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Bladder Hydro-Dissection to Overcome the Loss of Laparoscopic Triangulation
S156
Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252
Purpose: In this video, the technique of open (Hasson) entry to the peritoneal cavity is discussed. This technique is reviewed in comparison to closed entry with insufflation by Veress needle and also direct entry with visualization. The surgical steps of open entry are listed and described using written, verbal, and figurative means. The advantages and disadvantages of this approach are discussed. 515 Total Laparoscopic Hysterectomy with Left Salpingoophorectomy Using Sutures without the Use of Any Energy Source Marwah V, Dasgupta S, Mittal P. Division of Minimally Invasive Gynaecology, Max Superspeciality Hospital, New Delhi, Delhi, India Total laparoscopic hysterectomy with left salpingoophorectomy was carried out using sutures only, in a case of left tubo ovarian mass with left ovarian endometriotic cyst with severe endometriosis, adenomyosis uteri, and myoma uterus, with a history of previous myomectomy and ovarian cystectomy. The dissection aided with application of Marwah’s Uterine Manipulator vaginally,involved opening the anterior leaf of broad ligament through the avascular triangle on left side for delineation of uterine vessels. As access was not available on right side for the uterine vessels, the roof of broad ligament was incised for uterine artery. Ureter was identified and uterine artery ligated. Infundibulopelvic ligament, round ligament on left side, tubo ovarian and round ligament on right side ligated and cut. Colpotomy performed with hook scissors.The entire procedure was carried out with blunt and sharp dissection and with sutures only,without using any energy source, thus making it safer and better for the patient. 516 Laparoscopic Management of Huge Myoma Nascendi Sendag F, Peker N, G€ undogan S, Aydeniz EG. Obstetrics and Gynecology, Acibadem University, Istanbul, Turkey Objectives: To present a case with huge cervical myoma protruding from cervical external os managed with laparoscopic approach Methods: We performed laparoscopic myomectomy at patients with huge intramural-submucous myoma located at uterine corpus and protruding from cervical external os. The incision was closed three layer suturing with barbed suture. Conclusion: Cervical myoma with huge size should be managed laparoscopically Keywords: Laparoscopy, myoma, cervical. 517 Bladder Hydro-Dissection to Overcome the Loss of Laparoscopic Triangulation Adajar AA. Minimally Invasive Gynecologic Surgery, Illinois Institute of Gynecology & Advanced Pelvic Surgery, Chicago, Illinois Objective: The following video demonstrates the utility of hydro-dissection in laparoscopic bladder dissection, when performed from a mid-line instrument port. Description: The advancement of minimally invasive gynecologic surgery gives rise to new challenges, and techniques to overcome them. The advent of less invasive, scar-less surgical approaches, often results in decreased ergonomics from the loss of port placement triangulation. This creates challenges due to limited instrument utilization. This is especially true when performing bladder dissection. Hydro-dissection is a technique wherein pressurized fluid is delivered into the tissue, entering into the plane of least resistance. When used during bladder dissection, pressurized fluid is used to dissect into an avascular plane. The following video demonstrates the utility of bladder hydrodissection from a mid-line instrument port.
Conclusion: When performed from a mid-line instrument port, this technique allows the surgeon to overcome some of the challenges encountered from a mid-line instrument port. 518 Techniques to Increase Efficiency of Laparoscopic Suturing with Barbed Sutures Nguyen NT,1 Jeffries MJ,1 Regehr R,1 Yamamoto M,2 Zaritsky EF.1 1Kaiser Permanente Oakland, Oakland, California; 2Kaiser Permanente San Leandro, San Leandro, California It is well known that efficient laparoscopic techniques help decrease time of surgery. Using materials such as barbed sutures have allowed for more efficient laparoscopic surgery to be performed when suturing is involved. This video will provide a novel technique using barbed suture in an efficient way during laparoscopic suturing that may help surgeons decrease the surgical time associated with laparoscopic suturing. 519 Total Laparoscopic Hysterectomy Making Easy: The Technique and Tools – 8-Year Experience Quayyum MA, Farhat S. Ob/Gyn, Feni Pvt. Hospital and Laparoscopy Institute, Feni, Ctg, Bangladesh The aim of this video to evaluate our surgical technique with regards to the success of total laparoscopic hysterectomy (TLH) for the removal of the uterus. Methods: A Retrospective observational study was carried out at Feni pvt. Hospital(FPH), Feni and Chowmuhani general hospital(CGH) Noakhali, Bangladesh based on TLH operations performed from January 2008 to December 2015. The Q-Colpotomizer system a very simple uterine manipulator device were used . The Pneumoperitoneum was maintained by sterile wet sponge vaginal pack. Four thousands and ninty six women consented for TLH. Four thousands forty eight women (98.8.%) had successful TLH with twenty four minilaparotomy and twenty-four laparotomy conversions (1.2% failure rate). Conclusion: Total laparoscopic hysterectomy can be carried out successfully with very simple equipments and adequate training is associated with low morbidity, few complications and a high success rate. 520 Vagina-Assisted Laparoscopic Sacro-CervicoColpopexy with Prolene Mesh and Metal Screw and Bilateral Round Ligament Shortening Wang Y-T. Ob/Gyn, China Medical University Hospital, Taichung, Taiwan Laparoscopic sacral colpopexy is a surgical procedure to correct the prolapse of vagina. But, the procedure will be more difficult if the patient asks to preserve the uterus. The video also demonstrate the method via the vagina-assisted approach to reduce the difficulty of the operation. The video also states the important anatomy of pre-sacral space. And, in order to strengthen the prognosis of the surgery, we could perform bilateral round ligament shortening by electrocauterization and suture. This modified method has better effects of uterine suspension with greater satisfaction degree. 521 Bilateral Adhesiolysis and Tubal Plasty with Low Pressure (7mmHg) MicroLaparoscopy (3 mm) Sroussi J, Fazel A, Mezzadri M, Elies A, Benifla J-L. Gynecology and Obstetrics, Lariboisiere, Paris, France
Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252
Purpose: In this video, the technique of open (Hasson) entry to the peritoneal cavity is discussed. This technique is reviewed in comparison to closed entry with insufflation by Veress needle and also direct entry with visualization. The surgical steps of open entry are listed and described using written, verbal, and figurative means. The advantages and disadvantages of this approach are discussed. 515 Total Laparoscopic Hysterectomy with Left Salpingoophorectomy Using Sutures without the Use of Any Energy Source Marwah V, Dasgupta S, Mittal P. Division of Minimally Invasive Gynaecology, Max Superspeciality Hospital, New Delhi, Delhi, India Total laparoscopic hysterectomy with left salpingoophorectomy was carried out using sutures only, in a case of left tubo ovarian mass with left ovarian endometriotic cyst with severe endometriosis, adenomyosis uteri, and myoma uterus, with a history of previous myomectomy and ovarian cystectomy. The dissection aided with application of Marwah’s Uterine Manipulator vaginally,involved opening the anterior leaf of broad ligament through the avascular triangle on left side for delineation of uterine vessels. As access was not available on right side for the uterine vessels, the roof of broad ligament was incised for uterine artery. Ureter was identified and uterine artery ligated. Infundibulopelvic ligament, round ligament on left side, tubo ovarian and round ligament on right side ligated and cut. Colpotomy performed with hook scissors.The entire procedure was carried out with blunt and sharp dissection and with sutures only,without using any energy source, thus making it safer and better for the patient. 516 Laparoscopic Management of Huge Myoma Nascendi Sendag F, Peker N, G€ undogan S, Aydeniz EG. Obstetrics and Gynecology, Acibadem University, Istanbul, Turkey Objectives: To present a case with huge cervical myoma protruding from cervical external os managed with laparoscopic approach Methods: We performed laparoscopic myomectomy at patients with huge intramural-submucous myoma located at uterine corpus and protruding from cervical external os. The incision was closed three layer suturing with barbed suture. Conclusion: Cervical myoma with huge size should be managed laparoscopically Keywords: Laparoscopy, myoma, cervical. 517 Bladder Hydro-Dissection to Overcome the Loss of Laparoscopic Triangulation Adajar AA. Minimally Invasive Gynecologic Surgery, Illinois Institute of Gynecology & Advanced Pelvic Surgery, Chicago, Illinois Objective: The following video demonstrates the utility of hydro-dissection in laparoscopic bladder dissection, when performed from a mid-line instrument port. Description: The advancement of minimally invasive gynecologic surgery gives rise to new challenges, and techniques to overcome them. The advent of less invasive, scar-less surgical approaches, often results in decreased ergonomics from the loss of port placement triangulation. This creates challenges due to limited instrument utilization. This is especially true when performing bladder dissection. Hydro-dissection is a technique wherein pressurized fluid is delivered into the tissue, entering into the plane of least resistance. When used during bladder dissection, pressurized fluid is used to dissect into an avascular plane. The following video demonstrates the utility of bladder hydrodissection from a mid-line instrument port.
Conclusion: When performed from a mid-line instrument port, this technique allows the surgeon to overcome some of the challenges encountered from a mid-line instrument port. 518 Techniques to Increase Efficiency of Laparoscopic Suturing with Barbed Sutures Nguyen NT,1 Jeffries MJ,1 Regehr R,1 Yamamoto M,2 Zaritsky EF.1 1Kaiser Permanente Oakland, Oakland, California; 2Kaiser Permanente San Leandro, San Leandro, California It is well known that efficient laparoscopic techniques help decrease time of surgery. Using materials such as barbed sutures have allowed for more efficient laparoscopic surgery to be performed when suturing is involved. This video will provide a novel technique using barbed suture in an efficient way during laparoscopic suturing that may help surgeons decrease the surgical time associated with laparoscopic suturing. 519 Total Laparoscopic Hysterectomy Making Easy: The Technique and Tools – 8-Year Experience Quayyum MA, Farhat S. Ob/Gyn, Feni Pvt. Hospital and Laparoscopy Institute, Feni, Ctg, Bangladesh The aim of this video to evaluate our surgical technique with regards to the success of total laparoscopic hysterectomy (TLH) for the removal of the uterus. Methods: A Retrospective observational study was carried out at Feni pvt. Hospital(FPH), Feni and Chowmuhani general hospital(CGH) Noakhali, Bangladesh based on TLH operations performed from January 2008 to December 2015. The Q-Colpotomizer system a very simple uterine manipulator device were used . The Pneumoperitoneum was maintained by sterile wet sponge vaginal pack. Four thousands and ninty six women consented for TLH. Four thousands forty eight women (98.8.%) had successful TLH with twenty four minilaparotomy and twenty-four laparotomy conversions (1.2% failure rate). Conclusion: Total laparoscopic hysterectomy can be carried out successfully with very simple equipments and adequate training is associated with low morbidity, few complications and a high success rate. 520 Vagina-Assisted Laparoscopic Sacro-CervicoColpopexy with Prolene Mesh and Metal Screw and Bilateral Round Ligament Shortening Wang Y-T. Ob/Gyn, China Medical University Hospital, Taichung, Taiwan Laparoscopic sacral colpopexy is a surgical procedure to correct the prolapse of vagina. But, the procedure will be more difficult if the patient asks to preserve the uterus. The video also demonstrate the method via the vagina-assisted approach to reduce the difficulty of the operation. The video also states the important anatomy of pre-sacral space. And, in order to strengthen the prognosis of the surgery, we could perform bilateral round ligament shortening by electrocauterization and suture. This modified method has better effects of uterine suspension with greater satisfaction degree. 521 Bilateral Adhesiolysis and Tubal Plasty with Low Pressure (7mmHg) MicroLaparoscopy (3 mm) Sroussi J, Fazel A, Mezzadri M, Elies A, Benifla J-L. Gynecology and Obstetrics, Lariboisiere, Paris, France