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Application of a Polyethylene Oxide-Sodium Carboxymethylcellulose Gel To Prevent Intrauterine and Cervical Adhesions after Hysteroscopic Surgery
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Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S169–S178
To demonstrate the safety and feasibility of laparoscopic surgery in complete resection of bowel endometriosis. METHOD: This is a 39 year old G2P0 who presented with dysmenorrhea associated with rectal pain. Upon entry with the laparoscope we observed a large mass measuring 45 cm extending from the rectovaginal septum to the rectal wall which we resected meticulously using both the PlasmaJet and the CO2 laser. RESULTS: We were able to perform complete excision of bowel endometriosis without the need for bowel resection and without compromising the integrity of the bowel. There were no complication. Six weeks follow up visit, the patient was improving clinically and had no complaints. CONCLUSIONS: Complete resection of bowel endometriosis without need for disk excision or segmental resection can be accomplished laparoscopicaly in experienced hands using PlasmaJet and the CO2 laser. We avoid using electrocautery in cases of bowel endometriosis as there is a higher incidence of bowel perforation and delayed necrosis.
formation of intrauterine and cervical adhesions after common resectoscopic procedures.
563 Laparoscopic Myomectomy for a 4cm Type 1 Leiomyoma Milad M, Boukaidi S. Northwestern University Feinberg School of Medicine, Chicago, Illinois The case is a 40 year old woman who presented with severe menorrhagia requiring blood transfusion who had previously failed hysteroscopic resection of a 4 cm type 1 fibroid by an experienced surgeon x 2. The patient presented for laparoscopic resection, the fibroid was removed without incident through a hysterotomy incision and the defect closed in 4 layers with a baseball stitch used to approximate the serosa. Total operating time was 55 minutes, and blood loss less than 50 mL.
561 Original Technique of Combined Laparoscopic and Transanal Excision of Deep Endometriosis Nodules Infiltrating the Low and Middle Rectum Roman H,1 Bridoux V,2 Vassilieff M,1 Marpeau L,1 Tuech J-J.2 1 Gynecology and Obstetrics, Rouen University Hospital, Rouen, Normandy, France; 2Surgery, Rouen University Hospital, Rouen, Normandy, France We report an original surgical procedure usually performed by our team in the conservative management of middle and low rectal endometriosis (up to 10 cm above the anus). It starts by performing a rectal shaving, which separates the main part of the nodule from the rectum. Deep endometriosis nodule is then removed along with the adjacent infiltrated vaginal fornix and uterosacral ligaments, and vagina is sutured. The limits of the rectal wall involved by endometriosis are identified by transanal route and two stitches are placed on each side, allowing its intrarectal invagination. The ContourÒ 30 transtar stapler (Ethicon Endo-Surgery, Cincinnati) safely allows both excision and suture of the rectal wall surrounding the nodule site. The specimen may be as high as 50x60 mm. Bowel functional outcomes are excellent. This technique may interest those surgeons who do not intend systematically performing colorectal resection in deep infiltrating middle and low rectal endometriosis.
VIDEO FESTIVAL SESSION: LAPAROSCOPIC SURGERIES (EXCEPT HYSTERECTOMY) 564 New Horizons of Single Port Surgery – From Myomectomy to Malignancy Andou M, Kanao H, Nagase T, Fujiwara K. Gynecology, Kurashiki Medical Center, Kurashiki-shi, Okayama-ken, Japan The desire for minimal scar surgery promoted the advent of new approaches such as single port laparoscopy. We introduced our single incision multi-trocar approach and have been expanding applications. We will present 3 minimally invasive surgeries that use the same approach; myomectomy, hysterectomy and malignancy surgery including retroperitoneal lymphadenectomy. For this method we don’t use special platforms and only standard laparoscopic instruments are required. We create a 2.5 cm incision at the umbilical base and through this we expose the rectus fascia and make and place 3 different length 5 mm trocars in the fascia. After becoming accustomed to this approach with myomectomy and hysterectomy, we started using the same approach for pelvic lymphadenectomy then expanded to the para-aortic area with the aid of a vaginal telescope. This surgery offers the least invasive and most cosmetically appealing result desired by patients. Single incision laparoscopic surgery has the possibility of greater future potential.
VIDEO FESTIVAL SESSION: HYSTEROSCOPY, ENDOMETRIAL ABLATION 562
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Application of a Polyethylene Oxide-Sodium Carboxymethylcellulose Gel To Prevent Intrauterine and Cervical Adhesions after Hysteroscopic Surgery Di Spiezio Sardo A, Spinelli M, Scognamiglio M, Fernandez LM Sosa, Zizolfi B, Coppola C, Nappi C. University ‘‘Federic II’’ of Naples, Naples, Italy
Lighted Ureteral Catheters in Complex Laproscopic Surgery Bhavsar V, Nimaroff M. Department of Obstetrics and Gynecology, North Shore University Hospital, Manhasset, New York
The purpose of our video is to show the technique and efficacy of application of an absorbable adhesion barrier gel (Intercoat, Ethicon) in order to prevent intrauterine and cervical adhesions after hysteroscopic surgery. The technique consists in intra-uterine application of 10 ml of such gel under hysteroscopic vision, through the inflow channel of 27 Fr resectoscope, while the operator gradually moves the resectoscope from the fundus of the uterus back to the external uterine ostium in order to apply the gel throughout the cavity and the cervical canal. The procedure is considered complete when, under hysteroscopic visualization, the gel seems to have replaced all the liquid medium and the cavity appeared completely filled by the gel from tubal osthia to the external uterine orifice. The results of our recent study have shown that Intercoat gel is able to prevent
The routine use of prophylactic ureteral catheters has been shown to be of questionable benefit in gynecological surgery. However ureteral injury during hysterectomy continues to occur with rates of 0.5 to 1.5%. The routine use of ureteral stents is not recommended, however, is certainly a benefit in cases with dense pelvic adhesions, endometriosis, and extensive cervical pathology. The loss of tactile sensation during laparoscopy can be overcome with enhanced visualization with the use of lighted ureteral catheters (LUC). Case1: 42yo G2P2 with history of right ovarian cystectomy, laparoscopic cholectomy and laparoscopic bilateral tubal ligation presents with menometrorraghia and severe dysmenorrhea. Ultrasound demonstrated 13x7x6 cm fibroid uterus with 8.7 cm cervical fibroid. Patient underwent laparoscopic assisted vaginal hysterectomy with LUC. Case 2: 48yo G3P3 with a 10 cm broad ligament fibroid who underwent laparoscopic supracervical hysterectomy with LUC.
Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S169–S178
To demonstrate the safety and feasibility of laparoscopic surgery in complete resection of bowel endometriosis. METHOD: This is a 39 year old G2P0 who presented with dysmenorrhea associated with rectal pain. Upon entry with the laparoscope we observed a large mass measuring 45 cm extending from the rectovaginal septum to the rectal wall which we resected meticulously using both the PlasmaJet and the CO2 laser. RESULTS: We were able to perform complete excision of bowel endometriosis without the need for bowel resection and without compromising the integrity of the bowel. There were no complication. Six weeks follow up visit, the patient was improving clinically and had no complaints. CONCLUSIONS: Complete resection of bowel endometriosis without need for disk excision or segmental resection can be accomplished laparoscopicaly in experienced hands using PlasmaJet and the CO2 laser. We avoid using electrocautery in cases of bowel endometriosis as there is a higher incidence of bowel perforation and delayed necrosis.
formation of intrauterine and cervical adhesions after common resectoscopic procedures.
563 Laparoscopic Myomectomy for a 4cm Type 1 Leiomyoma Milad M, Boukaidi S. Northwestern University Feinberg School of Medicine, Chicago, Illinois The case is a 40 year old woman who presented with severe menorrhagia requiring blood transfusion who had previously failed hysteroscopic resection of a 4 cm type 1 fibroid by an experienced surgeon x 2. The patient presented for laparoscopic resection, the fibroid was removed without incident through a hysterotomy incision and the defect closed in 4 layers with a baseball stitch used to approximate the serosa. Total operating time was 55 minutes, and blood loss less than 50 mL.
561 Original Technique of Combined Laparoscopic and Transanal Excision of Deep Endometriosis Nodules Infiltrating the Low and Middle Rectum Roman H,1 Bridoux V,2 Vassilieff M,1 Marpeau L,1 Tuech J-J.2 1 Gynecology and Obstetrics, Rouen University Hospital, Rouen, Normandy, France; 2Surgery, Rouen University Hospital, Rouen, Normandy, France We report an original surgical procedure usually performed by our team in the conservative management of middle and low rectal endometriosis (up to 10 cm above the anus). It starts by performing a rectal shaving, which separates the main part of the nodule from the rectum. Deep endometriosis nodule is then removed along with the adjacent infiltrated vaginal fornix and uterosacral ligaments, and vagina is sutured. The limits of the rectal wall involved by endometriosis are identified by transanal route and two stitches are placed on each side, allowing its intrarectal invagination. The ContourÒ 30 transtar stapler (Ethicon Endo-Surgery, Cincinnati) safely allows both excision and suture of the rectal wall surrounding the nodule site. The specimen may be as high as 50x60 mm. Bowel functional outcomes are excellent. This technique may interest those surgeons who do not intend systematically performing colorectal resection in deep infiltrating middle and low rectal endometriosis.
VIDEO FESTIVAL SESSION: LAPAROSCOPIC SURGERIES (EXCEPT HYSTERECTOMY) 564 New Horizons of Single Port Surgery – From Myomectomy to Malignancy Andou M, Kanao H, Nagase T, Fujiwara K. Gynecology, Kurashiki Medical Center, Kurashiki-shi, Okayama-ken, Japan The desire for minimal scar surgery promoted the advent of new approaches such as single port laparoscopy. We introduced our single incision multi-trocar approach and have been expanding applications. We will present 3 minimally invasive surgeries that use the same approach; myomectomy, hysterectomy and malignancy surgery including retroperitoneal lymphadenectomy. For this method we don’t use special platforms and only standard laparoscopic instruments are required. We create a 2.5 cm incision at the umbilical base and through this we expose the rectus fascia and make and place 3 different length 5 mm trocars in the fascia. After becoming accustomed to this approach with myomectomy and hysterectomy, we started using the same approach for pelvic lymphadenectomy then expanded to the para-aortic area with the aid of a vaginal telescope. This surgery offers the least invasive and most cosmetically appealing result desired by patients. Single incision laparoscopic surgery has the possibility of greater future potential.
VIDEO FESTIVAL SESSION: HYSTEROSCOPY, ENDOMETRIAL ABLATION 562
565
Application of a Polyethylene Oxide-Sodium Carboxymethylcellulose Gel To Prevent Intrauterine and Cervical Adhesions after Hysteroscopic Surgery Di Spiezio Sardo A, Spinelli M, Scognamiglio M, Fernandez LM Sosa, Zizolfi B, Coppola C, Nappi C. University ‘‘Federic II’’ of Naples, Naples, Italy
Lighted Ureteral Catheters in Complex Laproscopic Surgery Bhavsar V, Nimaroff M. Department of Obstetrics and Gynecology, North Shore University Hospital, Manhasset, New York
The purpose of our video is to show the technique and efficacy of application of an absorbable adhesion barrier gel (Intercoat, Ethicon) in order to prevent intrauterine and cervical adhesions after hysteroscopic surgery. The technique consists in intra-uterine application of 10 ml of such gel under hysteroscopic vision, through the inflow channel of 27 Fr resectoscope, while the operator gradually moves the resectoscope from the fundus of the uterus back to the external uterine ostium in order to apply the gel throughout the cavity and the cervical canal. The procedure is considered complete when, under hysteroscopic visualization, the gel seems to have replaced all the liquid medium and the cavity appeared completely filled by the gel from tubal osthia to the external uterine orifice. The results of our recent study have shown that Intercoat gel is able to prevent
The routine use of prophylactic ureteral catheters has been shown to be of questionable benefit in gynecological surgery. However ureteral injury during hysterectomy continues to occur with rates of 0.5 to 1.5%. The routine use of ureteral stents is not recommended, however, is certainly a benefit in cases with dense pelvic adhesions, endometriosis, and extensive cervical pathology. The loss of tactile sensation during laparoscopy can be overcome with enhanced visualization with the use of lighted ureteral catheters (LUC). Case1: 42yo G2P2 with history of right ovarian cystectomy, laparoscopic cholectomy and laparoscopic bilateral tubal ligation presents with menometrorraghia and severe dysmenorrhea. Ultrasound demonstrated 13x7x6 cm fibroid uterus with 8.7 cm cervical fibroid. Patient underwent laparoscopic assisted vaginal hysterectomy with LUC. Case 2: 48yo G3P3 with a 10 cm broad ligament fibroid who underwent laparoscopic supracervical hysterectomy with LUC.