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Feasability and Clinical Outcome With Laparoscopic Management of Extrauterine Pregnancies
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Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
Different intravenous iron preparations are available and have been successfully utilized in the preoperative management in these cases, but older high molecular weight dextran-based products were cumbersome to use and posed significant risk of anaphylaxis. Newer molecules are currently available and can safely deliver high doses of iron in short periods of time with rapid improvements in hemoglobin levels, thus allowing for more prompt interventions and avoiding or minimizing transfusions of blood products. Intravenous iron replacement in these cases resulted in significant improvements in hemoglobin levels and replenishing of the body iron stores, which allowed to operate under better conditions improving patient’s safety and well-being. The administration of intravenous ferric carboxymaltose represents a valid alternative to current treatment modalities in the perioperative management of moderate to severe iron deficiency anemia.
(Canadian Task Force classification II-2). Setting: Major university teaching hospital. Patients: Eighty five women with symptomatic uterine myoma orearly stage cervical cancer. Intervention: In 85 patients undergoing TLH by a gynecologic oncologist from January, 2013, to March, 2014, Vaginal cuff closure was performed with two-layer running suture with polycolic acid (VicrylTM) in 53 patients (Traditional group) and with unidirectional barbed device, VLocTM, in 32 patients (Barbed group). Measurements and Main Results: The Barbed group (n=32) were not different from traditional group (n=53) in clinical characteristics. The mean vaginal cuff closure time (7.2 min vs. 12.2 min, P\.001), closure time per stitch (0.5 min vs. 1.0 min, P\ 001) in the barbed group were significantly faster than traditional group even if the number of stitch (14.1 vs. 12.3, P\.001) for stump suture in the barbed group were more than that in traditional group.
732 Use of the Articulating EnsealÒ Facilitates Completion of Complex Single Site Laparoscopic Surgery Osial PM,1 Walsh TM,2 Guan X.2 1Obstetrics and Gynecology, Jersey Shore University Medical Center, Neptune, New Jersey; 2Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas Study Objective: To demonstrate the use of the Enseal in a variety of complex gynecologic single site laparoscopic surgery. Design: Retrospective cohort study. Setting: Academic hospital. Patients: Patients undergoing laparoscopic surgery between October 2014 and March 2015. Intervention: Benign minimally invasive gynecologic surgery using single site laparoscopy with articulating Enseal device. Measurements and Main Results: A total of 38 patients who desired minimally invasive procedure were included. All the patients had a single-site laparoscopic surgery utilizing Enseal G2 Articulating Tissue Sealer (Ethicon Endo-Surgery, Blue Ash, Ohio). Average BMI of 42.4 kg/ m2. The majority (53%) of procedures included total laparoscopic hysterectomies (20) with high uterosacral ligament suspension and 1 Burch procedure, in addition to 2 abdominal cerclage placements, 6 stage III-IV endometriosis resections, 3 myomectomies, 7 salpingectomies, and ovarian cystectomies. The average estimated blood loss was 31.5 ml, and the average operating time was 2 hours and 50minutes. 45% of patients were discharged the same day, and 45% went home on postoperative day 1, with 10% staying in hospital between 2-6 days. Patients who required a delayed discharge had a history of chronic pelvic pain with high baseline narcotic requirements. One patient developed fever postoperatively that was attributed to herpes outbreak, however the workup that led to this diagnosis required extended hospital stay of 6 days. Otherwise there were no intraoperative or postoperative complications. Conclusion: Single site laparoscopic surgery has traditionally been associated with an increased learning curve primarily due to the poor ergonomics. We found that articulating Enseal enabled completion of these complex procedures with minimal addition to operative time and no complications. 733 Vaginal Cuff Closure With Unidirectional Barbed Suture During Total Laparoscopic Hysterectomy is a Safe and Feasible Procedure Park TC, Byun SW, Kim JH. Obstetrics and Gynecology, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeong Bu-Si, Gyeonggi-do, Republic of Korea Study Objective: Authors aim to analysis post operative outcomes and vaginal cuff suture time /stitch after vaginal cuff suture using the barbed suture compared with the vicryl suture performed by a single surgeon in a single institution. Design: Retrospective analysis of 85 consecutive Total laparoscopic hysterectomies performed by a single surgeon over 2 years.
Surgical outcome
Time to close vaginal cuff (min), mean(SD) Number of stitch(n) Time per stitch(min/n)
V-loc n=32 7.2(1.2)
Vircyl or Monocryl n=53 12.2(3.3)
p value \0.001
14.1(1.5) 0.5(0.1)
12.3(1.2) 1.0(0.3)
\0.001 \0.001
EBL = estimated blood loss; SD = standard deviation; min = minute
Postoperative complications including episodes of vaginal bleeding, vaginal cuff cellulitis and postoperative transfusion were not different between both groups. There was no vaginal cuff dehiscence in both groups. Conclusion: Vaginal cuff closure with unidirectional barbed suture during total laparoscopic hysterectomy is feasible and safe procedure, compared with the traditional suture 734 Feasability and Clinical Outcome With Laparoscopic Management of Extrauterine Pregnancies Ramphal SR. Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine, University of Kwa-Zulu Natal, Durban, Kwa-Zulu Natal, South Africa Study Objective: To evaluate the feasibility and safety of laparoscopic surgery with extrauterine pregnancies between 12 and 16 weeks gestation. Design: A description series of 9 patients with an emphasis on laparoscopic technique. Setting: Inkosi Albert Luthuli Central Hospital, a tertiary referral unit. Patients: The mean age of the patients was 34 years (21-41), mean parity 2 (1-2), mean BMI 29.8 (24-31.6), and mean gestational age at surgery being 14,4 weeks (13.1-15.5). Intervention: All cases were operated from the left upper quadrant using a 5mm O degree operative laparoscope. Harmonic scalpel was used as the energy source in 5 cases and bipolar in the other 4. Laparobags were used for the removal of the products. Seven were removed through the pouch of Douglas and two through the anterior abdominal wall. Measurements and Main Results: The average anaesthetic time was 122 minutes and the average pneumoperitoneum was 110 minutes. Six of the cases were unruptured and three had a partial rupture. Two cases required 2 units of blood (pre-operative Hb = 8.5 and 8.0) and another 1unit (preperative Hb = 10,3 and post-operative Hb =9.1). One patient with a heterotropic pregnancy went to 36 weeks gestation with the intrauterine pregnancy. No intraoperative complications were recorded. The average weight of the fetuses was 150 grams (110-200), and the placenta 168 grams (105-214). Five patients were discharged on day 1, and the other 4 on day 2. All patients had an uneventful recovery and were followed-up to 6 weeks. Conclusion: Laparoscopic surgery for extrauterine pregnancies between 12 and 16 weeks is feasible and safe in selected patients.
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
Different intravenous iron preparations are available and have been successfully utilized in the preoperative management in these cases, but older high molecular weight dextran-based products were cumbersome to use and posed significant risk of anaphylaxis. Newer molecules are currently available and can safely deliver high doses of iron in short periods of time with rapid improvements in hemoglobin levels, thus allowing for more prompt interventions and avoiding or minimizing transfusions of blood products. Intravenous iron replacement in these cases resulted in significant improvements in hemoglobin levels and replenishing of the body iron stores, which allowed to operate under better conditions improving patient’s safety and well-being. The administration of intravenous ferric carboxymaltose represents a valid alternative to current treatment modalities in the perioperative management of moderate to severe iron deficiency anemia.
(Canadian Task Force classification II-2). Setting: Major university teaching hospital. Patients: Eighty five women with symptomatic uterine myoma orearly stage cervical cancer. Intervention: In 85 patients undergoing TLH by a gynecologic oncologist from January, 2013, to March, 2014, Vaginal cuff closure was performed with two-layer running suture with polycolic acid (VicrylTM) in 53 patients (Traditional group) and with unidirectional barbed device, VLocTM, in 32 patients (Barbed group). Measurements and Main Results: The Barbed group (n=32) were not different from traditional group (n=53) in clinical characteristics. The mean vaginal cuff closure time (7.2 min vs. 12.2 min, P\.001), closure time per stitch (0.5 min vs. 1.0 min, P\ 001) in the barbed group were significantly faster than traditional group even if the number of stitch (14.1 vs. 12.3, P\.001) for stump suture in the barbed group were more than that in traditional group.
732 Use of the Articulating EnsealÒ Facilitates Completion of Complex Single Site Laparoscopic Surgery Osial PM,1 Walsh TM,2 Guan X.2 1Obstetrics and Gynecology, Jersey Shore University Medical Center, Neptune, New Jersey; 2Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas Study Objective: To demonstrate the use of the Enseal in a variety of complex gynecologic single site laparoscopic surgery. Design: Retrospective cohort study. Setting: Academic hospital. Patients: Patients undergoing laparoscopic surgery between October 2014 and March 2015. Intervention: Benign minimally invasive gynecologic surgery using single site laparoscopy with articulating Enseal device. Measurements and Main Results: A total of 38 patients who desired minimally invasive procedure were included. All the patients had a single-site laparoscopic surgery utilizing Enseal G2 Articulating Tissue Sealer (Ethicon Endo-Surgery, Blue Ash, Ohio). Average BMI of 42.4 kg/ m2. The majority (53%) of procedures included total laparoscopic hysterectomies (20) with high uterosacral ligament suspension and 1 Burch procedure, in addition to 2 abdominal cerclage placements, 6 stage III-IV endometriosis resections, 3 myomectomies, 7 salpingectomies, and ovarian cystectomies. The average estimated blood loss was 31.5 ml, and the average operating time was 2 hours and 50minutes. 45% of patients were discharged the same day, and 45% went home on postoperative day 1, with 10% staying in hospital between 2-6 days. Patients who required a delayed discharge had a history of chronic pelvic pain with high baseline narcotic requirements. One patient developed fever postoperatively that was attributed to herpes outbreak, however the workup that led to this diagnosis required extended hospital stay of 6 days. Otherwise there were no intraoperative or postoperative complications. Conclusion: Single site laparoscopic surgery has traditionally been associated with an increased learning curve primarily due to the poor ergonomics. We found that articulating Enseal enabled completion of these complex procedures with minimal addition to operative time and no complications. 733 Vaginal Cuff Closure With Unidirectional Barbed Suture During Total Laparoscopic Hysterectomy is a Safe and Feasible Procedure Park TC, Byun SW, Kim JH. Obstetrics and Gynecology, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeong Bu-Si, Gyeonggi-do, Republic of Korea Study Objective: Authors aim to analysis post operative outcomes and vaginal cuff suture time /stitch after vaginal cuff suture using the barbed suture compared with the vicryl suture performed by a single surgeon in a single institution. Design: Retrospective analysis of 85 consecutive Total laparoscopic hysterectomies performed by a single surgeon over 2 years.
Surgical outcome
Time to close vaginal cuff (min), mean(SD) Number of stitch(n) Time per stitch(min/n)
V-loc n=32 7.2(1.2)
Vircyl or Monocryl n=53 12.2(3.3)
p value \0.001
14.1(1.5) 0.5(0.1)
12.3(1.2) 1.0(0.3)
\0.001 \0.001
EBL = estimated blood loss; SD = standard deviation; min = minute
Postoperative complications including episodes of vaginal bleeding, vaginal cuff cellulitis and postoperative transfusion were not different between both groups. There was no vaginal cuff dehiscence in both groups. Conclusion: Vaginal cuff closure with unidirectional barbed suture during total laparoscopic hysterectomy is feasible and safe procedure, compared with the traditional suture 734 Feasability and Clinical Outcome With Laparoscopic Management of Extrauterine Pregnancies Ramphal SR. Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine, University of Kwa-Zulu Natal, Durban, Kwa-Zulu Natal, South Africa Study Objective: To evaluate the feasibility and safety of laparoscopic surgery with extrauterine pregnancies between 12 and 16 weeks gestation. Design: A description series of 9 patients with an emphasis on laparoscopic technique. Setting: Inkosi Albert Luthuli Central Hospital, a tertiary referral unit. Patients: The mean age of the patients was 34 years (21-41), mean parity 2 (1-2), mean BMI 29.8 (24-31.6), and mean gestational age at surgery being 14,4 weeks (13.1-15.5). Intervention: All cases were operated from the left upper quadrant using a 5mm O degree operative laparoscope. Harmonic scalpel was used as the energy source in 5 cases and bipolar in the other 4. Laparobags were used for the removal of the products. Seven were removed through the pouch of Douglas and two through the anterior abdominal wall. Measurements and Main Results: The average anaesthetic time was 122 minutes and the average pneumoperitoneum was 110 minutes. Six of the cases were unruptured and three had a partial rupture. Two cases required 2 units of blood (pre-operative Hb = 8.5 and 8.0) and another 1unit (preperative Hb = 10,3 and post-operative Hb =9.1). One patient with a heterotropic pregnancy went to 36 weeks gestation with the intrauterine pregnancy. No intraoperative complications were recorded. The average weight of the fetuses was 150 grams (110-200), and the placenta 168 grams (105-214). Five patients were discharged on day 1, and the other 4 on day 2. All patients had an uneventful recovery and were followed-up to 6 weeks. Conclusion: Laparoscopic surgery for extrauterine pregnancies between 12 and 16 weeks is feasible and safe in selected patients.