457: Laparoscopic Tubal Anastomosis

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Journal of Minimally Invasive Gynecology, Vol 14, No 6, November/December Supplement 2007

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successful completion of a potentially complicated hysterectomy in mullerian anomalies.

Trans-Obturator Post-Anal Sling (TOPAS) Procedure for Fecal Incontinence Rosenblatt PL. Boston Urogynecology Associates, Cambridge, Massachusetts The Trans-Obturator Post-Anal Sling (TOPAS) procedure is a novel percutaneous procedure for the treatment of fecal incontinence. A synthetic polypropylene mesh is placed in a slinglike position behind the anus, and is brought up through the ischiorectal fossa and the medial obturator foramen. The TOPAS procedure provides an augmentation of support to the posterior anorectum, in a manner that simulates the normal function of the puborectalis muscle. The procedure has been performed in 13 women. Improvements were observed on the FIQOL at 6 weeks, and were maintained in the subset evaluated at 12 weeks, 6 months, and 12 months. 453 The Vasopressin Injection Technique for Excision of Ovarian Endometrioma Saeki A. Osaka, Japan Study Objective: Sometimes, removing an endometrioma from normal ovarian tissue is difficult. We demonstrated a novel technique to inject diluted vasopressin into endometrioma. Patients: Thirty-one women who underwent laparoscopic cystectomy of ovarian endometrioma: 16 without (group A) and 15 with (group B) vasopressin injection. Interventions: We injected diluted vasopressin (0.1 U/mL) into the space between endometrioma and normal tissue. Measurements and Main Results: Operating time and bleeding were not significantly different. However, group B cases took shorter time to stop bleeding by using bipolar coagulation. Conclusion: Vasopressin injection technique is effective to remove endometrioma quickly and safely. This procedure can prevent damage and/or accidental removal of normal ovarian tissue during surgery. 454 Robot Assisted Laparoscopic Hysterectomy and Vaginal Septoplasty in Uterine Didelphys Senapati S, Wang KC. University of Michigan, Ann Arbor, Michigan The objective of this video is to demonstrate the use of the daVinci surgical system to facilitate management of an extirpative procedure for a mullerian anomaly. This is a case report of a 48-year-old nulligravida with a complicated medical history including congenital absence of one kidney and renal failure status post left-sided kidney transplant who had abnormal uterine bleeding secondary to complex endometrial hyperplasia with atypia. She has a known uterine didelphys and vaginal septum. The improved visualization and ergonomics of the daVinci surgical system allow for the

455 Laparoscopic Approach for the Large Cervical Leiomyoma Song JY. Oak Brook Institute of Endoscopy, Rush University Medical Center, St. Charles, Illinois This video demonstrates technique for performing laparoscopic myomectomy of large cervical leiomyomas. Twentynine y/o nulligravida with large cervical fibroid, indicated conservative surgery impossible to perform; hysterectomy recommended, eliminating possible child bearing. Second opinion proposed management plan, performed laparoscopic myomectomy for large cervical fibroid. End result during second look laparoscopy, excellent healing with normal appearing uterus and bilateral tubal patency. Regardless of size, type, and anatomical position of fibroid(s), laparoscopic approach for even large cervical leiomyoma is not only feasible, but safe if performed under capable hands in a well prepared and established surgical setting. This case may represent the first instance of a true, large, full thickness (not pedunculated) cervical fibroid arising from the posterior aspect of the cervical musculature. 456 Laparoscopic Trachelectomy Song JY. Oak Brook Institute of Endoscopy, Rush University Medical Center, St. Charles, Illinois This video demonstrates our technique for performing laparoscopic trachelectomy in a patient that has undergone a laparoscopic supracervical hysterectomy (LSH) years prior. A 47 y/o multiparous patient, who underwent an LSH 7 years prior for symptomatic uterine fibroids, was referred to our institute due to continuous vaginal spotting and severe mucorrhea unresponsive to conservative, medical management. The patient had normal pap smears. A step-by-step video demonstration of a laparoscopic trachelectomy is presented. The patient’s symptoms resolved following the procedure. Laparoscopic trachelectomy is a safe and effective method for cervical stump removal and compares favorably with the vaginal or abdominal approach. 457 Laparoscopic Tubal Anastomosis 1 Song JY, 2Sueldo C, 1Rotman CA. 1Oak Brook Institute of Endoscopy, Rush University Medical Center, St. Charles, Illinois; 2University of California, Fresno, Fresno, California Objective: To offer patients seeking fertility after tubal sterilization/segmental tubal occlusion, an option other than laparotomy or IVF.

DVD Presentations

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Setting: The Oak Brook Institute of Endoscopy, Chicago, Illinois. Interventions: Video presentation of our technique of performing a laparoscopic tubal anastomosis. Results: The majority of the patients who have undergone this approach demonstrated tubal patency and pregnancy. Conclusions: In most cases, abdominal entrance, evaluation of tubal disease, visualization of previous sterilization, and tubal reconstructive surgery with anastomosis, are mucheasily performed by laparoscopy than by laparotomy. Results in over three hundred cases are very encouraging

exposure techniques, different tips and tricks to achieve good and stable exposure all through the surgery, adapted to the surgical steps required in the treatment of various pathologies. We show the benefits and advantages that the surgeon can expect from adequate exposure. To overcome the reputation of laparoscopic surgery for being complex, difficult to perform and to teach, we have to return to fundamental surgical principles such as ergonomics and more importantly, adequate exposure. Teaching adequate exposure should be an integral part of laparoscopic training.

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DIY Laproscopic Traing Box Takaki YT. Kurashiki-shi Okayana-ken, Japan

Laparoscopic Promontofixation Thoma V. Schiltigheim, Strasbourg, France

Today many kinds of the training boxes are available, however, they are too expensive and are not always suitable for specific procedures. Now we have developed a new training box which is similar in size to the female pelvis - an optimal training tool for our procedure. The box is easy to make with general commercial available materials. This video shows the unique architecture and how to make it. With our video, you will be able to make your own training box instantly. We introduce our advanced training method using our box.

Performed for more than 15 years, laparoscopic promontofixation has shown its ability to achieve perfect anatomical correction and remarkable functional results. The time has now come to simplify the techniques and to make them reproducible, with acceptable operating times. In this video, we show the technique, our tips and tricks, in a promotofixation procedure performed in a 51 years old women presenting with complete genital prolapse, affecting the 3 levels of the pelvic floor.

459 A Novel Technique of Laparoscopic Myomectomy Tanase YT, Kuno A. Osaka Central Hospital, Kita-ku, Osaka, Japan

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Study objective: Performing laparoscopic myomectomy (LM), we encounter unexpected bleeding. We demonstrated the Bottom-up technique to solve the problem. The efficacy was evaluated. Design: Retrospective analysis of 132 cases of LM. Setting: Osaka central hospital. Patients: Of the 132 cases, 29 women performed with this technique and 32 without this technique for laparoscopic myomectomy. Interventions: Laparoscopic myomectomy. Measurements and Main Results: Operation time, blood loss and weight of the fibroma in the two groups were tested. And correlation analysis was performed. There was no statistical difference, but we could see the usefulness. Conclusion: The Bottom-up technique is effective for LM. With this technique it is possible to suture the defect and reduce blood loss.

In a small proportion of women, cervical cerclage cannot be performed vaginally; an abdominal approach is needed. This is due to extremely short cervix, deformed, or absent cervix preventing adequate placement of the vaginal cerclage. Most of the abdominal cerclages are performed abdominally. In this video, we will demonstrate a simple laparoscopic abdominal cerclage. Instead of tracking the uterine vessels and creating a window in the broad ligament, we use a disposable suturing device piercing the cervix medial to the uterine vessels. It facilitates the procedure without the need of vessels dissection.

460 Exposure in Laparoscopy Thoma V. Schiltigheim, Strasbourg, France In laparoscopy, as in conventional surgery, exposure is the key factor for the success of the procedure. We demonstrate

A Simple Laparoscopic Abdominal Cerclage Tulandi T. Montreal, Quebec, Canada

463 Allen-Turner Booted Cane Lithotomy Stirrups: The ABC Stirrups 1 Turner RJ, 2Allen DR. 1Genesisi Physicians’ Group, Plano, Texas; 2Medicus USA, Newbury, Ohio The ABC stirrup represents the first true hybrid surgical leg holder that combines the patient safety features and benefits of a booted “Allen Style” stirrup with the comfortable and convenient surgical site access provided by a traditional “candy cane” stirrup. ● ABC stirrups allow easy and safe low lithotomy leg