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Laparoscopic Abdominal Cerclage
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253 421 Cyst Removal With Dilute Vasopressin Sullivan SE,1 Zaritsky EF,1 Yamamoto MP.2 1Ob/Gyn, Kaiser Permanente Northern CA, Oakland, Oakland, California; 2Ob/Gyn, Kaiser Permanente Northern CA, San Leandro, San Leandro, California In this video, we review 2 cases of laparoscopic ovarian cystectomy with intraoperative local injection of dilute vasopressin. The improvement in hemostasis is demonstrated. Both cases involve stage IV endometriosis. A hemorrhagic cyst and endometrioma resection are shown. We briefly review the mechanism of action of Vasopressin, it’s usefulness and current research.
422 Radiofrequency Ablation of Symptomatic Uterine Fibroids: The AcessaÔ Procedure Levine DJ. Minimally Invasive Gynecologic Surgery, Mercy Hospital, St. Louis, Missouri Salient details of the interventional Acessa Procedure for radiofrequency ablation of symptomatic uterine fibroids are presented. The procedure is unique: ablation is guided by intra-abdominal laparoscopic ultrasound, does not require laparoscopic suturing or subsequent overnight hospital stay, but does require basic laparoscopic and ultrasound skills. Hemostasis is achieved by coagulation of the handpiece track upon withdrawal of the handpiece from the fibroid and uterus. Fibroids 0.7 to 15 cm in diameter have been treated. The patient is a 31 year-old, nulligravida black female who presented with menorrhagia, abdominal fullness and pelvic pressure. Ultrasound detected a 17-cm uterus with multiple intramural and subserosal fibroids, the two largest being 6 cm and 3 cm in greatest diameters. The patient desired outpatient, surgical, and uterine-conserving therapy. She was discharged 5 hours post-procedure with acetaminophencodeine and nonsteroidal anti-inflammatory drugs. The average patient misses a median of 5 workdays.
423 Laparoscopic Abdominal Cerclage Sendag F,1 Peker N,1 Aydeniz EG,1 Akdemir A,2 Gundogan S.1 1Obstetrics and Gynecology, Acibadem University Atakent Hospital, Istanbul, Atakent, Turkey; 2Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Bornova, Turkey A 30 years old women with the history of recurrent, painless second trimester abortion was admitted. We performed a laparoscopic abdominal cerclage procedure without any complication. We aimed to demonstrate the surgical steps of the laparoscopic abdominal cerclage.
424 Cheap and Easy: Laparoscopic Appendectomy Through the Umbilicus Zanatta A,1,2 Sousa JS,1 Polcheira PA.1 1Pelvi Urogynecology and Gynecologic Surgery, Brasili, Distrito Federal, Brazil; 2Obstetrics and Gynecology, University of Brasilia, Brasilia, Distrito Federal, Brazil Endometriosis of the appendix is occurs in 5% to 30% of patients with the disease. Some authors recommend treatment based on ‘‘see and treat’’: whichever macroscopic abnormality detected, such as nodule, irregularity or hypervascularization, should be an indication for appendectomy. The objective of this video is to demonstrate an easy, cheap technique for performing laparoscopic appendectomy in the setting of endometriosis. We mobilize the appendix and cecum from the right abdominal wall and parietocolic gutter. Once the appendiceal vessels are controlled, we
S135
exteriorize the appendix through umbilicus. Then, we can perform the appendectomy by the technique we want. One of the main advantages of this technique is that is cheap. We use only regular instruments. Endoscopic staplers or harmonic scalpel are not necessary at all. Every gynecologic surgeon should inspect the appendix for macroscopic abnormalities during laparoscopy for endometriosis, and should be able to perform the appendectomy if needed.
425 Laparoscopic Management of Broad Ligament and Cervical Fibroids With Reconstruction of Ectocervical Canal Bhardwaj P. Obstetrics and Gynaecology, Sir Ganga Ram Hospital, New Delhi, Delhi, India Myomectomy is indicated in symptomatic cases with menorrhagia, pelvic pain, pressure symptoms and infertility. False broad ligament fibroids originate from lateral wall of uterus or cervix. Randomized control trials have stated good results and faster recovery, shorter hospital stay and less morbidity with laparoscopic management of these fibroids. We have operated 16 cases of false broad ligament fibroids. All were removed through laparoscopic route with very minimal blood loss and no complications. Two patients have undergone term pregnancy with elective CS. The reconstruction of ectocervical canal was gratifying and gave good anatomical and functional results though laparoscopic suturing was demanding.
426
Video Session 14 - New Instruments (3:20 PM - 5:00 PM)
Robotic Single-Site Myomectomy: A Step-by-Step Tutorial Gargiulo AR, Lewis EI, Kaser DJ, Srouji SS. Center for Infertility and Reproductive Surgery, Brigham and Women’s Hospital, Boston, Massachusetts Our video demonstrates a technique for single-site robot-assisted laparoscopic myomectomy. A 2.5-cm vertical incision is made within the umbilicus. A multi-lumen single-site port (da Vinci Single-Site, Intuitive Surgical, Inc.) is seated. An 8.5-mm 0-degree laparoscope is introduced, and the da Vinci Si robot is docked. Two wristed semi-rigid needle drivers are inserted through 5-mm curved cannulae. An 8-mm assistant cannula permits concomitant entry of a flexible CO2 laser fiber and 5-mm laparoscopic instruments. Intracapsular myomectomy is performed, followed by repair in multiple layers with unidirectional barbed suture (Stratafix, Ethicon, US, LLC). After uterine reconstruction and undocking of the robot, the single-site port is exchanged for a self-retaining wound retractor with a gel-sealed cap (GelPOINT Mini, Applied Medical, Inc.). The specimen is placed in an endoscopic pouch and an extracorporeal tissue extraction is carried out. A running fascial closure and a subcuticular suture are performed to repair the umbilicus.
427 Innovative Technique for Enclosed Morcellation Using a Surgical Glove Akdemir A, Taylan E, Zeybek B, Ergenoglu AM, Sendag F. Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Bornova, Turkey Electromechanical morcellation has been performed inside the abdomen without any containment. Therefore, it has recently undergone increased scrutiny because of important concerns related to tissue dissemination. As
422 Radiofrequency Ablation of Symptomatic Uterine Fibroids: The AcessaÔ Procedure Levine DJ. Minimally Invasive Gynecologic Surgery, Mercy Hospital, St. Louis, Missouri Salient details of the interventional Acessa Procedure for radiofrequency ablation of symptomatic uterine fibroids are presented. The procedure is unique: ablation is guided by intra-abdominal laparoscopic ultrasound, does not require laparoscopic suturing or subsequent overnight hospital stay, but does require basic laparoscopic and ultrasound skills. Hemostasis is achieved by coagulation of the handpiece track upon withdrawal of the handpiece from the fibroid and uterus. Fibroids 0.7 to 15 cm in diameter have been treated. The patient is a 31 year-old, nulligravida black female who presented with menorrhagia, abdominal fullness and pelvic pressure. Ultrasound detected a 17-cm uterus with multiple intramural and subserosal fibroids, the two largest being 6 cm and 3 cm in greatest diameters. The patient desired outpatient, surgical, and uterine-conserving therapy. She was discharged 5 hours post-procedure with acetaminophencodeine and nonsteroidal anti-inflammatory drugs. The average patient misses a median of 5 workdays.
423 Laparoscopic Abdominal Cerclage Sendag F,1 Peker N,1 Aydeniz EG,1 Akdemir A,2 Gundogan S.1 1Obstetrics and Gynecology, Acibadem University Atakent Hospital, Istanbul, Atakent, Turkey; 2Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Bornova, Turkey A 30 years old women with the history of recurrent, painless second trimester abortion was admitted. We performed a laparoscopic abdominal cerclage procedure without any complication. We aimed to demonstrate the surgical steps of the laparoscopic abdominal cerclage.
424 Cheap and Easy: Laparoscopic Appendectomy Through the Umbilicus Zanatta A,1,2 Sousa JS,1 Polcheira PA.1 1Pelvi Urogynecology and Gynecologic Surgery, Brasili, Distrito Federal, Brazil; 2Obstetrics and Gynecology, University of Brasilia, Brasilia, Distrito Federal, Brazil Endometriosis of the appendix is occurs in 5% to 30% of patients with the disease. Some authors recommend treatment based on ‘‘see and treat’’: whichever macroscopic abnormality detected, such as nodule, irregularity or hypervascularization, should be an indication for appendectomy. The objective of this video is to demonstrate an easy, cheap technique for performing laparoscopic appendectomy in the setting of endometriosis. We mobilize the appendix and cecum from the right abdominal wall and parietocolic gutter. Once the appendiceal vessels are controlled, we
S135
exteriorize the appendix through umbilicus. Then, we can perform the appendectomy by the technique we want. One of the main advantages of this technique is that is cheap. We use only regular instruments. Endoscopic staplers or harmonic scalpel are not necessary at all. Every gynecologic surgeon should inspect the appendix for macroscopic abnormalities during laparoscopy for endometriosis, and should be able to perform the appendectomy if needed.
425 Laparoscopic Management of Broad Ligament and Cervical Fibroids With Reconstruction of Ectocervical Canal Bhardwaj P. Obstetrics and Gynaecology, Sir Ganga Ram Hospital, New Delhi, Delhi, India Myomectomy is indicated in symptomatic cases with menorrhagia, pelvic pain, pressure symptoms and infertility. False broad ligament fibroids originate from lateral wall of uterus or cervix. Randomized control trials have stated good results and faster recovery, shorter hospital stay and less morbidity with laparoscopic management of these fibroids. We have operated 16 cases of false broad ligament fibroids. All were removed through laparoscopic route with very minimal blood loss and no complications. Two patients have undergone term pregnancy with elective CS. The reconstruction of ectocervical canal was gratifying and gave good anatomical and functional results though laparoscopic suturing was demanding.
426
Video Session 14 - New Instruments (3:20 PM - 5:00 PM)
Robotic Single-Site Myomectomy: A Step-by-Step Tutorial Gargiulo AR, Lewis EI, Kaser DJ, Srouji SS. Center for Infertility and Reproductive Surgery, Brigham and Women’s Hospital, Boston, Massachusetts Our video demonstrates a technique for single-site robot-assisted laparoscopic myomectomy. A 2.5-cm vertical incision is made within the umbilicus. A multi-lumen single-site port (da Vinci Single-Site, Intuitive Surgical, Inc.) is seated. An 8.5-mm 0-degree laparoscope is introduced, and the da Vinci Si robot is docked. Two wristed semi-rigid needle drivers are inserted through 5-mm curved cannulae. An 8-mm assistant cannula permits concomitant entry of a flexible CO2 laser fiber and 5-mm laparoscopic instruments. Intracapsular myomectomy is performed, followed by repair in multiple layers with unidirectional barbed suture (Stratafix, Ethicon, US, LLC). After uterine reconstruction and undocking of the robot, the single-site port is exchanged for a self-retaining wound retractor with a gel-sealed cap (GelPOINT Mini, Applied Medical, Inc.). The specimen is placed in an endoscopic pouch and an extracorporeal tissue extraction is carried out. A running fascial closure and a subcuticular suture are performed to repair the umbilicus.
427 Innovative Technique for Enclosed Morcellation Using a Surgical Glove Akdemir A, Taylan E, Zeybek B, Ergenoglu AM, Sendag F. Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Bornova, Turkey Electromechanical morcellation has been performed inside the abdomen without any containment. Therefore, it has recently undergone increased scrutiny because of important concerns related to tissue dissemination. As