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Laparoscopic Abdominal Cerclage: Tips and Tricks
Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201 The objective of this video is to describe and demonstrate the use of a lowcost simulation model created for teaching dissection of an obliterated posterior cul-de-sac. 16 residents participated in this feasibility study. The participants watched a pre-test video that demonstrated techniques to be used while completing the simulation. Participants also took a survey querying past surgical experiences and specifically how comfortable they were with an obliterated posterior cul-de-sac dissection. After completing the simulation, a post-test survey was completed which again asked about comfort with this dissection as well as an assessment of the realism (face validity) of the model. All scores were collected on a Likert scale. Participants showed a statistically significant increase in comfort with posterior obliterated culde-sac dissection after a single 30 minute session from a mean Likert score of 1 (IQR 1–1.5) to 2.5 (IQR 2–3) p < .0001. 595
Video Session 10 – Basic Science, Research & Education (3:25 PM - 5:05 PM) 5:04 PM – GROUP C
Routine Practice of Retroperitoneal Uterine Artery Ligation at Its Origin: Its Role in Benign Hysterectomies Gupta N, Boren T, Depasquale S. University of Tennessee College of Medicine, Chattanooga, Tennessee This video presents the technique and benefits of performing retroperitoneal dissection and uterine artery ligation at its origin. We routinely perform uterine artery ligation at its origin before starting the hysterectomy. This allows MIGS fellows to gain knowledge of detailed anatomy of retroperitoneal space, attain confidence in performing this dissection and improve speed of dissection. This approach also decreases estimated blood loss, overall operative time and risk of ureteral injuries. It has also been shown to decrease the risk of conversion to open procedures and postoperative transfusions. MIGS trained surgeons when encountered with complicated cases like large fibroid uteri, endometriosis and difficult myomectomies can utilize this skill. This video demonstrates the technique to open and navigate the retroperitoneal space and isolate key vital structures in the space. We believe this technique is safe and effective for the patients, as well as beneficial for education of MIGS fellows.
WEDNESDAY, NOVEMBER 15, 2017 298
Video Session 11 – Laparoscopy (3:25 PM - 5:05 PM) 3:25 PM – GROUP A
Ovarian Torsion During Third Trimester of Pregnancy: Laparoscopic Management Heredia FM,1 Stecher JF,2 Bustos A,1 Donetch GR,3 Hinostroza M,2 Escalona JR2. 1Departamento de Obstetricia y Ginecologica, Universidad de Concepción, Concepción, Biobío, Chile; 2Departamento de Obstetricia y Ginecologica, Universidad Catolica de la Santisima Concepcion, Concepcion, Biobio, Chile; 3Servicio Urgencia Maternidad, Clinica de la Mujer Sanatorio Aleman, Concepcion, Biobio, Chile This video shows a rare case of ovarian torsion during 33rd week of gestation managed laparoscopically. An open 10 mmHg pneumoperitoneum was performed in the subxyphoid area. Three auxiliary ports were placed after tilting the operation table to the left. Careful untwisting of the uteroovaric pedicle followed by an inbag cyst aspiration and then cystectomy were done with minimal bipolar coagulation of the tumoral bed. Biopsy proved a benign serous cystoadenoma. Baby was delivered uneventfully at 39 weeks, 6 weeks after this surgery was performed.
S101
The purpose of this video is to demonstrate feasibility of a simple, safe and reproductible technique which requires basic training and instruments widely available.
299
Video Session 11 – Laparoscopy (3:25 PM - 5:05 PM) 3:32 PM – GROUP A
Laparoscopic Abdominal Cerclage: Tips and Tricks Pepin KJ, Clark NV, Einarsson J. Brigham and Women’s Hospital, Boston, Massachusetts 30 year old G2P0200 with a history of recurrent 2nd trimester pregnancy loss presented for abdominal cerclage prior to attempting pregnancy for a third time. Her cerclage was placed without complication. We aimed to review advantages of abdominal cerclage placement, timing of placement and tips and tricks for successful placement of a laparoscopic abdominal cerclage, based on our institution’s 10 years of experience.
300
Video Session 11 – Laparoscopy (3:25 PM - 5:05 PM) 3:39 PM – GROUP A
Laparoscopic Excision of Anterior Vaginal Wall Prolapse Mesh Kit Gupta N, Furr RS. University of Tennessee College of Medicine, Chattanooga, Tennessee This video presents the technique of laparoscopic excision of an anterior vaginal wall prolapse mesh kit. A 67-year-old female underwent repair of anterior compartment defect using transvaginal synthetic mesh in 2009. She complained of persistent vaginal pain and dyspareunia. We removed the central portion of the mesh vaginally, followed by laparoscopic excision of remaining 4 arms of the mesh. This video will demonstrate the anatomical relations of the mesh and the key surgical principles followed during mesh dissection from the underlying tissue. Mesh was extracted successfully from both sides and resulted in resolution of patient’s symptoms on the follow up.
301
Video Session 11 – Laparoscopy (3:25 PM – 5:05 PM) 3:46 PM – GROUP A
Resection of Abdominal Wall Mass Aguirre AG, Mourad J. Minimally Invasive Gynecologic Surgery, Banner University Medical Center Phoenix, Phoenix, Arizona In this video we present the case of a postpartum patient with a pelvic mass suggestive of a degenerating, pedunculate fibroid. The patient underwent laparoscopy and was found to have a mass within the anterior abdominal wall, separate from the uterus and adnexa. Final pathology revealed desmoid tumor. Growth of these tumors is associated with the high estrogenic state of pregnancy and can have high recurrence rates if surgical margins are positive. We further present the use of ultrasound dissection with the Sonicision device.
302
Video Session 11 – Laparoscopy (3:25 PM – 5:05 PM) 3:57 PM – GROUP B
Interstitial Ectopic Pregnancy: Cornual Resection and Repair with Barbed Delayed Absorbable Suture Galhotra S, Adajar A. Obstetrics and Gynecology, Rush University Medical Center, Chicago, Illinois
Video Session 10 – Basic Science, Research & Education (3:25 PM - 5:05 PM) 5:04 PM – GROUP C
Routine Practice of Retroperitoneal Uterine Artery Ligation at Its Origin: Its Role in Benign Hysterectomies Gupta N, Boren T, Depasquale S. University of Tennessee College of Medicine, Chattanooga, Tennessee This video presents the technique and benefits of performing retroperitoneal dissection and uterine artery ligation at its origin. We routinely perform uterine artery ligation at its origin before starting the hysterectomy. This allows MIGS fellows to gain knowledge of detailed anatomy of retroperitoneal space, attain confidence in performing this dissection and improve speed of dissection. This approach also decreases estimated blood loss, overall operative time and risk of ureteral injuries. It has also been shown to decrease the risk of conversion to open procedures and postoperative transfusions. MIGS trained surgeons when encountered with complicated cases like large fibroid uteri, endometriosis and difficult myomectomies can utilize this skill. This video demonstrates the technique to open and navigate the retroperitoneal space and isolate key vital structures in the space. We believe this technique is safe and effective for the patients, as well as beneficial for education of MIGS fellows.
WEDNESDAY, NOVEMBER 15, 2017 298
Video Session 11 – Laparoscopy (3:25 PM - 5:05 PM) 3:25 PM – GROUP A
Ovarian Torsion During Third Trimester of Pregnancy: Laparoscopic Management Heredia FM,1 Stecher JF,2 Bustos A,1 Donetch GR,3 Hinostroza M,2 Escalona JR2. 1Departamento de Obstetricia y Ginecologica, Universidad de Concepción, Concepción, Biobío, Chile; 2Departamento de Obstetricia y Ginecologica, Universidad Catolica de la Santisima Concepcion, Concepcion, Biobio, Chile; 3Servicio Urgencia Maternidad, Clinica de la Mujer Sanatorio Aleman, Concepcion, Biobio, Chile This video shows a rare case of ovarian torsion during 33rd week of gestation managed laparoscopically. An open 10 mmHg pneumoperitoneum was performed in the subxyphoid area. Three auxiliary ports were placed after tilting the operation table to the left. Careful untwisting of the uteroovaric pedicle followed by an inbag cyst aspiration and then cystectomy were done with minimal bipolar coagulation of the tumoral bed. Biopsy proved a benign serous cystoadenoma. Baby was delivered uneventfully at 39 weeks, 6 weeks after this surgery was performed.
S101
The purpose of this video is to demonstrate feasibility of a simple, safe and reproductible technique which requires basic training and instruments widely available.
299
Video Session 11 – Laparoscopy (3:25 PM - 5:05 PM) 3:32 PM – GROUP A
Laparoscopic Abdominal Cerclage: Tips and Tricks Pepin KJ, Clark NV, Einarsson J. Brigham and Women’s Hospital, Boston, Massachusetts 30 year old G2P0200 with a history of recurrent 2nd trimester pregnancy loss presented for abdominal cerclage prior to attempting pregnancy for a third time. Her cerclage was placed without complication. We aimed to review advantages of abdominal cerclage placement, timing of placement and tips and tricks for successful placement of a laparoscopic abdominal cerclage, based on our institution’s 10 years of experience.
300
Video Session 11 – Laparoscopy (3:25 PM - 5:05 PM) 3:39 PM – GROUP A
Laparoscopic Excision of Anterior Vaginal Wall Prolapse Mesh Kit Gupta N, Furr RS. University of Tennessee College of Medicine, Chattanooga, Tennessee This video presents the technique of laparoscopic excision of an anterior vaginal wall prolapse mesh kit. A 67-year-old female underwent repair of anterior compartment defect using transvaginal synthetic mesh in 2009. She complained of persistent vaginal pain and dyspareunia. We removed the central portion of the mesh vaginally, followed by laparoscopic excision of remaining 4 arms of the mesh. This video will demonstrate the anatomical relations of the mesh and the key surgical principles followed during mesh dissection from the underlying tissue. Mesh was extracted successfully from both sides and resulted in resolution of patient’s symptoms on the follow up.
301
Video Session 11 – Laparoscopy (3:25 PM – 5:05 PM) 3:46 PM – GROUP A
Resection of Abdominal Wall Mass Aguirre AG, Mourad J. Minimally Invasive Gynecologic Surgery, Banner University Medical Center Phoenix, Phoenix, Arizona In this video we present the case of a postpartum patient with a pelvic mass suggestive of a degenerating, pedunculate fibroid. The patient underwent laparoscopy and was found to have a mass within the anterior abdominal wall, separate from the uterus and adnexa. Final pathology revealed desmoid tumor. Growth of these tumors is associated with the high estrogenic state of pregnancy and can have high recurrence rates if surgical margins are positive. We further present the use of ultrasound dissection with the Sonicision device.
302
Video Session 11 – Laparoscopy (3:25 PM – 5:05 PM) 3:57 PM – GROUP B
Interstitial Ectopic Pregnancy: Cornual Resection and Repair with Barbed Delayed Absorbable Suture Galhotra S, Adajar A. Obstetrics and Gynecology, Rush University Medical Center, Chicago, Illinois