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Avoiding Major Complications in Laparoscopic Intrafascial Hysterectomy: Experience in 1157 Consecutive Cases
Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159 354
Video Session 11dHysterectomy/Endoscopic Techniques (8:05 AM d 8:11 AM)
Laparoscopic Hysterectomy in the Setting of a Large Intracervical Fibroid Einarsson JI. Division of Minimally Invasive Gyn Surgery, Brigham and Women’s Hospital, Boston, Massachusetts We present an unusual case of a laparoscopic hysterectomy in the setting of a 13 cm intracervical fibroid. Fibroids extending retroperitoneally or from the lower uterine segment can create difficulties during standard dissection during a laparoscopic hysterectomy. In this case, the large fibroid was intracervical, thereby mimicking the thinned out lower uterine segment one would encounter during a cesarean section arrest of descent of the fetal head. We were able to remove the uterus by using a systematic approach as can be seen in this video.
355
Video Session 11dHysterectomy/Endoscopic Techniques (8:12 AM d 8:20 AM)
Total Laparoscopic Hysterectomy with No Risk of Ureteral Injury (Laparoscopic Aldridge’s Method) Watanabe T, Okamura C. Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan The purpose of this video is to introduce a method of total laparoscopic hysterectomy without risk of ureteral injury and show the details of the procedure. The operation consists of three stages. Firstly, ureter is identified by dissecting the posterior leaf of the broad ligament after cutting the round ligament. Secondly, adnexa is removed or preserved after making a window on the posterior leaf of the broad ligament. Finally uterus is removed intrafascially after uterine vessels are cut at the level at least 2 cm above the ureter. With this method ureter can be seen throughout the procedure and coagulation or dessication is performed with enough distance being kept from the ureter so that there is no risk of ureteral injury.
S95
TLH was carried out using the Colpo-Probe vaginal fornix delineator for all aspects of the procedure including, dissection of the upper pedicles, bladder dissection, colpotomy, laparoscopic scalpel morcellation, and cuff closure. For these two patients the estimated blood loss was 200 cc, hospital stay less than 24 hours, with no intraoperative or postoperative complications, and minimal analgesia requirements. The mean OR time was 90 minutes; a saving compared to previous morcellation techniques used in the past (e.g. electrical morcellator). Another advantage over other morcellation techniques is the preservation of the specimen with minimal tissue fragments to be left behind. TLH with laparoscopic scalpel morcellation with ColpoProbe assistance has been found to be safe, time-saving with widespread patient application and satisfaction.
360
Video Session 11dHysterectomy/Endoscopic Techniques (8:38 AM d 8:46 AM)
Avoiding Major Complications in Laparoscopic Intrafascial Hysterectomy: Experience in 1157 Consecutive Cases Cavalli N, Galletto D, Soria HL, Cavalli LO, Cavalli N Jr. Obstetrics and Gynecology, Genesis Hospital, Cascavel, Parana, Brazil To describe intrafascial dissection technique and demonstrate safety steps to avoid major complications during laparoscopic hysterectomy. Material and Method: 1557 Laparoscopic-assisted vaginal hysterectomies using intrafascial dissection from 1991 to 2008 in a private hospital. Results: Simple and important safety steps are shown to prevent major complications during the procedure. The complication rate was 2,42 %. No blood transfusions nor injuries to ureter and bowel occured. Conclusion: Intrafascial dissection provides preservation of vaginal support improving the length, configuration and axis of the vagina, preserves the complex relationships between the endopelvic fascia and the vagina. In experienced well trained surgeons Laparoscopic Intrafascial Hysterectomy is a safe technique associated with a low rate of major complications such as vaginal vault prolapse and injury to bowel and ureter.
356 Abstract moved to 350.5 361 357
Video Session 11dHysterectomy/Endoscopic Techniques (8:21 AM d 8:28 AM)
CISH Procedure with Transcervical Uterine Morcellation Makai GEH, DiSciullo AJ. Obstetrics and Gynecology, Mt. Auburn Hospital, Cambridge, Massachusetts This video demonstrates the classical intrafascial Semm hysterectomy (CISH) combined with a new method of uterine morcellation. Transcervical morcellation is used in this case after an entire core of cervix and uterine corpus is removed vaginally. Using the CISH procedure aids in alignment of the calibrated uterine resection tool (CURT). The transfer rod used to perforate the uterine fundus is placed in such a way as to prevent wandering of the CURT and resulting incomplete endocervical gland resection. Axial alignment of the CURT also aids in proper central placement of the transcervical morcellator.
Video Session 11dHysterectomy/Endoscopic Techniques (8:47 AM d 8:54 AM)
Basic Principles of Laparoscopic Suturing Akl MN, Magrina JF, Kho RM. Gynecologic Surgery, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Phoenix, Arizona Objective: This video demonstrates the basic steps and principles of laparoscopic suturing. Description: Using the operating room for basic skill acquisition for laparoscopic suturing may be inefficient and expensive. We present an educational video illustrating the basic laparoscopic suturing principles in the laparoscopy lab. The video demonstrates the details of the following laparoscopic suturing tasks: 1. Introduction of a needle through a trocar 2. Picking up and loading a needle for suturing using a laparoscopic needle-holder 3.Running a continuous suture 4.Tying an intra and extracorporeal knot. Conclusion: Teaching of laparoscopic suturing is best done in the laparoscopy lab. All laparoscopic surgeons should be familiar with the basic principles of laparoscopic suturing.
358 Abstract Withdrawn 362 359
Video Session 11dHysterectomy/Endoscopic Techniques (8:29 AM d 8:37 AM)
Laparoscopic Scalpel Morcellation with Colpo-Probe Assistance Rosenthal DM. Obstetrics and Gynecology, North York General Hospital, Toronto, Ontario, Canada This video demonstrates a technique of morcellation at Total Laparoscopic Hysterectomy (TLH). Two patients are presented who had symptomatic uterine fibroids with limited vaginal access and requiring hysterectomy.
Video Session 11dHysterectomy/Endoscopic Techniques (8:55 AM d 9:01 AM)
Oopheroloop e Operative Ovarian Retraction Chetty N, Kingston A, Lyons SD, Abbott JA, Vancaillie TG. Endogynecology, Royal Hospital for Women, Randwick, NSW, Australia Operating on the pelvic sidewall or board ligament is common during laparoscopy- for pathologies requiring excision of peritoneum, ureterolysis or hysterectomy. These procedures can be made difficult by the position of the ipsilateral adnexa. It is usually necessary for the assistant to hold the ovary toward the pelvic brim in order to allow the
Video Session 11dHysterectomy/Endoscopic Techniques (8:05 AM d 8:11 AM)
Laparoscopic Hysterectomy in the Setting of a Large Intracervical Fibroid Einarsson JI. Division of Minimally Invasive Gyn Surgery, Brigham and Women’s Hospital, Boston, Massachusetts We present an unusual case of a laparoscopic hysterectomy in the setting of a 13 cm intracervical fibroid. Fibroids extending retroperitoneally or from the lower uterine segment can create difficulties during standard dissection during a laparoscopic hysterectomy. In this case, the large fibroid was intracervical, thereby mimicking the thinned out lower uterine segment one would encounter during a cesarean section arrest of descent of the fetal head. We were able to remove the uterus by using a systematic approach as can be seen in this video.
355
Video Session 11dHysterectomy/Endoscopic Techniques (8:12 AM d 8:20 AM)
Total Laparoscopic Hysterectomy with No Risk of Ureteral Injury (Laparoscopic Aldridge’s Method) Watanabe T, Okamura C. Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan The purpose of this video is to introduce a method of total laparoscopic hysterectomy without risk of ureteral injury and show the details of the procedure. The operation consists of three stages. Firstly, ureter is identified by dissecting the posterior leaf of the broad ligament after cutting the round ligament. Secondly, adnexa is removed or preserved after making a window on the posterior leaf of the broad ligament. Finally uterus is removed intrafascially after uterine vessels are cut at the level at least 2 cm above the ureter. With this method ureter can be seen throughout the procedure and coagulation or dessication is performed with enough distance being kept from the ureter so that there is no risk of ureteral injury.
S95
TLH was carried out using the Colpo-Probe vaginal fornix delineator for all aspects of the procedure including, dissection of the upper pedicles, bladder dissection, colpotomy, laparoscopic scalpel morcellation, and cuff closure. For these two patients the estimated blood loss was 200 cc, hospital stay less than 24 hours, with no intraoperative or postoperative complications, and minimal analgesia requirements. The mean OR time was 90 minutes; a saving compared to previous morcellation techniques used in the past (e.g. electrical morcellator). Another advantage over other morcellation techniques is the preservation of the specimen with minimal tissue fragments to be left behind. TLH with laparoscopic scalpel morcellation with ColpoProbe assistance has been found to be safe, time-saving with widespread patient application and satisfaction.
360
Video Session 11dHysterectomy/Endoscopic Techniques (8:38 AM d 8:46 AM)
Avoiding Major Complications in Laparoscopic Intrafascial Hysterectomy: Experience in 1157 Consecutive Cases Cavalli N, Galletto D, Soria HL, Cavalli LO, Cavalli N Jr. Obstetrics and Gynecology, Genesis Hospital, Cascavel, Parana, Brazil To describe intrafascial dissection technique and demonstrate safety steps to avoid major complications during laparoscopic hysterectomy. Material and Method: 1557 Laparoscopic-assisted vaginal hysterectomies using intrafascial dissection from 1991 to 2008 in a private hospital. Results: Simple and important safety steps are shown to prevent major complications during the procedure. The complication rate was 2,42 %. No blood transfusions nor injuries to ureter and bowel occured. Conclusion: Intrafascial dissection provides preservation of vaginal support improving the length, configuration and axis of the vagina, preserves the complex relationships between the endopelvic fascia and the vagina. In experienced well trained surgeons Laparoscopic Intrafascial Hysterectomy is a safe technique associated with a low rate of major complications such as vaginal vault prolapse and injury to bowel and ureter.
356 Abstract moved to 350.5 361 357
Video Session 11dHysterectomy/Endoscopic Techniques (8:21 AM d 8:28 AM)
CISH Procedure with Transcervical Uterine Morcellation Makai GEH, DiSciullo AJ. Obstetrics and Gynecology, Mt. Auburn Hospital, Cambridge, Massachusetts This video demonstrates the classical intrafascial Semm hysterectomy (CISH) combined with a new method of uterine morcellation. Transcervical morcellation is used in this case after an entire core of cervix and uterine corpus is removed vaginally. Using the CISH procedure aids in alignment of the calibrated uterine resection tool (CURT). The transfer rod used to perforate the uterine fundus is placed in such a way as to prevent wandering of the CURT and resulting incomplete endocervical gland resection. Axial alignment of the CURT also aids in proper central placement of the transcervical morcellator.
Video Session 11dHysterectomy/Endoscopic Techniques (8:47 AM d 8:54 AM)
Basic Principles of Laparoscopic Suturing Akl MN, Magrina JF, Kho RM. Gynecologic Surgery, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Phoenix, Arizona Objective: This video demonstrates the basic steps and principles of laparoscopic suturing. Description: Using the operating room for basic skill acquisition for laparoscopic suturing may be inefficient and expensive. We present an educational video illustrating the basic laparoscopic suturing principles in the laparoscopy lab. The video demonstrates the details of the following laparoscopic suturing tasks: 1. Introduction of a needle through a trocar 2. Picking up and loading a needle for suturing using a laparoscopic needle-holder 3.Running a continuous suture 4.Tying an intra and extracorporeal knot. Conclusion: Teaching of laparoscopic suturing is best done in the laparoscopy lab. All laparoscopic surgeons should be familiar with the basic principles of laparoscopic suturing.
358 Abstract Withdrawn 362 359
Video Session 11dHysterectomy/Endoscopic Techniques (8:29 AM d 8:37 AM)
Laparoscopic Scalpel Morcellation with Colpo-Probe Assistance Rosenthal DM. Obstetrics and Gynecology, North York General Hospital, Toronto, Ontario, Canada This video demonstrates a technique of morcellation at Total Laparoscopic Hysterectomy (TLH). Two patients are presented who had symptomatic uterine fibroids with limited vaginal access and requiring hysterectomy.
Video Session 11dHysterectomy/Endoscopic Techniques (8:55 AM d 9:01 AM)
Oopheroloop e Operative Ovarian Retraction Chetty N, Kingston A, Lyons SD, Abbott JA, Vancaillie TG. Endogynecology, Royal Hospital for Women, Randwick, NSW, Australia Operating on the pelvic sidewall or board ligament is common during laparoscopy- for pathologies requiring excision of peritoneum, ureterolysis or hysterectomy. These procedures can be made difficult by the position of the ipsilateral adnexa. It is usually necessary for the assistant to hold the ovary toward the pelvic brim in order to allow the