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A Novel Approach to Overcoming Cervical Stenosis and False Passages
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S51–S66
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vesicovaginal space. We successfully removed the micro-insert using a combination of fluoroscopy and laparoscopy. Conclusion: For the avid laparoscopist, intra-operative live fluoroscopy should be considered as an adjunct resource to locate any misplaced laparoscopic instruments, lost needles or migrated metallic foreign bodies not readily seen on laparoscopic survey. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS:
visualization, and subsequent dilation of the obliterated endocervical canal with the vessel dilator. Conclusion: The case presented shows how cervical stenosis and a false passage can be overcome, using a guide wire and vessel dilator, when placed under hysterscopic guidance. These tools are readily available in any operating room. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS:
Shan Shan Jiang: Nothing to disclose Quan Bui: Nothing to disclose Emma Lewinter: Nothing to disclose Tyler M. Muffly: Nothing to disclose
Allan A. Adajar: Nothing to disclose Andrew J. Rivera: Nothing to disclose Video Cafe 22
Video Cafe 20 Hysteroscopic Managment of a Double Uterine Pathology Abdelaziz A,1 Fahmi I,1 Zaghmout O,1 Joseph S,2 Abuzeid M.1 1OBGYN, Hurley Medical Center - Michigan State University, Flint, Michigan; 2IVF Michigan, Rochester, Michigan Objective: An operative video presentation showing the managment of a combined uterine pathology (septum and fibroid), which can be managed in the same setting. Description: Video presentation showing the managment of uterine septum with concomitant removal of uterine fibroid hysteroscopically. The video shows the technique used for removal of each pathology, the instruments which was used during surgery, the steps which was taken intraoperatively, and postoperative care, which was done to avoid any complications. Conclusion: Managment of a double uterine pathologyin the uterus (submucous fibroidand uterine septum) can be done safely by an experienced surgeon in the same setting sparing the patient to go for another operation and reducing the cost. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Ahmed Abdelaziz: Nothing to disclose Islam Fahmi: Nothing to disclose Osama Zaghmout: Nothing to disclose Salem Joseph: Nothing to disclose Mostafa Abuzeid: Nothing to disclose
Video Cafe 21 A Novel Approach to Overcoming Cervical Stenosis and False Passages Adajar AA,1 Rivera AJ.2 1Illinois Institute of Gynecology and Advanced Pelvic Surgery, Glenview, Illinois; 2Misha Media Photography, Hoffman Estates, Illinois Objective: Cervical stenosis, and inadvertant creation of a cervical wall defect, is a difficult complication to overcome. This video demonstrates an intraoperative technique to overcome cervical stenosis and creation of a false passage, using hysteroscopic hydrodilation, and vessel dilator over a guide wire. Description: Cervical stenosis, and creation of a cervical stromal tract, during cervical dilation is an infrequent but difficult intraoperative complication to overcome. Preoperative techniques to decrease the risk of this complication have been described, and has proven benefits. Once a false passage has been created, attempts to overcome this complication often results in worsening of the stromal defect, and places the patient at greater risk for perforation at the level of the cervix. This video demonstrates an intraoperative technique to overcome cervical stenosis, and creation of a false passage, using hysteroscopic hydrodilation and a vessel dilator over a guide wire. Hysteroscopic hydrodilation provides adequate distention of both the false passage and endocervical canal, allowing adequate differentiation between the two. This technique also allows proper placement of a guide wire under direct
A Technique for Vascular Control during Robotic Myomectomy Clark L,1 Menderes G,1 Azodi M.1,2 1OB/GYN, Bridgeport Hospital/Yale New Haven Health System, Bridgeport, Connecticut; 2OB/GYN, Yale University, New Haven, Connecticut Objective: The objective of this video is to describe a unique method for vascular control when performing a robotic myomectomy. Description: Myomectomy is a procedure often reserved for the treatment of symptomatic myomas in women who desire fertility preservation. While traditionally performed via laparotomy, laparoscopic and robotic-assisted myomectomy are increasing in popularity. While studies suggest a decrease in blood loss with a robotic approach, one of the limitations to myomectomy is the remains concern for significant blood loss. In this video we demonstrate a technique for optimizing vascular control during myomectomy in a Jehovah’s Witness. She was known to have a large fibroid, heavy bleeding, and anemia. She desired fertility preservation. She was interested in a myomectomy for treatment, and was counseled regarding the risk of hysterectomy in the case of heavy bleeding. In addition to injection with a dilute solution of vasopressin, we utilized vascular clips and Bulldog clamps to temporarily occlude the uterine arteries while performing the procedure. The uterine vessels were exposed at the level of the cervix in order to provide access for the clips. Additional Bulldog clamps were available to transiently place on the utero-ovarian vessels if heavy bleeding was encountered and temporary control was needed. Estimated blood was 150mL, and her post-operative hemoglobin was 9.6 from 10.3 preoperatively. The patient was discharged home the following day. Conclusion: Techniques such as temporarily occluding the uterine vessels can be utilized during robotic-assisted myomectomy to provide improved vascular control during myomectomy. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Lindsay Clark: Nothing to disclose Gulden Menderes: Nothing to disclose Masoud Azodi: Nothing to disclose Video Cafe 23 A Standardized Approach to the Excision of Midurethral Slings Ellington DR, Meyer IS, Parden AM, Richter HE. Division of Urogynecology and Pelvic Reconstructive Surgery, University of Alabama at Birmingham, Birmingham, Alabama Objective: The purpose of this video presentation is to illustrate a standardized surgical technique for the excision of retropubic or transobturator midurethral slings. Description: Many indications exist for the removal of retropubic and transobturator midurethral slings (MUS), including pain, vaginal mesh exposure or extrusion, urinary obstruction, and dyspareunia, to name few. For most of these indications, a standardized vaginal approach for its excision is feasible. Several key factors go into successful excision of a MUS including: clear identification of the MUS, release of the dorsal aspect of the MUS from the urethra, and careful dissection of the MUS along its course out to the inferior pubic rami. In this case, we present a
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vesicovaginal space. We successfully removed the micro-insert using a combination of fluoroscopy and laparoscopy. Conclusion: For the avid laparoscopist, intra-operative live fluoroscopy should be considered as an adjunct resource to locate any misplaced laparoscopic instruments, lost needles or migrated metallic foreign bodies not readily seen on laparoscopic survey. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS:
visualization, and subsequent dilation of the obliterated endocervical canal with the vessel dilator. Conclusion: The case presented shows how cervical stenosis and a false passage can be overcome, using a guide wire and vessel dilator, when placed under hysterscopic guidance. These tools are readily available in any operating room. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS:
Shan Shan Jiang: Nothing to disclose Quan Bui: Nothing to disclose Emma Lewinter: Nothing to disclose Tyler M. Muffly: Nothing to disclose
Allan A. Adajar: Nothing to disclose Andrew J. Rivera: Nothing to disclose Video Cafe 22
Video Cafe 20 Hysteroscopic Managment of a Double Uterine Pathology Abdelaziz A,1 Fahmi I,1 Zaghmout O,1 Joseph S,2 Abuzeid M.1 1OBGYN, Hurley Medical Center - Michigan State University, Flint, Michigan; 2IVF Michigan, Rochester, Michigan Objective: An operative video presentation showing the managment of a combined uterine pathology (septum and fibroid), which can be managed in the same setting. Description: Video presentation showing the managment of uterine septum with concomitant removal of uterine fibroid hysteroscopically. The video shows the technique used for removal of each pathology, the instruments which was used during surgery, the steps which was taken intraoperatively, and postoperative care, which was done to avoid any complications. Conclusion: Managment of a double uterine pathologyin the uterus (submucous fibroidand uterine septum) can be done safely by an experienced surgeon in the same setting sparing the patient to go for another operation and reducing the cost. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Ahmed Abdelaziz: Nothing to disclose Islam Fahmi: Nothing to disclose Osama Zaghmout: Nothing to disclose Salem Joseph: Nothing to disclose Mostafa Abuzeid: Nothing to disclose
Video Cafe 21 A Novel Approach to Overcoming Cervical Stenosis and False Passages Adajar AA,1 Rivera AJ.2 1Illinois Institute of Gynecology and Advanced Pelvic Surgery, Glenview, Illinois; 2Misha Media Photography, Hoffman Estates, Illinois Objective: Cervical stenosis, and inadvertant creation of a cervical wall defect, is a difficult complication to overcome. This video demonstrates an intraoperative technique to overcome cervical stenosis and creation of a false passage, using hysteroscopic hydrodilation, and vessel dilator over a guide wire. Description: Cervical stenosis, and creation of a cervical stromal tract, during cervical dilation is an infrequent but difficult intraoperative complication to overcome. Preoperative techniques to decrease the risk of this complication have been described, and has proven benefits. Once a false passage has been created, attempts to overcome this complication often results in worsening of the stromal defect, and places the patient at greater risk for perforation at the level of the cervix. This video demonstrates an intraoperative technique to overcome cervical stenosis, and creation of a false passage, using hysteroscopic hydrodilation and a vessel dilator over a guide wire. Hysteroscopic hydrodilation provides adequate distention of both the false passage and endocervical canal, allowing adequate differentiation between the two. This technique also allows proper placement of a guide wire under direct
A Technique for Vascular Control during Robotic Myomectomy Clark L,1 Menderes G,1 Azodi M.1,2 1OB/GYN, Bridgeport Hospital/Yale New Haven Health System, Bridgeport, Connecticut; 2OB/GYN, Yale University, New Haven, Connecticut Objective: The objective of this video is to describe a unique method for vascular control when performing a robotic myomectomy. Description: Myomectomy is a procedure often reserved for the treatment of symptomatic myomas in women who desire fertility preservation. While traditionally performed via laparotomy, laparoscopic and robotic-assisted myomectomy are increasing in popularity. While studies suggest a decrease in blood loss with a robotic approach, one of the limitations to myomectomy is the remains concern for significant blood loss. In this video we demonstrate a technique for optimizing vascular control during myomectomy in a Jehovah’s Witness. She was known to have a large fibroid, heavy bleeding, and anemia. She desired fertility preservation. She was interested in a myomectomy for treatment, and was counseled regarding the risk of hysterectomy in the case of heavy bleeding. In addition to injection with a dilute solution of vasopressin, we utilized vascular clips and Bulldog clamps to temporarily occlude the uterine arteries while performing the procedure. The uterine vessels were exposed at the level of the cervix in order to provide access for the clips. Additional Bulldog clamps were available to transiently place on the utero-ovarian vessels if heavy bleeding was encountered and temporary control was needed. Estimated blood was 150mL, and her post-operative hemoglobin was 9.6 from 10.3 preoperatively. The patient was discharged home the following day. Conclusion: Techniques such as temporarily occluding the uterine vessels can be utilized during robotic-assisted myomectomy to provide improved vascular control during myomectomy. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Lindsay Clark: Nothing to disclose Gulden Menderes: Nothing to disclose Masoud Azodi: Nothing to disclose Video Cafe 23 A Standardized Approach to the Excision of Midurethral Slings Ellington DR, Meyer IS, Parden AM, Richter HE. Division of Urogynecology and Pelvic Reconstructive Surgery, University of Alabama at Birmingham, Birmingham, Alabama Objective: The purpose of this video presentation is to illustrate a standardized surgical technique for the excision of retropubic or transobturator midurethral slings. Description: Many indications exist for the removal of retropubic and transobturator midurethral slings (MUS), including pain, vaginal mesh exposure or extrusion, urinary obstruction, and dyspareunia, to name few. For most of these indications, a standardized vaginal approach for its excision is feasible. Several key factors go into successful excision of a MUS including: clear identification of the MUS, release of the dorsal aspect of the MUS from the urethra, and careful dissection of the MUS along its course out to the inferior pubic rami. In this case, we present a