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Assessing the Feasibility of Prolapse Repair with TLH without the Use of Mesh
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Abstracts / Journal of Minimally Invasive Gynecology 19 (2012) S179–S188
that performing TVH with the aid of a bipolar energy may decrease the learning curve for this. The purpose of this video is to highlight the use of a bipolar tissue sealing device to perform a TVH. 651 Assessing the Feasibility of Prolapse Repair with TLH without the Use of Mesh Jain N. Vardhman Endoscopy and Infertility Center, Muzaffar Nagar, Uttar Pradesh To assess the efficacy, success and safety of Total Laparoscopic Hysterectomy for significant utero vaginal prolapse without the use of mesh. Patients of utero vaginal prolapse who needed hysterectomy and prolapse repair. Tertiary referral centre for advance endoscopic surgery doing dedicated work in urogynaecology. 7 patients with significant cystocoele, rectocoele and utero vaginal descent outside the introitus. Prolapse repair without the use of mesh. Uterosacral plication and pubocervical fascia plication is done before the colpotomy. After colpotomy the vaginal vault angles are sutured and reinforced by anterior and posterior non-absorbable suture plication. All patients withstood the procedure well and good cures were found immediate post-op and after one year follow-up. Conclusion: Site specific repair of prolapse appears to be a safe and effective way of treating various degrees of prolapse. 652 Robotic Assisted Rectocele Repair as an Alternative to Traditional Method for Selective Cases Kashani S, Goodman L, Edusa V, Azodi M. Department of Obstetrics and Gynecology, Yale New Haven Health/Bridgeport Hospital Minimally Invasive Gynecologic Surgery Fellowship Program, Bridgeport, Connecticut A variety of surgical techniques have been described to repair a rectocele including posterior colporrhaphy, defect directed repair, transanal and transabdominal approaches. We introduce robotic assisted rectocele repair as an alternative to traditional methods, in selective cases. At the beginning of each case ureter on both sides were identified. The dissection of rectovginal septum begins superiorly at the cul-du-sac and continued downward and laterally between two uterosacral ligaments. At this point two EEA sizer were placed, one vaginally and one in the rectum. They were separated, helping to create a space between rectum and vagina and to facilitate the dissection. The weakened fascia then reapproximated with delayed absorbable suture. We do not recommend robotic approach solely for the repair of rectocele but we have done several robotic assisted rectocele repairs in conjunction with hysterectomy, sacralcolpopexy and sacralcervicopexy. We have had excellent surgical result with minimal complication.
653 Right Extraperitoneal Approach for Sacrocolpopexy Surgery: A Cadaver Feasibility Study for Development a New Minimally Invasive Approach Kilic GS,1 Tapisiz OL,1 Alanbay I,2 Borahay M,1 Onol FF,3 Miller BT,4 Onol YS.5 1Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas; 2Department of Obstetrics and Gynecology, GATA (Gulhane Military Medicine Faculty), Ankara, Turkey; 3 Department of Urology, Umraniye Teaching and Research Hospital, Istanbul, Turkey; 4Department of Neuroscience and Cell Biology, Division of Anatomy, The University of Texas Medical Branch, Galveston, Texas; 5 Department of Urology, Bezmi Alem Vakif University Hospital, Istanbul, Turkey
The aim of the study was to determine the feasibility of a new retroperitoneal approach to sacrocolpopexy using minimal invasive surgery technique at cadaver model. This experimental study performed on a female cadaver at a University Hospital setting. We placed 5 mm laparoscopic trocars in right lumbar area to reach retroperitoneal space. Extraperitoneal and retroperitoneal pelvic view obtained. Anatomical landmarks of retroperitoneal area at the level of sacral promontory to vaginal posterior wall marked. Sacral promontory and posterior vaginal space dissected via laparoscopic dissectors. Creating retroperitoneal area, right ureteral dissection, posterior vaginal dissection, placement of mesh between sacral promontory and retrovaginal space, and laparoscopic suturing of mesh were feasible. In conclusion, the right retroperitoneal side approach for sacrocolpopexy with minimally invasive approach is feasible in cadaver study.
654 The Effects of Fatigue on Residents’ Performance in Laparoscopy Tsafrir Z, Korianski J, Almog B, Many A, Lessing JB, Levin I. The Department of Gynecology, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel Objective: To assess the influence of fatigue on residents’ performance in laparoscopy through a computer-based virtual reality simulation model. Method: 26 residents (14 novices, 12 experienced) were recruited. Each participant was initially tested on 8 virtual reality simulation based tasks: camera manipulation at 0 & 30 angles, eye-hand coordination, grasping and clipping, cutting, electrocautery, peg transfer and pattern cutting. In the second step, each resident had 10 hours of hands on practice of the specific tasks chosen. Finally, participants were evaluated before and after 24 hours call. For each task a set of parameters which reflects proficiency/ efficacy and safety was recorded and documented. Results: In most of the tasks assessed, Sleep deprivation (SD) had a significant deleterious effect on the performance of residents, both in terms of efficiency (i.e. time to complete the task), and safety (errors). These observations were more pronounced among novices (non experienced residents). For example, in camera manipulation at 30 angle, the total time to complete the task was slower after sleep deprivation, and it was more significant among novices (novices: SD = 136 sec, control = 119 sec; experienced: SD = 112 sec, control = 103 sec; p = 0.03). In ‘grasping and clipping’ task, lower accuracy rate after SD was noted (novices: SD = 82.8%, control = 87.9%; experienced: SD = 87.6%, control = 90.8%; p = 0.05). Conclusion: In this study we observed reduced efficiency and safety in the performance of residents after sleep deprivation. The fact that experienced residents performed relatively better after night shift, comparing to novices, may be attributed to their higher basic skills in laparoscopy or to better adaptation to sleep deprivation. 655 Ultrasound Evaluation of Pelvic Deep Infiltrating Endometriosis (DIE): Accuracy in Differentiating Rectal from Sigmoid Lesions Lazzer L,2 Exacoustos C,1 Zupi E,2 Di Giovanni A,1 Pinzauti S,2 Tosti C, Malzoni M,3 Arduini D,1 Petraglia D.2 1Department of Obstetrics and Gynecology, Universita degli Studi di Roma ‘‘Tor Vergata’’, Rome, Italy; 2 Department of Obstetrics and Gynecology, Universita degli Studi di Siena, Siena, Italy; 3Advanced Gynecological Endoscopy Center, Malzoni Medical Center, Avellino, Italy Objectives: Rectal and sigmoid endometriosis lesions have surgically different approaches but also different postsurgical events and complications. The management and counseling of the affected patients is very different according also to the prevalent symptoms: pain and infertility. The aim of this study was to evaluate the accuracy in the differentiation of rectal from sigmoid DIE lesions by different sonographic approaches, compared to laparoscopical and histological findings.
Abstracts / Journal of Minimally Invasive Gynecology 19 (2012) S179–S188
that performing TVH with the aid of a bipolar energy may decrease the learning curve for this. The purpose of this video is to highlight the use of a bipolar tissue sealing device to perform a TVH. 651 Assessing the Feasibility of Prolapse Repair with TLH without the Use of Mesh Jain N. Vardhman Endoscopy and Infertility Center, Muzaffar Nagar, Uttar Pradesh To assess the efficacy, success and safety of Total Laparoscopic Hysterectomy for significant utero vaginal prolapse without the use of mesh. Patients of utero vaginal prolapse who needed hysterectomy and prolapse repair. Tertiary referral centre for advance endoscopic surgery doing dedicated work in urogynaecology. 7 patients with significant cystocoele, rectocoele and utero vaginal descent outside the introitus. Prolapse repair without the use of mesh. Uterosacral plication and pubocervical fascia plication is done before the colpotomy. After colpotomy the vaginal vault angles are sutured and reinforced by anterior and posterior non-absorbable suture plication. All patients withstood the procedure well and good cures were found immediate post-op and after one year follow-up. Conclusion: Site specific repair of prolapse appears to be a safe and effective way of treating various degrees of prolapse. 652 Robotic Assisted Rectocele Repair as an Alternative to Traditional Method for Selective Cases Kashani S, Goodman L, Edusa V, Azodi M. Department of Obstetrics and Gynecology, Yale New Haven Health/Bridgeport Hospital Minimally Invasive Gynecologic Surgery Fellowship Program, Bridgeport, Connecticut A variety of surgical techniques have been described to repair a rectocele including posterior colporrhaphy, defect directed repair, transanal and transabdominal approaches. We introduce robotic assisted rectocele repair as an alternative to traditional methods, in selective cases. At the beginning of each case ureter on both sides were identified. The dissection of rectovginal septum begins superiorly at the cul-du-sac and continued downward and laterally between two uterosacral ligaments. At this point two EEA sizer were placed, one vaginally and one in the rectum. They were separated, helping to create a space between rectum and vagina and to facilitate the dissection. The weakened fascia then reapproximated with delayed absorbable suture. We do not recommend robotic approach solely for the repair of rectocele but we have done several robotic assisted rectocele repairs in conjunction with hysterectomy, sacralcolpopexy and sacralcervicopexy. We have had excellent surgical result with minimal complication.
653 Right Extraperitoneal Approach for Sacrocolpopexy Surgery: A Cadaver Feasibility Study for Development a New Minimally Invasive Approach Kilic GS,1 Tapisiz OL,1 Alanbay I,2 Borahay M,1 Onol FF,3 Miller BT,4 Onol YS.5 1Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas; 2Department of Obstetrics and Gynecology, GATA (Gulhane Military Medicine Faculty), Ankara, Turkey; 3 Department of Urology, Umraniye Teaching and Research Hospital, Istanbul, Turkey; 4Department of Neuroscience and Cell Biology, Division of Anatomy, The University of Texas Medical Branch, Galveston, Texas; 5 Department of Urology, Bezmi Alem Vakif University Hospital, Istanbul, Turkey
The aim of the study was to determine the feasibility of a new retroperitoneal approach to sacrocolpopexy using minimal invasive surgery technique at cadaver model. This experimental study performed on a female cadaver at a University Hospital setting. We placed 5 mm laparoscopic trocars in right lumbar area to reach retroperitoneal space. Extraperitoneal and retroperitoneal pelvic view obtained. Anatomical landmarks of retroperitoneal area at the level of sacral promontory to vaginal posterior wall marked. Sacral promontory and posterior vaginal space dissected via laparoscopic dissectors. Creating retroperitoneal area, right ureteral dissection, posterior vaginal dissection, placement of mesh between sacral promontory and retrovaginal space, and laparoscopic suturing of mesh were feasible. In conclusion, the right retroperitoneal side approach for sacrocolpopexy with minimally invasive approach is feasible in cadaver study.
654 The Effects of Fatigue on Residents’ Performance in Laparoscopy Tsafrir Z, Korianski J, Almog B, Many A, Lessing JB, Levin I. The Department of Gynecology, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel Objective: To assess the influence of fatigue on residents’ performance in laparoscopy through a computer-based virtual reality simulation model. Method: 26 residents (14 novices, 12 experienced) were recruited. Each participant was initially tested on 8 virtual reality simulation based tasks: camera manipulation at 0 & 30 angles, eye-hand coordination, grasping and clipping, cutting, electrocautery, peg transfer and pattern cutting. In the second step, each resident had 10 hours of hands on practice of the specific tasks chosen. Finally, participants were evaluated before and after 24 hours call. For each task a set of parameters which reflects proficiency/ efficacy and safety was recorded and documented. Results: In most of the tasks assessed, Sleep deprivation (SD) had a significant deleterious effect on the performance of residents, both in terms of efficiency (i.e. time to complete the task), and safety (errors). These observations were more pronounced among novices (non experienced residents). For example, in camera manipulation at 30 angle, the total time to complete the task was slower after sleep deprivation, and it was more significant among novices (novices: SD = 136 sec, control = 119 sec; experienced: SD = 112 sec, control = 103 sec; p = 0.03). In ‘grasping and clipping’ task, lower accuracy rate after SD was noted (novices: SD = 82.8%, control = 87.9%; experienced: SD = 87.6%, control = 90.8%; p = 0.05). Conclusion: In this study we observed reduced efficiency and safety in the performance of residents after sleep deprivation. The fact that experienced residents performed relatively better after night shift, comparing to novices, may be attributed to their higher basic skills in laparoscopy or to better adaptation to sleep deprivation. 655 Ultrasound Evaluation of Pelvic Deep Infiltrating Endometriosis (DIE): Accuracy in Differentiating Rectal from Sigmoid Lesions Lazzer L,2 Exacoustos C,1 Zupi E,2 Di Giovanni A,1 Pinzauti S,2 Tosti C, Malzoni M,3 Arduini D,1 Petraglia D.2 1Department of Obstetrics and Gynecology, Universita degli Studi di Roma ‘‘Tor Vergata’’, Rome, Italy; 2 Department of Obstetrics and Gynecology, Universita degli Studi di Siena, Siena, Italy; 3Advanced Gynecological Endoscopy Center, Malzoni Medical Center, Avellino, Italy Objectives: Rectal and sigmoid endometriosis lesions have surgically different approaches but also different postsurgical events and complications. The management and counseling of the affected patients is very different according also to the prevalent symptoms: pain and infertility. The aim of this study was to evaluate the accuracy in the differentiation of rectal from sigmoid DIE lesions by different sonographic approaches, compared to laparoscopical and histological findings.