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Hysteroscopic Management of Cystic Adenomyosis
S32 surgery (ie, midurethral sling placement or laparoscopic benign adnexal surgery). Patients were excluded if they had a cancer diagnosis, history of chronic pain, chronically used narcotics, non-english speakers, surgery converted to laparotomy or the subject was admitted to the hospital postoperatively for pain control. Interventions: NA Measurements and Main Results: Sixty-four subjects were enrolled and information regarding narcotic use was obtained from 58 subjects. Subjects on average were prescribed 15.5 tablets of narcotics (most often Norco) correlating to 77.5 morphine equivalents whereas subjects on average used 4.4 (correlating to 22 morphine equivalents) with 75% of patients using 6 tablets or less after surgery. Our study suggests that patients recover from the postoperative period with an average excess of 11 narcotic tablets (70% of prescribed pills) from ambulatory benign gynecologic surgeries. Conclusion: Gynecologic surgeons tend to prescribe narcotics in excess of patients’ needs. Open Communications 4: Laparoscopy (11:00 AM — 12:45 PM)
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97 the ectopic pregnancy tissue was evacuated using a suction irrigator. The uterine defect was closed to insure hemostasis. Conclusion: In a selective patient population, a laparoscopic cornuostomy is an option for treatment of an interstitial ectopic pregnancy. This is particularly true for a small interstitial ectopic where a wedge resection may be impossible without significant damage to the uterus. It is still important to follow the quantitative beta human chorionic gonadotropin levels to zero to insure resolution of the pregnancy. Open Communications 4: Laparoscopy (11:00 AM — 12:45 PM) 11:56 AM Vaginal Myomectomy using the "Single-Port / Pneumovagina Technique" Heredia F,*,1 Donetch G,2 Escalona JR,3 Hinostroza M1. 1Departamento de Ginecologıa y Obstetricia, Universidad de Concepci on, Concepci on, Chile; 2Hospital Las Higueras, Talcahuano, Chile; 3Departamento de Obstetricia y Ginecologia, Universidad de Concepcion, Concepci on, Chile *Corresponding author.
11:42 AM Hysteroscopic Management of Cystic Adenomyosis Demirel LC,*,1 Kaya DG,2 T€ ulek F,1 Lembet A,2 Ergin T1. 1IVF and Minimally Invasive Surgery, Atasehir Memorial Hospital, Istanbul, Turkey; 2IVF and Minimally Invasive Surgery, Liv Hospital, Istanbul, Turkey *Corresponding author. Video Objective: To demonstrate a case of cystic adenomyosis treated by hysteroscopic intervention and the course of the lesion thereafter. Setting: The patient is a 42 years old, G3 P1 woman complaining of heavy menstrual bleeding of 6 months duration with concomitant severe dysmenorrhea. Ultrasound examination revealed a 32 £ 30 mm cystic mass in the anterior uterine wall at the junctional zone. Interventions: Following hysteroscopic resection with a wire loop resectoscope and rollerball coagulation of the inner surface of the adenomyotic cyst, there was complete disappearance of the anterior myometrial defect and resolution of symptoms 4 months after the surgery. Conclusion: Symptomatic cystic adenomyosis on the junctional zone can be managed by hysteroscopic resection. Following creation of an opening on the cyst wall, internal surfaces may be treated with rollerball coagulation. Healing appears complete with no residual dead space on the junctional zone. Open Communications 4: Laparoscopy (11:00 AM — 12:45 PM) 11:49 AM Interstitial Ectopic Cornuostomy Whitmore G,*,1 Stickrath E2. 1Obstetric and Gynecology, University of Colorado, Denver, CO; 2Obstetrics and Gynecology, Denver Health Medical Center, Denver, CO *Corresponding author. Video Objective: The objective of this video is to demonstrate a laparoscopic technique for surgical management of an interstitial ectopic pregnancy. Setting: A patient with a history of a right ectopic pregnancy that was treated with methotrexate administration 4 years prior, presents with a right two-centimeter interstitial ectopic pregnancy. After extensive counseling, the patient declined medical treatment with methotrexate and desired surgical management with preservation of her fertility. Interventions: Laparoscopically, the fallopian tube and utero-ovarian ligament were ligated. In a purse string fashion, the interstitial ectopic pregnancy was isolated. A monopolar hook was used to incise the cornua and
Video Objective: To show a further application for the "Single Port/Pneumovagina technique". Setting: 35 year old nulligravida who complained of dyspareunia. On pelvic examination she had a 3 cm vaginal leiomyoma, lateral and posterior to the cervix. Pelvic ultrasound showed no communication with the uterus or cervix. Interventions: Under spinal anesthesia she underwent a vaginal myomectomy using a single port device to create a pneumovagina. 4 ports were inserted to the devices cap (0˚ optics, bipolar, scissors and myoma screw). Pneumovagina was created with a 12mmHg Co2 pressure and 5l/min flow. Conclusion: we shower a further application for the "Single Port/Pneumovagina technique", which we had previously described for the treatment of vaginal septums. Open Communications 4: Laparoscopy (11:00 AM — 12:45 PM) 12:03 PM Laparoscopic Management of Posthysterectomy Vesicovaginal Fistula Escalona JR,*,1,2,3 Heredia F,4,5 Donetch G,3 Hinostroza M3,4. 1 Departamento de Obstetricia y Ginecologia, Universidad de Concepcion, Concepci on, Chile; 2Unidad de cirugıa minimamente invasiva y rob otica, Clinica Universitaria de Concepcion, Concepci on, Chile; 3Hospital Las Higueras, Talcahuano, Chile; 4Departamento de Ginecologıa y Obstetricia, Universidad de Concepci on, Concepci on, Chile; 5Unidad de cirugıa mınimamente invasiva y rob otica, Clınica Universitaria de Concepci on, Concepci on, Chile *Corresponding author. Video Objective: To show our standardized method to surgically tackle posthysterectomy vesicovaginal fistulas by laparoscopy. Setting: Universitary hospital, and reference center for gynecological diseases. Interventions: We present two cases of posthysterectomy vesicovaginal fistulas referred to our hospital. Both had abdominal prior hysterectomies. We maintained Foleys catheter 3 months prior to definitive surgery to avoid usual acute inflamation surrounding the fistula. We followed a very standardized method which consists of 5 steps: 1.- Anatomical survey / Adhesiolysis, 2.- Identification of vesicovaginal avascular space, 3.- Fistula identification, 4.- Further dissection of the vesico vaginal space, 5.Individual vesical and vaginal defect closure. Conclusion: Both patients were discharged 48 hours after surgery. Foleys catheter was maintained for 14 days. We had performed such surgery in 6 consecutive cases with no fistula relapse.
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97 the ectopic pregnancy tissue was evacuated using a suction irrigator. The uterine defect was closed to insure hemostasis. Conclusion: In a selective patient population, a laparoscopic cornuostomy is an option for treatment of an interstitial ectopic pregnancy. This is particularly true for a small interstitial ectopic where a wedge resection may be impossible without significant damage to the uterus. It is still important to follow the quantitative beta human chorionic gonadotropin levels to zero to insure resolution of the pregnancy. Open Communications 4: Laparoscopy (11:00 AM — 12:45 PM) 11:56 AM Vaginal Myomectomy using the "Single-Port / Pneumovagina Technique" Heredia F,*,1 Donetch G,2 Escalona JR,3 Hinostroza M1. 1Departamento de Ginecologıa y Obstetricia, Universidad de Concepci on, Concepci on, Chile; 2Hospital Las Higueras, Talcahuano, Chile; 3Departamento de Obstetricia y Ginecologia, Universidad de Concepcion, Concepci on, Chile *Corresponding author.
11:42 AM Hysteroscopic Management of Cystic Adenomyosis Demirel LC,*,1 Kaya DG,2 T€ ulek F,1 Lembet A,2 Ergin T1. 1IVF and Minimally Invasive Surgery, Atasehir Memorial Hospital, Istanbul, Turkey; 2IVF and Minimally Invasive Surgery, Liv Hospital, Istanbul, Turkey *Corresponding author. Video Objective: To demonstrate a case of cystic adenomyosis treated by hysteroscopic intervention and the course of the lesion thereafter. Setting: The patient is a 42 years old, G3 P1 woman complaining of heavy menstrual bleeding of 6 months duration with concomitant severe dysmenorrhea. Ultrasound examination revealed a 32 £ 30 mm cystic mass in the anterior uterine wall at the junctional zone. Interventions: Following hysteroscopic resection with a wire loop resectoscope and rollerball coagulation of the inner surface of the adenomyotic cyst, there was complete disappearance of the anterior myometrial defect and resolution of symptoms 4 months after the surgery. Conclusion: Symptomatic cystic adenomyosis on the junctional zone can be managed by hysteroscopic resection. Following creation of an opening on the cyst wall, internal surfaces may be treated with rollerball coagulation. Healing appears complete with no residual dead space on the junctional zone. Open Communications 4: Laparoscopy (11:00 AM — 12:45 PM) 11:49 AM Interstitial Ectopic Cornuostomy Whitmore G,*,1 Stickrath E2. 1Obstetric and Gynecology, University of Colorado, Denver, CO; 2Obstetrics and Gynecology, Denver Health Medical Center, Denver, CO *Corresponding author. Video Objective: The objective of this video is to demonstrate a laparoscopic technique for surgical management of an interstitial ectopic pregnancy. Setting: A patient with a history of a right ectopic pregnancy that was treated with methotrexate administration 4 years prior, presents with a right two-centimeter interstitial ectopic pregnancy. After extensive counseling, the patient declined medical treatment with methotrexate and desired surgical management with preservation of her fertility. Interventions: Laparoscopically, the fallopian tube and utero-ovarian ligament were ligated. In a purse string fashion, the interstitial ectopic pregnancy was isolated. A monopolar hook was used to incise the cornua and
Video Objective: To show a further application for the "Single Port/Pneumovagina technique". Setting: 35 year old nulligravida who complained of dyspareunia. On pelvic examination she had a 3 cm vaginal leiomyoma, lateral and posterior to the cervix. Pelvic ultrasound showed no communication with the uterus or cervix. Interventions: Under spinal anesthesia she underwent a vaginal myomectomy using a single port device to create a pneumovagina. 4 ports were inserted to the devices cap (0˚ optics, bipolar, scissors and myoma screw). Pneumovagina was created with a 12mmHg Co2 pressure and 5l/min flow. Conclusion: we shower a further application for the "Single Port/Pneumovagina technique", which we had previously described for the treatment of vaginal septums. Open Communications 4: Laparoscopy (11:00 AM — 12:45 PM) 12:03 PM Laparoscopic Management of Posthysterectomy Vesicovaginal Fistula Escalona JR,*,1,2,3 Heredia F,4,5 Donetch G,3 Hinostroza M3,4. 1 Departamento de Obstetricia y Ginecologia, Universidad de Concepcion, Concepci on, Chile; 2Unidad de cirugıa minimamente invasiva y rob otica, Clinica Universitaria de Concepcion, Concepci on, Chile; 3Hospital Las Higueras, Talcahuano, Chile; 4Departamento de Ginecologıa y Obstetricia, Universidad de Concepci on, Concepci on, Chile; 5Unidad de cirugıa mınimamente invasiva y rob otica, Clınica Universitaria de Concepci on, Concepci on, Chile *Corresponding author. Video Objective: To show our standardized method to surgically tackle posthysterectomy vesicovaginal fistulas by laparoscopy. Setting: Universitary hospital, and reference center for gynecological diseases. Interventions: We present two cases of posthysterectomy vesicovaginal fistulas referred to our hospital. Both had abdominal prior hysterectomies. We maintained Foleys catheter 3 months prior to definitive surgery to avoid usual acute inflamation surrounding the fistula. We followed a very standardized method which consists of 5 steps: 1.- Anatomical survey / Adhesiolysis, 2.- Identification of vesicovaginal avascular space, 3.- Fistula identification, 4.- Further dissection of the vesico vaginal space, 5.Individual vesical and vaginal defect closure. Conclusion: Both patients were discharged 48 hours after surgery. Foleys catheter was maintained for 14 days. We had performed such surgery in 6 consecutive cases with no fistula relapse.