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A Case for Adenomyomectomy
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Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
A large portion of the injuries sustained in laparoscopic surgery occur during placement of the primary trocar. The purpose of this video is to encourage use of the left upper quadrant as a routine site for primary peritoneal access in laparoscopic gynecologic surgery. We demonstrate a safe and effective entry technique, utilizing an optical view trocar at this location. We highlight tips and tricks to help identify the correct location and ensure safe placement. Additionally, indications, efficacy, possible complications and relevant anatomy are reviewed.
415 Laparoscopic Uterine Retrieval With Preservation of Uterine Vascular Pedicles: Promising Application for Human Uterine Transplants Ramirez ER,1 Ehrenburg M,1 Silver R,2 Churchill SJ,3 Ramirez HA.4 1 Gynecology, Community Memorial Hospital, Ventura, California; 2 Gynecology, California Hospital Medical Center, Los Angeles, California; 3Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California; 4Gynecology, Universidad Nacional de Colombia, Bogota, Colombia, Colombia The purpose of the present study was to evaluate the technical feasibility of performing a laparoscopic uterine retrieval with preservation of uterine vascular pedicles using a posterior parametrial approach. Seventy-two female patients with benign indications for hysterectomy were operated on by the same primary surgeon. The women were divided into two groups: laparoscopic hysterectomy with uterine preservation (n=12) and non-uterine vascular preservation (n=60) group that served as a control. There were no difference between the two groups insofar as age, BMI, blood loss, rate of complication and hospital stay. Despite the fact that the present study was performed in a relatively small group of patients, our data suggest that a uterine retrieval procedure with the preservation of vascular pedicles can be safely performed using a minimally invasive approach.
416 Tips, Tricks, and Risks of Laparoscopic Myomectomy: Presented With a Case of a Broad Ligament Fibroid Klietheremes CJ, Holloran-Schwartz B. Obstetrics and Gynecology, St. Louis University, St. Louis, Missouri The goal of this video is to help teach laparoscopic surgeons different techniques and skills utilized by the authors of the video to help improve surgical methods and avoid injury. Port placement and problem solving help achieve a successful surgery. The vascular injury that occurs during the surgery helps teach other surgeons to always be aware and that, even despite what appears to be proper dissection, tissue can be misleading, resulting in injury. The surgeons are prepared to control the bleeding, and take measures to minimize damage and avoid further injury. Unique techniques, such as the ‘‘Flowseal hemostatic matrix’’ and barbed suture help to then ensure hemostasis and restore normal anatomy. These are tips and tricks used in a broad ligament fibroid, but can be applied to all laparoscopic myomectomies. 417 A Case for Adenomyomectomy Rosenthal DM, Mills KE. Obstetrics and Gynecology, North York General Hospital, Toronto, Ontario, Canada The surgical approach to leiomyomas and adenomyomas tends to differ. The former are commonly removed by myomectomy. Adenomyomectomy, however, has been fraught with difficulties and is therefore not a common procedure. There has been concern about difficult surgery resulting in
poor outcomes. Our experience in a small group of patients has been positive resulting in symptomatic improvement and, more recently, in a pregnancy. Our protocol and experience with these successful outcomes will be outlined in this video which makes a case for adenomyomectomy.
418 Airseal Bag Morcellation Winter ML. Saddleback Memorial Medical Center, Laguna Hills, California Given the recent FDA warnings regarding the use of power morcellation, several techniques have been used to minimize the chance of tissue spread during the removal of fibroids. These alternatives include laparotomy, mini-laparotomy with hand morcellation within a containment bag, and laparoscopic power morcellation within a containment bag. Our video will demonstrate the use of laparoscopic power morcellation within a containment bag using the Surgiquest Airseal insufflation system. This system assists in creating a steady pressure inflating the containment bag and keeping excellent visualization throughout the morcellation process. The video will also demonstrate our technique for placing.
419 Laparoscopy in Hemodynamicaly Unstable Patients: Some Tips & Tricks Kar S. Kar Clinic & Hospital Pvt. Ltd., Bhubaneswar, Odisha, India Ectopic pregnancy can present as sudden acute hemodynamic shock which needs urgent diagnosis and management. Laparoscopy is the gold standard. However when the patient is in hemodynamic shock, often the surgical team may decide on laparotomy for the ease and rapidity of surgery .we are presenting some tips and tricks for performing effortless laparoscopy in hemodynamically unstable patients. Retrospective analysis of five years data, with eighty two patients of hemoperitoneum of gynaecologic origin was evaluated. Seventeen patients qualified as hemodynamic shock, hemoglobin \5gms%, shock index > 1.4, and an estimated hemoperitoneum of more than 1 – 1.5 litres. Only one pateint with spontaneous second trimester rupture uterus needed laparotomy. There was no per-operative complication. Thus with improved anaesthesia, cardiovascular monitoring, availability of blood together with skill and experience of the surgoen, it is possible to manage women with severe shock, laparoscopicaly.
420 A Lateral to Anterior Approach to the Scarred Bladder Flap and Anterior Abdominal Wall Adhesions at the Time of Laparoscopic Hysterectomy Hudgens JL, Luna Russo M. Obstetrics and Gynecology Division of Minimally Invasive Gynecology, University of Mississippi, Jackson, Mississippi The purpose of this video is to present a lateral to anterior approach to the scarred bladder flap and anterior abdominal wall adhesions. The increase in cesarean section rate has made this surgical scenario more prevalent. We will present videos from two separate case. Both patient has 2 previous cesarean sections, suspected adenomyosis, and had failed medical management. We will demonstrate an anatomic based technique where the paravesicle spaces are developed bilaterally. The bladder is then backfilled and the adhesions over the supravaginal septum are transected. The vesicouterine ligaments are then transected at their origin at the pericervical ring. This allows the vesicovaginal space to be developed.
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
A large portion of the injuries sustained in laparoscopic surgery occur during placement of the primary trocar. The purpose of this video is to encourage use of the left upper quadrant as a routine site for primary peritoneal access in laparoscopic gynecologic surgery. We demonstrate a safe and effective entry technique, utilizing an optical view trocar at this location. We highlight tips and tricks to help identify the correct location and ensure safe placement. Additionally, indications, efficacy, possible complications and relevant anatomy are reviewed.
415 Laparoscopic Uterine Retrieval With Preservation of Uterine Vascular Pedicles: Promising Application for Human Uterine Transplants Ramirez ER,1 Ehrenburg M,1 Silver R,2 Churchill SJ,3 Ramirez HA.4 1 Gynecology, Community Memorial Hospital, Ventura, California; 2 Gynecology, California Hospital Medical Center, Los Angeles, California; 3Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California; 4Gynecology, Universidad Nacional de Colombia, Bogota, Colombia, Colombia The purpose of the present study was to evaluate the technical feasibility of performing a laparoscopic uterine retrieval with preservation of uterine vascular pedicles using a posterior parametrial approach. Seventy-two female patients with benign indications for hysterectomy were operated on by the same primary surgeon. The women were divided into two groups: laparoscopic hysterectomy with uterine preservation (n=12) and non-uterine vascular preservation (n=60) group that served as a control. There were no difference between the two groups insofar as age, BMI, blood loss, rate of complication and hospital stay. Despite the fact that the present study was performed in a relatively small group of patients, our data suggest that a uterine retrieval procedure with the preservation of vascular pedicles can be safely performed using a minimally invasive approach.
416 Tips, Tricks, and Risks of Laparoscopic Myomectomy: Presented With a Case of a Broad Ligament Fibroid Klietheremes CJ, Holloran-Schwartz B. Obstetrics and Gynecology, St. Louis University, St. Louis, Missouri The goal of this video is to help teach laparoscopic surgeons different techniques and skills utilized by the authors of the video to help improve surgical methods and avoid injury. Port placement and problem solving help achieve a successful surgery. The vascular injury that occurs during the surgery helps teach other surgeons to always be aware and that, even despite what appears to be proper dissection, tissue can be misleading, resulting in injury. The surgeons are prepared to control the bleeding, and take measures to minimize damage and avoid further injury. Unique techniques, such as the ‘‘Flowseal hemostatic matrix’’ and barbed suture help to then ensure hemostasis and restore normal anatomy. These are tips and tricks used in a broad ligament fibroid, but can be applied to all laparoscopic myomectomies. 417 A Case for Adenomyomectomy Rosenthal DM, Mills KE. Obstetrics and Gynecology, North York General Hospital, Toronto, Ontario, Canada The surgical approach to leiomyomas and adenomyomas tends to differ. The former are commonly removed by myomectomy. Adenomyomectomy, however, has been fraught with difficulties and is therefore not a common procedure. There has been concern about difficult surgery resulting in
poor outcomes. Our experience in a small group of patients has been positive resulting in symptomatic improvement and, more recently, in a pregnancy. Our protocol and experience with these successful outcomes will be outlined in this video which makes a case for adenomyomectomy.
418 Airseal Bag Morcellation Winter ML. Saddleback Memorial Medical Center, Laguna Hills, California Given the recent FDA warnings regarding the use of power morcellation, several techniques have been used to minimize the chance of tissue spread during the removal of fibroids. These alternatives include laparotomy, mini-laparotomy with hand morcellation within a containment bag, and laparoscopic power morcellation within a containment bag. Our video will demonstrate the use of laparoscopic power morcellation within a containment bag using the Surgiquest Airseal insufflation system. This system assists in creating a steady pressure inflating the containment bag and keeping excellent visualization throughout the morcellation process. The video will also demonstrate our technique for placing.
419 Laparoscopy in Hemodynamicaly Unstable Patients: Some Tips & Tricks Kar S. Kar Clinic & Hospital Pvt. Ltd., Bhubaneswar, Odisha, India Ectopic pregnancy can present as sudden acute hemodynamic shock which needs urgent diagnosis and management. Laparoscopy is the gold standard. However when the patient is in hemodynamic shock, often the surgical team may decide on laparotomy for the ease and rapidity of surgery .we are presenting some tips and tricks for performing effortless laparoscopy in hemodynamically unstable patients. Retrospective analysis of five years data, with eighty two patients of hemoperitoneum of gynaecologic origin was evaluated. Seventeen patients qualified as hemodynamic shock, hemoglobin \5gms%, shock index > 1.4, and an estimated hemoperitoneum of more than 1 – 1.5 litres. Only one pateint with spontaneous second trimester rupture uterus needed laparotomy. There was no per-operative complication. Thus with improved anaesthesia, cardiovascular monitoring, availability of blood together with skill and experience of the surgoen, it is possible to manage women with severe shock, laparoscopicaly.
420 A Lateral to Anterior Approach to the Scarred Bladder Flap and Anterior Abdominal Wall Adhesions at the Time of Laparoscopic Hysterectomy Hudgens JL, Luna Russo M. Obstetrics and Gynecology Division of Minimally Invasive Gynecology, University of Mississippi, Jackson, Mississippi The purpose of this video is to present a lateral to anterior approach to the scarred bladder flap and anterior abdominal wall adhesions. The increase in cesarean section rate has made this surgical scenario more prevalent. We will present videos from two separate case. Both patient has 2 previous cesarean sections, suspected adenomyosis, and had failed medical management. We will demonstrate an anatomic based technique where the paravesicle spaces are developed bilaterally. The bladder is then backfilled and the adhesions over the supravaginal septum are transected. The vesicouterine ligaments are then transected at their origin at the pericervical ring. This allows the vesicovaginal space to be developed.