, which is likely to reduce graft-related erosion and healing complications. 448 Anatomic Implications for the Treatment of Rudimentary Uterine Horn Ridgeway BM, Falcone T, Attaran M. Cleveland Clinic, Cleveland, Ohio Unicornuate uterus with rudimentary uterine horn is a class II reproductive tract congenital anomaly that can lead to debilitating pain or devastating reproductive complications. Accurate pre-operative diagnosis is critical to surgical approach and technique. Imaging such as magnetic resonance will aid in diagnosis and identification of associated urinary tract abnormalities. This video provides a systematic approach to laparoscopic resection of rudimentary uterine horn, including identification of pertinent anatomic landmarks. Laparoscopic resection of rudimentary uterine horn is safe and feasible. The available literature supports the laparoscopic approach and reports excellent post-operative outcomes. 449 Laparoscopic Paravaginal Repair With the Autonomy Laparo-Angle Device 1 Rosenblatt PL, 2Ferzandi TR, 3Hong S, 4Kim D. 1Boston Urogynecology Associates, Cambridge, Massachusetts; 2 Mount Auburn Hospital, Cambridge, Massachusetts; 3 Cheil General Hospital and Women’s Healthcare Center, Jung-gu, Seoul, Korea; 4Chung-ang University Medical Center, Dongjak-gu, Seoul, Korea

S151 Laparoscopic reconstructive surgery requires advanced laparoscopic suturing techniques. One of the shortcomings of laparoscopic suturing has been the limited angles achieved with traditional needle drivers. Robotic systems have introduced “wrist articulation”, which allows surgeons to perform complex maneuvers that imitate the surgeon’s hand movements, but at a significant cost. We demonstrate the new Autonomy Laparo-Angle Instrument from Cambridge Endo during a laparoscopic paravaginal repair. This is a 5mm instrument that has the advantage of an articulating tip with seven degrees of freedom, the ability to rotate 360 degrees around its axis at any angle, and control with one hand. 450 Laparoscopic Sacrocervicopexy With 3-D Head Mounted Display Rosenblatt PL. Boston Urogynecology Associates, Cambridge, Massachusetts Laparoscopic sacrocervicopexy is a challenging procedure that requires advanced laparoscopic skills, including endoscopic suturing. In any case, a minimum of 12 sutures is used to secure the synthetic mesh to the cervix, posterior endopelvic fascia, and anterior ligament of the sacrum. One of the technical difficulties encountered with suturing laparoscopically is the inability to see depth, and therefore other visual cues need to be used to determine the position of the needle. We demonstrate a lightweight 3-D visualization system with a headmounted display to assist with laparoscopic suturing during a laparoscopic sacrocervicopexy. 451 Total Laparoscopic Hysterectomy and Bisalpingooophorectomy for Endometrial Cancer After Laparoscopic Sacrocervicopexy With Mesh 1 Rosenblatt PL, 2Awtrey CS, 3Ferzandi TR. 1Boston Urogynecology Associates, Cambridge, Massachustts; 2 Beth Israel Deaconess Medical Center, Boston, Massachusetts; 3Mount Auburn Hospital, Cambridge, Massachusetts Laparoscopic sacrocervicopexy (LSCx) with synthetic mesh has been shown to be an effective treatment for uterine prolapse, which does not require hysterectomy. We present an interesting case of a woman who underwent a successful LSCx but then returned three years later with post-menopausal bleeding and was found to have endometrial carcinoma on biopsy. The patient underwent a total laparoscopic hysterectomy with BSO without disruption of the mesh maintaining the support of her vaginal vault. This video illustrates the feasibility of hysterectomy, if needed, following sacrocervicopexy.