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Laparoscopic Adnexal Surgery in the Mid-Trimester of Pregnancy: Usage of Harmonic Scalpel and Left Upper Quadrant Approach
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Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S103eS157
Conclusion: Laparoscopic surgery for extrauterine pregnancies between 12 and 16 weeks is feasible.
470 Laparoscopic Adnexal Surgery in the Mid-Trimester of Pregnancy: Usage of Harmonic Scalpel and Left Upper Quadrant Approach Ramphal SR. Obstetrics and Gynaecology, University of KwaZulu-Natal, Nelson R. Mandela School of Medicine, Congella, KwaZulu-Natal, South Africa Study Objective: Feasibility of laparscopic surgery in second trimester pregnancy. Design: Descriptive study. Setting: Endoscopic unit in a university academic hospital. Patients: 11 patients in the second trimester of pregnancy. Intervention: Laparoscopic adnexal surgery. Measurements and Main Results: Laparoscopic surgery in pregnancy is infrequently performed because of concerns to both mother and fetus. Recently, with advances in technique, instrumentation and experience, there is an increasing interest in performing this type of surgery in pregnancy. All cases were operated using the Veress needle for insufflation in the left upper quadrant, followed by a 5 mm primary trocar insertion at this site. A Stortz 5 mm 0o operative laparoscope was used in all cases. Harmonic scalpel was used as the energy source for adhesiolysis, dissection and coagulation; and laparobags were used in cases of dermoids. The clinical data (all data given as averages) were as follows: age 27.4 years; BMI 27.1’ gestational age at booking 12.2 weeks and gestational age at time of surgery 18.8 weeks (range 14e24). Indications for surgery were lower abdominal pain and discomfort in 10 patients (4 had torsion) while one patient had an acute abdomen. The cyst size was 8.6 cm x 9.4 cm, duration of anaesthesia was 108 minutes and the duration of pneumoperitoneum was 92 minutes. The average gestational age at delivery of all 11 patients was 36.9 weeks and birth weight was 2.9 kg. There were no maternal, fetal or surgical complications with the surgery. Average hospital stay was 2 days. Conclusion: Laparoscopic adnexal surgery in the second trimester of pregnancy is safe and feasible with good outcomes.
471 Unusual Location for a Perforating Intra-Uterine Device Ribeiro SC, Tormena RA, Vanni D, Pereira CL, Andrade M, Baracat EC. Gynecology, School of Medicine, University of Sa˜o Paulo, Sao Paulo, Brazil Study Objective: To report the unusual location for a perforating intrauterine device. Design: Case report. Setting: A university hospital. Patients: We describe the case of a healthy 24 year old woman who had a copper IUD inserted four months after delivering her third child. She became pregnant a few months later, and the IUD could not be located through physical examination or ultra-sound. At the time of the cesarean section, the surgeon was also unable to locate it and the IUD was presumed to have been expelled. When the patient performed a pelvic Xray for an orthopedic complaint, the IUD was visualized in the pelvis. Intervention: Laparoscopy and colonoscopy revealed that it had dissected the muscularis of the colon, parallel to but not perforating the mucosa. Measurements and Main Results: As the patient was asymptomatic, a multi-specialty team opted for conservative management with close follow up. After six months, the patient remains without complaints. Conclusion: Laparoscopy is widely used in the management of perforating IUD’s. Laparotomy is justified in some cases, if the laparoscopic removal is unsuccessful. Some reports of IUD’s perforating viscera describe more aggressive approaches, including bowel resection. The unusual location seen in this case warranted more conservative management.
472 Single-Port (10mm) Hand-Assisted Laparoscopic Surgery (Transportal): Ovarian Cystectomy with a Multichannel Port e Technical Report of 2 Cases in Adolescent Roh H-J,1,8 Yoo HJ,1,8 Joo W-D,1,8 Na Y-J,2,8 Kim HG,2,8 Park SH,3,8 Sun ST,4,8 Chae HJ,5,8 Kim TG,6,8 Park JS,7,8 Jung MH.9 1Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Gyeongnam, Republic of Korea; 2Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, Gyeongnam, Republic of Korea; 3Obstetrics and Gynecology, Dong Eui Hospital, Busan, Republic of Korea; 4Obstetrics and Gynecology, Jamo Women’s Hospital, Busan, Republic of Korea; 5Obstetrics and Gynecology, Maryknoll Hospital, Busan, Republic of Korea; 6Obstetrics and Gynecology, Wallace Memorial Baptist Hospital, Busan, Republic of Korea; 7Obstetrics and Gynecology, Changwon Fatima Hospital, Changwon, Republic of Korea; 8Obstetrics and Gynecology, Busan Gyeongnam Gynecologic Endoscopy Group, Yangsan, Gyeongnam, Republic of Korea; 9Obstetrics and Gynecology, Kyung Hee University, School of Medicine, Kyung Hee Medical Center, Seoul, Republic of Korea Study Objective: To present the feasibility and technique of the single port hand-assisted laparoscopic surgery in benign ovarian tumor. Design: Technical reports of single-port hand assisted laparoscopic cystectomy between February and March 2009. Setting: University of Ulsan College of Medicine, Ulsan University Hospital. Patients: I e 17 years old virgin, 10 cm benign paraovarian cyst II e 14 years old virgin, 15 cm mature cystic teratoma. Intervention: Single-port hand-assisted laparoscopic ovarian cystectomy. Measurements and Main Results: 1) Technique An intraumbilical vertical incision about 1 cm in length was performed and a 10 mm trocar was inserted. Pneumoperitoneum was obtained and 5 mm 0-degree laparoscope was introduced. The abdominal cavity was carefully inspected. After the trocar was removed, fascia and peritoneum incision under umbilicus was extended by about 1.5 cm. An AlexisÒ wound retractor XS was inserted through the umbilicus. The wrist portion of a 6 ½ glove wrapped the wound retractor, and 3 trocars (10 mm, 5 mm,
Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S103eS157
Conclusion: Laparoscopic surgery for extrauterine pregnancies between 12 and 16 weeks is feasible.
470 Laparoscopic Adnexal Surgery in the Mid-Trimester of Pregnancy: Usage of Harmonic Scalpel and Left Upper Quadrant Approach Ramphal SR. Obstetrics and Gynaecology, University of KwaZulu-Natal, Nelson R. Mandela School of Medicine, Congella, KwaZulu-Natal, South Africa Study Objective: Feasibility of laparscopic surgery in second trimester pregnancy. Design: Descriptive study. Setting: Endoscopic unit in a university academic hospital. Patients: 11 patients in the second trimester of pregnancy. Intervention: Laparoscopic adnexal surgery. Measurements and Main Results: Laparoscopic surgery in pregnancy is infrequently performed because of concerns to both mother and fetus. Recently, with advances in technique, instrumentation and experience, there is an increasing interest in performing this type of surgery in pregnancy. All cases were operated using the Veress needle for insufflation in the left upper quadrant, followed by a 5 mm primary trocar insertion at this site. A Stortz 5 mm 0o operative laparoscope was used in all cases. Harmonic scalpel was used as the energy source for adhesiolysis, dissection and coagulation; and laparobags were used in cases of dermoids. The clinical data (all data given as averages) were as follows: age 27.4 years; BMI 27.1’ gestational age at booking 12.2 weeks and gestational age at time of surgery 18.8 weeks (range 14e24). Indications for surgery were lower abdominal pain and discomfort in 10 patients (4 had torsion) while one patient had an acute abdomen. The cyst size was 8.6 cm x 9.4 cm, duration of anaesthesia was 108 minutes and the duration of pneumoperitoneum was 92 minutes. The average gestational age at delivery of all 11 patients was 36.9 weeks and birth weight was 2.9 kg. There were no maternal, fetal or surgical complications with the surgery. Average hospital stay was 2 days. Conclusion: Laparoscopic adnexal surgery in the second trimester of pregnancy is safe and feasible with good outcomes.
471 Unusual Location for a Perforating Intra-Uterine Device Ribeiro SC, Tormena RA, Vanni D, Pereira CL, Andrade M, Baracat EC. Gynecology, School of Medicine, University of Sa˜o Paulo, Sao Paulo, Brazil Study Objective: To report the unusual location for a perforating intrauterine device. Design: Case report. Setting: A university hospital. Patients: We describe the case of a healthy 24 year old woman who had a copper IUD inserted four months after delivering her third child. She became pregnant a few months later, and the IUD could not be located through physical examination or ultra-sound. At the time of the cesarean section, the surgeon was also unable to locate it and the IUD was presumed to have been expelled. When the patient performed a pelvic Xray for an orthopedic complaint, the IUD was visualized in the pelvis. Intervention: Laparoscopy and colonoscopy revealed that it had dissected the muscularis of the colon, parallel to but not perforating the mucosa. Measurements and Main Results: As the patient was asymptomatic, a multi-specialty team opted for conservative management with close follow up. After six months, the patient remains without complaints. Conclusion: Laparoscopy is widely used in the management of perforating IUD’s. Laparotomy is justified in some cases, if the laparoscopic removal is unsuccessful. Some reports of IUD’s perforating viscera describe more aggressive approaches, including bowel resection. The unusual location seen in this case warranted more conservative management.
472 Single-Port (10mm) Hand-Assisted Laparoscopic Surgery (Transportal): Ovarian Cystectomy with a Multichannel Port e Technical Report of 2 Cases in Adolescent Roh H-J,1,8 Yoo HJ,1,8 Joo W-D,1,8 Na Y-J,2,8 Kim HG,2,8 Park SH,3,8 Sun ST,4,8 Chae HJ,5,8 Kim TG,6,8 Park JS,7,8 Jung MH.9 1Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Gyeongnam, Republic of Korea; 2Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, Gyeongnam, Republic of Korea; 3Obstetrics and Gynecology, Dong Eui Hospital, Busan, Republic of Korea; 4Obstetrics and Gynecology, Jamo Women’s Hospital, Busan, Republic of Korea; 5Obstetrics and Gynecology, Maryknoll Hospital, Busan, Republic of Korea; 6Obstetrics and Gynecology, Wallace Memorial Baptist Hospital, Busan, Republic of Korea; 7Obstetrics and Gynecology, Changwon Fatima Hospital, Changwon, Republic of Korea; 8Obstetrics and Gynecology, Busan Gyeongnam Gynecologic Endoscopy Group, Yangsan, Gyeongnam, Republic of Korea; 9Obstetrics and Gynecology, Kyung Hee University, School of Medicine, Kyung Hee Medical Center, Seoul, Republic of Korea Study Objective: To present the feasibility and technique of the single port hand-assisted laparoscopic surgery in benign ovarian tumor. Design: Technical reports of single-port hand assisted laparoscopic cystectomy between February and March 2009. Setting: University of Ulsan College of Medicine, Ulsan University Hospital. Patients: I e 17 years old virgin, 10 cm benign paraovarian cyst II e 14 years old virgin, 15 cm mature cystic teratoma. Intervention: Single-port hand-assisted laparoscopic ovarian cystectomy. Measurements and Main Results: 1) Technique An intraumbilical vertical incision about 1 cm in length was performed and a 10 mm trocar was inserted. Pneumoperitoneum was obtained and 5 mm 0-degree laparoscope was introduced. The abdominal cavity was carefully inspected. After the trocar was removed, fascia and peritoneum incision under umbilicus was extended by about 1.5 cm. An AlexisÒ wound retractor XS was inserted through the umbilicus. The wrist portion of a 6 ½ glove wrapped the wound retractor, and 3 trocars (10 mm, 5 mm,