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Chronic 3rd Degree Laceration Repair
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253 305
302 Laparoscopic Excision of Isolated Para-Aortic Lymph Node Recurrence Lee WM,1 Choi JS,1 Bae J,1 Koh AR,1 Jung US,2 Ko JH.3 1 Hanyang University College of Medicine, Seoul, Republic of Korea; 2 Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea; 3Kangwon National University Hospital, Gangwon-Do, Republic of Korea A 54-year-old Korean woman was referred to my department because PETCT scan showed a hypermetabolic spot on the aortocaval area. She underwent radical abdominal hysterectomy with bilateral salpingooophorectomy, appendectomy, and bilateral pelvic lymphadenectomy followed by concurrent chemo-radiation because of pelvic lymph node metastasis and parametrial involvement in other hospital a few years ago. We performed laparoscopic excision of para-aortic metastatic lymph nodes on Jul 16, 2013. The final histopathological report showed that aortocaval lymph node was metastatic squamous cell carcinoma which greatest size was 2.6cm with extranodal extension. Six of all retrocaval lymph node was metastatic squamous cell carcinoma. After surgery, she received adjuvant chemotherapy and she is healthy without evidence of disease recurrence.
303
S117
Video Session 2 - Urogynecology (11:00 AM - 12:00 PM)
Post-Hysterectomy Laparoscopic Uterosacral Ligament Suspension Wyman AM, Hahn L, Mikhail E, Hart S. Female Pelvic Medicine and Reconstructive Surgery, University of South Florida, Tampa, Florida Uterosacral ligament suspension (USLS) is a common surgical procedure frequently performed at the time of a hysterectomy to address apical prolapse. Sacral colpopexy or sacrospinous ligament suspension are predominately performed in patients with a past surgical history of a hysterectomy. This is an educational video that focuses on surgical technique for laparoscopic uterosacral ligament suspension in a posthysterectomy patient. We will also focus on the anatomy of the uterosacral ligaments and relevant surrounding structures. We present a case of 58-year-old G4P3 female with symptomatic stage III POP. She had a history of a total abdominal hysterectomy 30 years ago and strongly desired no usage of mesh for her surgical procedure. This video provides a step-by-step guide on how to perform a laparoscopic uterosacral ligament suspension as native tissue option for patients with the need for post hysterectomy apical suspension.
304 Surgical Excision of Urethral Prolapse Hill AJ,1 Siff L,1 Vasavada SP,2 Paraiso MFR.1 1Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, Cleveland, Ohio; 2Urology, Cleveland Clinic, Cleveland, Ohio Urethral prolapse is a rare condition that results in the eversion of the urethral mucosa through the distal urethra. Management is divided into two categories: conservative treatment and surgical intervention. We present a case of urethral prolapse with severe symptoms that were minimally responsive to topical estrogen. Surgical excision is achieved with resection of the redundant urethral mucosa. The remaining urethral mucosa is then approximated to the surrounding vaginal epithelium for creation of a new external urethral meatus. This video highlights surgical techniques that can be used for excision of urethral prolapse. In conclusion, management of urethral prolapse should be individualized based on the symptom severity, anatomic compromise, and surgical morbidity. Surgical management should be considered in cases of vascular compromise or failed medical management.
Hybrid Laparoscopic Sacrocolpopexy for Pelvic Organ Prolapse With Severe Cystocele Ichikawa M, Sekine M, Ono S, Mine K, Akira S, Takeshita T. Ob/Gyn, Nippon Medical School, Tokyo, Japan Abdominal sacrocolpopexy is the gold standard for treating pelvic organ prolapse (POP) because of safety and durable good results. More recently laparoscopic sacrocolpopexy (LSC), a less invasive approach, has become popular. Although these surgeries are versatile and can treat almost all patients with POP, these techniques have shortcomings. Specifically, reinforcement of lateral vaginal defects are not very strong, thus patients with POP and a severe paravaginal defect are not good candidates for abdominal or laparoscopic sacrocolpopexy. To overcome this problem, we developed a novel type of LSC, which can reinforce severe paravaginal defects by using a reversed T-shaped anterior mesh combining the advantage of transvaginal mesh surgery. We refer to this novel surgery as ‘hybrid LSC’. Thus far, 40 patients have successfully undergone this surgery. Hybrid LSC is a simple and secure method, and is an alternative treatment for POP with a severe paravaginal defect. 306 Chronic 3rd Degree Laceration Repair Liao CC, Navas JJ, Yazdany T. Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, California Anal sphincter injuries occur in approximately 5-13% of vaginal deliveries. This can be complicated by perineal wound breakdown. Patients with this complication often experience significant morbidity and psychosocial distress. Meticulous surgical technique requires adherence to the tenets of a successful repair, which include the following: good blood supply, an absence of infection in the tissues involved, and closure of repair without tension on the sutures. The purpose of this video is to demonstrate a step-by-step repair of a chronic third degree laceration using an overlapping anal sphincteroplasty technique. 307 Cystoscopic Evaluation of Ureteral Jets: Alternatives to Indigo Carmine Arnolds KS, Espaillat-Rijo L, Sprague ML, Zimberg SE. Department of Gynecology Section of Minimally Invasive Gynecology, Cleveland Clinic Florida, Weston, Florida Cystoscopy plays an important role in gynecologic surgery to assess ureteral patency and bladder integrity. This video illustrates the utilization of saline, indigo carmine, methylene blue, dextrose, phenazopyridine as well as sodium fluorescein for cystoscopic evaluation of ureteral jets and discusses advantages and disadvantages. Recently, manufacturing of indigo carmine is delayed and a re-supply date is unknown, so alternatives are needed. Cystoscopy with saline, does not allow conclusive visualization of the ureteral jets as demonstrated in the beginning of the video. Dextrose solution may be used in its 50 % and 10% concentration. Administration of 200 mg of oral phenazopyridine preoperatively, will aid in the visualization of the ureteral jet. Methylene blue has colorization properties, however it does not reliably stain the urine and needs to be used cautiously due to its interactions. Sodium fluorescein is used for retinal angiography and stains the urine neon yellow, which is clearly visible. 308 A Rare Complication of Sacrocolpopexy Lingenfelter BM, Long JB, Pugh CJ. Obstetrics and Gynecology, Reading Hospital, West Reading, Pennsylvania
302 Laparoscopic Excision of Isolated Para-Aortic Lymph Node Recurrence Lee WM,1 Choi JS,1 Bae J,1 Koh AR,1 Jung US,2 Ko JH.3 1 Hanyang University College of Medicine, Seoul, Republic of Korea; 2 Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea; 3Kangwon National University Hospital, Gangwon-Do, Republic of Korea A 54-year-old Korean woman was referred to my department because PETCT scan showed a hypermetabolic spot on the aortocaval area. She underwent radical abdominal hysterectomy with bilateral salpingooophorectomy, appendectomy, and bilateral pelvic lymphadenectomy followed by concurrent chemo-radiation because of pelvic lymph node metastasis and parametrial involvement in other hospital a few years ago. We performed laparoscopic excision of para-aortic metastatic lymph nodes on Jul 16, 2013. The final histopathological report showed that aortocaval lymph node was metastatic squamous cell carcinoma which greatest size was 2.6cm with extranodal extension. Six of all retrocaval lymph node was metastatic squamous cell carcinoma. After surgery, she received adjuvant chemotherapy and she is healthy without evidence of disease recurrence.
303
S117
Video Session 2 - Urogynecology (11:00 AM - 12:00 PM)
Post-Hysterectomy Laparoscopic Uterosacral Ligament Suspension Wyman AM, Hahn L, Mikhail E, Hart S. Female Pelvic Medicine and Reconstructive Surgery, University of South Florida, Tampa, Florida Uterosacral ligament suspension (USLS) is a common surgical procedure frequently performed at the time of a hysterectomy to address apical prolapse. Sacral colpopexy or sacrospinous ligament suspension are predominately performed in patients with a past surgical history of a hysterectomy. This is an educational video that focuses on surgical technique for laparoscopic uterosacral ligament suspension in a posthysterectomy patient. We will also focus on the anatomy of the uterosacral ligaments and relevant surrounding structures. We present a case of 58-year-old G4P3 female with symptomatic stage III POP. She had a history of a total abdominal hysterectomy 30 years ago and strongly desired no usage of mesh for her surgical procedure. This video provides a step-by-step guide on how to perform a laparoscopic uterosacral ligament suspension as native tissue option for patients with the need for post hysterectomy apical suspension.
304 Surgical Excision of Urethral Prolapse Hill AJ,1 Siff L,1 Vasavada SP,2 Paraiso MFR.1 1Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, Cleveland, Ohio; 2Urology, Cleveland Clinic, Cleveland, Ohio Urethral prolapse is a rare condition that results in the eversion of the urethral mucosa through the distal urethra. Management is divided into two categories: conservative treatment and surgical intervention. We present a case of urethral prolapse with severe symptoms that were minimally responsive to topical estrogen. Surgical excision is achieved with resection of the redundant urethral mucosa. The remaining urethral mucosa is then approximated to the surrounding vaginal epithelium for creation of a new external urethral meatus. This video highlights surgical techniques that can be used for excision of urethral prolapse. In conclusion, management of urethral prolapse should be individualized based on the symptom severity, anatomic compromise, and surgical morbidity. Surgical management should be considered in cases of vascular compromise or failed medical management.
Hybrid Laparoscopic Sacrocolpopexy for Pelvic Organ Prolapse With Severe Cystocele Ichikawa M, Sekine M, Ono S, Mine K, Akira S, Takeshita T. Ob/Gyn, Nippon Medical School, Tokyo, Japan Abdominal sacrocolpopexy is the gold standard for treating pelvic organ prolapse (POP) because of safety and durable good results. More recently laparoscopic sacrocolpopexy (LSC), a less invasive approach, has become popular. Although these surgeries are versatile and can treat almost all patients with POP, these techniques have shortcomings. Specifically, reinforcement of lateral vaginal defects are not very strong, thus patients with POP and a severe paravaginal defect are not good candidates for abdominal or laparoscopic sacrocolpopexy. To overcome this problem, we developed a novel type of LSC, which can reinforce severe paravaginal defects by using a reversed T-shaped anterior mesh combining the advantage of transvaginal mesh surgery. We refer to this novel surgery as ‘hybrid LSC’. Thus far, 40 patients have successfully undergone this surgery. Hybrid LSC is a simple and secure method, and is an alternative treatment for POP with a severe paravaginal defect. 306 Chronic 3rd Degree Laceration Repair Liao CC, Navas JJ, Yazdany T. Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, California Anal sphincter injuries occur in approximately 5-13% of vaginal deliveries. This can be complicated by perineal wound breakdown. Patients with this complication often experience significant morbidity and psychosocial distress. Meticulous surgical technique requires adherence to the tenets of a successful repair, which include the following: good blood supply, an absence of infection in the tissues involved, and closure of repair without tension on the sutures. The purpose of this video is to demonstrate a step-by-step repair of a chronic third degree laceration using an overlapping anal sphincteroplasty technique. 307 Cystoscopic Evaluation of Ureteral Jets: Alternatives to Indigo Carmine Arnolds KS, Espaillat-Rijo L, Sprague ML, Zimberg SE. Department of Gynecology Section of Minimally Invasive Gynecology, Cleveland Clinic Florida, Weston, Florida Cystoscopy plays an important role in gynecologic surgery to assess ureteral patency and bladder integrity. This video illustrates the utilization of saline, indigo carmine, methylene blue, dextrose, phenazopyridine as well as sodium fluorescein for cystoscopic evaluation of ureteral jets and discusses advantages and disadvantages. Recently, manufacturing of indigo carmine is delayed and a re-supply date is unknown, so alternatives are needed. Cystoscopy with saline, does not allow conclusive visualization of the ureteral jets as demonstrated in the beginning of the video. Dextrose solution may be used in its 50 % and 10% concentration. Administration of 200 mg of oral phenazopyridine preoperatively, will aid in the visualization of the ureteral jet. Methylene blue has colorization properties, however it does not reliably stain the urine and needs to be used cautiously due to its interactions. Sodium fluorescein is used for retinal angiography and stains the urine neon yellow, which is clearly visible. 308 A Rare Complication of Sacrocolpopexy Lingenfelter BM, Long JB, Pugh CJ. Obstetrics and Gynecology, Reading Hospital, West Reading, Pennsylvania