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Appendectomy in Gynecologic Surgery
S20 70
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S1–S44 Video Session 4 - Education (12:12 PM - 12:18 PM)
Optimizing Multiport In Bag Morcellation Wang KC, Manoucheri E, Cohen SL, Einarsson JI. Brigham and Women’s Hospital, Boston, Massachusetts We present a video of Multiport In Bag Morcellation utilizing the 3M Steri Drape isolation bag which allows for improved visualization when compared to the single port approach. Steps of the procedure along with tips to facilitate successful completion are reviewed. Contained morcellation would provide a means to avoid dissemination of unexpected malignancy in cases of presumed fibroids while maintaining the clinical benefits of a minimally invasive approach.
71
Video Session 4 - Education (12:19 PM - 12:25 PM)
Interstitial Ectopic Pregnancy: An Overview and Example of Laparoscopic Management Truong M, Halfon J. Obstetrics and Gynecology, Columbia University Medical Center, New York, New York Interstitial ectopic pregnancies are rare, accounting for only 2-3% of all tubal ectopic pregnancies. They can be managed medically with methotrexate or surgically via laparotomy or laparoscopy. The objectives of this video is to 1) provide an overview of interstitial ectopic pregnancy, 2) review surgical approaches and key surgical techniques and, 3) demonstrate an example of a laparoscopic cornual resection in the management of a 40yo G3P1011 at 7+2wga with a 5cm left interstitial ectopic pregnancy.
72
Video Session 4 - Education (12:26 PM - 12:32 PM)
Appendectomy in Gynecologic Surgery Wesa M. OBGYN, The Ottawa Hospital, Ottawa, Ontario, Canada We propose that appendices inspection be a part of routine gynecologic survey in gynecologic surgery. In addition, appendectomy should be included as part of gynecologic surgical training. This video will demonstrate the technique of laparoscopic appendectomy as well as emphasize the importance of this skill in general gynecologic surgery.
73
Video Session 4 - Education (12:33 PM - 12:39 PM)
Teaching the Basics of the TVH Kammire LD, Miyazaki D. OB-Gyn, Wake Forest School of Medicine, Winston-Salem, North Carolina It is more important now than ever that residents have the TVH in their surgical repertoire as their primary route of hysterectomy for benign disease. Not only is it the least invasive and safest, but also considerably less expensive than other forms of hysterectomy. However resident training for TVH is lacking in many program. We present in this video the techniques that we have found helpful for teaching the vaginal hysterectomy to residents: We have a rising chief resident performing a TVH with morcellation on a 46 yo multiparous patient with menorrhagia and a 10 wk size fibroid uterus. Points covered include $ Pt positioning ergonomics for patient, surgeon, and assistants $ Bladdder flap development $ Cul de sac entry $ Clamp placement and $ Suturing pedicles $ Adnexae $ Presentation of the Miyamodel, a pelvic trainer that we have found helpful to simulate an entire TVH.
74
Video Session 4 - Education (12:40 PM - 12:46 PM)
Solving Laparoscopic Knot-Tying Technique: Fundamental Principles of Curves, Angles and Planes Mackenzie MW,1 Simoni MK.2 1Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, Massachusetts; 2Harvard Medical School, Boston, Massachusetts Laparoscopic intracorporeal knot tying is a difficult skill to acquire. Different tying techniques identify prescriptive movements or the use of adjunctive tools to achieve the purpose. For the learner however, such techniques do not apply to all circumstances. By analyzing the requisite mechanisms of successful instrument tying we have identified core geometric concepts that are the sine qua non for performing this complex task and that underlie all tying techniques. The purpose of this video is to demonstrate these geometric relationships critical for laparoscopic intracorporeal knot tying and suturing. Understanding the fundamental geometric relationships between the knottying instruments and the suture informs a highly reproducible method for reliable knot tying in even the most challenging circumstances. 75
Video Session 4 - Education (12:47 PM - 12:53 PM)
Proper Patient Positioning for Gynecologic Laparoscopic Surgery Pratts ME, Weinrobe MH, Scheib SA. Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland This teaching video is intended for house staff and medical students and demonstrates proper patient positioning for gynecologic laparoscopic surgery. The goal of this video is to instruct trainees on the proper positioning elements intended to minimize the risk of nerve and soft tissue injury. They will learn how and why proper positioning not only prevents injury but also allows the surgeon to operate with full effectiveness. Nerve anatomy as well as common positioning mistakes will be demonstrated in order to show how these mistakes lead to injury. This video is intended to serve as an introduction to patient positioning that is best reviewed just prior to the start of a gynecology rotation for a medical student or junior resident. Supplemental references are supplied so the trainee can continue to learn about the important skill of proper patient positioning. 76
Video Session 4 - Education (12:54 PM - 1:00 PM)
Appendectomy in Gynecology Tepperman ED, Sobel ML, Murji A, Leyland NA. Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada Appendectomy is one of the most common operations performed by general surgeons. From a gynecologic perspective, there are important additional considerations for removal of the appendix and this straightforward operation may be performed in a safe, timely and cost effective manner in the hands of a properly trained gynecologic surgeon. This video will review the gynecologic indications for appendectomy, the relevant anatomy, the surgical procedure and complications of appendectomy that the gynecologist should be aware of. 77
Video Session 4 - Education (1:01 PM - 1:06 PM)
Robotic Uterosacral Vaginal Vault Suspension Farnam RW. Minimally Invasive Surgery, Las Palmas Medical Center, El Paso, Texas This surgical video is intended to demonstrate a new rendition of the uterosacral ligament apical prolapse repair technique. The high uterosacral vault suspension has classically been described as a vaginal procedure. However abdominal and laparoscopic procedures have been described. The risk of ureteric injury during a uterosacral suspension is 211%. The main advantage of the laparoscopic approach is the ability to
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S1–S44 Video Session 4 - Education (12:12 PM - 12:18 PM)
Optimizing Multiport In Bag Morcellation Wang KC, Manoucheri E, Cohen SL, Einarsson JI. Brigham and Women’s Hospital, Boston, Massachusetts We present a video of Multiport In Bag Morcellation utilizing the 3M Steri Drape isolation bag which allows for improved visualization when compared to the single port approach. Steps of the procedure along with tips to facilitate successful completion are reviewed. Contained morcellation would provide a means to avoid dissemination of unexpected malignancy in cases of presumed fibroids while maintaining the clinical benefits of a minimally invasive approach.
71
Video Session 4 - Education (12:19 PM - 12:25 PM)
Interstitial Ectopic Pregnancy: An Overview and Example of Laparoscopic Management Truong M, Halfon J. Obstetrics and Gynecology, Columbia University Medical Center, New York, New York Interstitial ectopic pregnancies are rare, accounting for only 2-3% of all tubal ectopic pregnancies. They can be managed medically with methotrexate or surgically via laparotomy or laparoscopy. The objectives of this video is to 1) provide an overview of interstitial ectopic pregnancy, 2) review surgical approaches and key surgical techniques and, 3) demonstrate an example of a laparoscopic cornual resection in the management of a 40yo G3P1011 at 7+2wga with a 5cm left interstitial ectopic pregnancy.
72
Video Session 4 - Education (12:26 PM - 12:32 PM)
Appendectomy in Gynecologic Surgery Wesa M. OBGYN, The Ottawa Hospital, Ottawa, Ontario, Canada We propose that appendices inspection be a part of routine gynecologic survey in gynecologic surgery. In addition, appendectomy should be included as part of gynecologic surgical training. This video will demonstrate the technique of laparoscopic appendectomy as well as emphasize the importance of this skill in general gynecologic surgery.
73
Video Session 4 - Education (12:33 PM - 12:39 PM)
Teaching the Basics of the TVH Kammire LD, Miyazaki D. OB-Gyn, Wake Forest School of Medicine, Winston-Salem, North Carolina It is more important now than ever that residents have the TVH in their surgical repertoire as their primary route of hysterectomy for benign disease. Not only is it the least invasive and safest, but also considerably less expensive than other forms of hysterectomy. However resident training for TVH is lacking in many program. We present in this video the techniques that we have found helpful for teaching the vaginal hysterectomy to residents: We have a rising chief resident performing a TVH with morcellation on a 46 yo multiparous patient with menorrhagia and a 10 wk size fibroid uterus. Points covered include $ Pt positioning ergonomics for patient, surgeon, and assistants $ Bladdder flap development $ Cul de sac entry $ Clamp placement and $ Suturing pedicles $ Adnexae $ Presentation of the Miyamodel, a pelvic trainer that we have found helpful to simulate an entire TVH.
74
Video Session 4 - Education (12:40 PM - 12:46 PM)
Solving Laparoscopic Knot-Tying Technique: Fundamental Principles of Curves, Angles and Planes Mackenzie MW,1 Simoni MK.2 1Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, Massachusetts; 2Harvard Medical School, Boston, Massachusetts Laparoscopic intracorporeal knot tying is a difficult skill to acquire. Different tying techniques identify prescriptive movements or the use of adjunctive tools to achieve the purpose. For the learner however, such techniques do not apply to all circumstances. By analyzing the requisite mechanisms of successful instrument tying we have identified core geometric concepts that are the sine qua non for performing this complex task and that underlie all tying techniques. The purpose of this video is to demonstrate these geometric relationships critical for laparoscopic intracorporeal knot tying and suturing. Understanding the fundamental geometric relationships between the knottying instruments and the suture informs a highly reproducible method for reliable knot tying in even the most challenging circumstances. 75
Video Session 4 - Education (12:47 PM - 12:53 PM)
Proper Patient Positioning for Gynecologic Laparoscopic Surgery Pratts ME, Weinrobe MH, Scheib SA. Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland This teaching video is intended for house staff and medical students and demonstrates proper patient positioning for gynecologic laparoscopic surgery. The goal of this video is to instruct trainees on the proper positioning elements intended to minimize the risk of nerve and soft tissue injury. They will learn how and why proper positioning not only prevents injury but also allows the surgeon to operate with full effectiveness. Nerve anatomy as well as common positioning mistakes will be demonstrated in order to show how these mistakes lead to injury. This video is intended to serve as an introduction to patient positioning that is best reviewed just prior to the start of a gynecology rotation for a medical student or junior resident. Supplemental references are supplied so the trainee can continue to learn about the important skill of proper patient positioning. 76
Video Session 4 - Education (12:54 PM - 1:00 PM)
Appendectomy in Gynecology Tepperman ED, Sobel ML, Murji A, Leyland NA. Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada Appendectomy is one of the most common operations performed by general surgeons. From a gynecologic perspective, there are important additional considerations for removal of the appendix and this straightforward operation may be performed in a safe, timely and cost effective manner in the hands of a properly trained gynecologic surgeon. This video will review the gynecologic indications for appendectomy, the relevant anatomy, the surgical procedure and complications of appendectomy that the gynecologist should be aware of. 77
Video Session 4 - Education (1:01 PM - 1:06 PM)
Robotic Uterosacral Vaginal Vault Suspension Farnam RW. Minimally Invasive Surgery, Las Palmas Medical Center, El Paso, Texas This surgical video is intended to demonstrate a new rendition of the uterosacral ligament apical prolapse repair technique. The high uterosacral vault suspension has classically been described as a vaginal procedure. However abdominal and laparoscopic procedures have been described. The risk of ureteric injury during a uterosacral suspension is 211%. The main advantage of the laparoscopic approach is the ability to