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Laparoscopic Approach and Surgical Tactic for Deep Endometriosis
S140
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
453 Rectosigmoid Segmental Resection and Reanastamosis for Invasive Endometriosis Fatehchehr S, Macik P, Sinervo K. Center for Endometriosis Care, Atlanta, Georgia Incident of bowel Endometriosis: 3-37%; Symptoms: Painful bowel movements, constipation, diarrhea, alternating constipation and diarrhea, intestinal cramping, nausea and/or vomiting, abdominal pain, rectal pain, rectal bleeding, appendicitis. 90% the rectum or sigmoid colon are involved; Multidisciplinary laparoscopic treatment of extensive bowel endometriosis is standard of care; Indication for bowel resection: Invasion of more than 50% of the bowel circumference, multiple nodules, or nodules larger than 3 cm; Complications: Anastomotic leakages 0.7-1.5%, Pelvic abscesses 0.3%, and rectovaginal fistulae 0.7-2.7%; Recurrence rate after bowel resection in 2 years: 4.7-25%; The cumulative pregnancy rate after bowel resection: Conclusion: Multidisciplinary minimally invasive laparoscopic excision and resection of extensive bowel endometriosis is standard of care and has better treatment outcomes, therefore is recommended segmental resection of the invasive bowel endometriosis can be safely performed in multidisciplinary context at the tertiary center depending on the number of the lesions, size and the location of the lesions.
454 Laparoscopic Approach and Surgical Tactic for Deep Endometriosis Jorge CE,1 Kehdi IP,1 Gagliardi AM,1 Carvalho RG,1 Silva AS.2 1 SCOPE, S~ ao Paulo, Brazil; 2UNISA, S~ao Paulo, Brazil
Study Objective: To demonstrate the surgical technique of double discoid resection in deep intestinal endometriosis. Design: Case report (Canadian Task Force Classification III). Setting: A private practice hospital in Curitiba, Brazil. Patient: A 31 year-old woman with a bulky endometriotic lesion measuring 40mm and affecting the retrocervical area, the uterosacral ligaments, the posterior vaginal fornix and the anterior rectal wall 7cm distant from the anal verge. Intervention: Full thickness anterior rectal wall resection was performed using the double discoid technique. Measurements & Main Results: The procedure was performed successfully in 160 minutes. Estimated blood loss was 50mL and the patient was discharged home 19 hours after the procedure. Conclusion: Double discoid resection seems to be feasible and may be an alternative technique to treat patients with big rectal nodules without the need for a segmental bowel resection. 457 Retroperitoneal Dissection of Ovarian Endometrioma Using J-Plasma Technology Parsa M. Gynecology, Mark Twain Medical Center, San Andreas, California J-Plasma technology is a new FDA approved multi-modal electrosurgical alternative to traditional mono polar, bipolar, ultrasonic or laser device. Using a helium gas plasma, it allows surgeons to cut, coagulate, fulgurate and dissect tissue with extreme precision and minimal thermal spread to surrounding tissues. The added benefits of precision and minimal lateral and depth of thermal spread may allow surgeons to more aggressively treat endometriosis lesions in close proximity to vital organs. This is a video presentation of safe retroperitoneal dissection of ovarian endometrioma densely adhered to the rectosigmoid colon. 458
Objectives: This video shows how to address profound endometriosis with intestinal invasion. This disease affects 6–10% of women in reproductive age and 40% of the affected woman feature deep endometriosis. Description: This video is an edition of several surgeries and it details the surgery in 3 steps: first the bilateral ureteral dissection, followed by the dissection of the uterosacral ligaments and resection of the lesions from these ligaments, showing just far we can go without of prejudicing the hypogastric plexus (parasympathetic nerve). Then, as the last step, we show how to open and dissect the rectovaginal septum and perform the rectosigmoidectomy. We always approach the lesions from a centripetal way. Conclusion: With the detailing of this surgical tactic in 3 practical steps, we hope to enable new surgeons to learn this procedure and perform it safely.
455 Laparoscopic Resection of Ureter and Bladder Endometriosis Yao S. Ob/Gyn Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China This video is intend to introduce laparoscopic resection of ureter and bladder endometriosis which located in the ureter bladder junction. This endometriotic lesion involve the bladder wall and cause left ureter stenosis. Hydronephrosis was found in the left kindey. Laparoscopic ureterovesical reimplantation and repair of bladder were performed. 456 Double Discoid Resection in Deep Intestinal Endometriosis Kondo W, Ribeiro R, Zomer MT, Hayashi R, Ferreira LR, Martin RL. Gynecology, Sugisawa Medical Center, Curitiba, Parana, Brazil
Single-Port Laparoscopy for Deep Infiltrating Endometriosis Surgery Sendag F,1 Akdemir A,2 Simsek D,2 Oztekin MK.2 1Obstetrics and Gynecology, Acibadem University Atakent Hospital, Istanbul, Atakent, Turkey; 2Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Bornova, Turkey Single-port laparoscopic surgery is an emerging technique and an option for improving the benefits of laparoscopic surgery. On the other hand, the single port laparoscopic surgery has some own challenges. However, despite the challenges, the current topic of interest is the use of single port laparoscopic surgery for the surgical treatment of endometriosis. Besides, initial reports have reported the feasibility of the single port laparoscopic surgery for endometriosis treatment. The use of the more advanced single access ports with single hole such as Octoport, instead of multi-channel single ports has been reported to be more feasible. Moreover, advanced optics such as flexible optics and angled optics are the potential instruments to facilitate the use of single port laparoscopic surgery. Eventually, when the advanced laparoscopic skills of the experienced surgeon merge with the aforementioned instruments, the difficulties and the challenges of single-port laparoscopic surgery will come more implementable. 459 Laparoscopic Deep Infiltrating Endometriosis Surgery With PKS OMNI Aksu S,1 Misirlioglu S,2 Taskiran C,2 Urman B.2 1Obstetrics and Gynaecology, VKF American Hospital, Istanbul, Turkey; 2Obstetrics and Gynaecology, Koc University School of Medicine, Istanbul, Turkey This video presents a laparoscopic deep infiltrating endometriosis which is include bowel and bladder endometriosis. Our case of 39-year-old nulliparous woman. She has suffered of dysmenorrhea, chronic pelvic
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
453 Rectosigmoid Segmental Resection and Reanastamosis for Invasive Endometriosis Fatehchehr S, Macik P, Sinervo K. Center for Endometriosis Care, Atlanta, Georgia Incident of bowel Endometriosis: 3-37%; Symptoms: Painful bowel movements, constipation, diarrhea, alternating constipation and diarrhea, intestinal cramping, nausea and/or vomiting, abdominal pain, rectal pain, rectal bleeding, appendicitis. 90% the rectum or sigmoid colon are involved; Multidisciplinary laparoscopic treatment of extensive bowel endometriosis is standard of care; Indication for bowel resection: Invasion of more than 50% of the bowel circumference, multiple nodules, or nodules larger than 3 cm; Complications: Anastomotic leakages 0.7-1.5%, Pelvic abscesses 0.3%, and rectovaginal fistulae 0.7-2.7%; Recurrence rate after bowel resection in 2 years: 4.7-25%; The cumulative pregnancy rate after bowel resection: Conclusion: Multidisciplinary minimally invasive laparoscopic excision and resection of extensive bowel endometriosis is standard of care and has better treatment outcomes, therefore is recommended segmental resection of the invasive bowel endometriosis can be safely performed in multidisciplinary context at the tertiary center depending on the number of the lesions, size and the location of the lesions.
454 Laparoscopic Approach and Surgical Tactic for Deep Endometriosis Jorge CE,1 Kehdi IP,1 Gagliardi AM,1 Carvalho RG,1 Silva AS.2 1 SCOPE, S~ ao Paulo, Brazil; 2UNISA, S~ao Paulo, Brazil
Study Objective: To demonstrate the surgical technique of double discoid resection in deep intestinal endometriosis. Design: Case report (Canadian Task Force Classification III). Setting: A private practice hospital in Curitiba, Brazil. Patient: A 31 year-old woman with a bulky endometriotic lesion measuring 40mm and affecting the retrocervical area, the uterosacral ligaments, the posterior vaginal fornix and the anterior rectal wall 7cm distant from the anal verge. Intervention: Full thickness anterior rectal wall resection was performed using the double discoid technique. Measurements & Main Results: The procedure was performed successfully in 160 minutes. Estimated blood loss was 50mL and the patient was discharged home 19 hours after the procedure. Conclusion: Double discoid resection seems to be feasible and may be an alternative technique to treat patients with big rectal nodules without the need for a segmental bowel resection. 457 Retroperitoneal Dissection of Ovarian Endometrioma Using J-Plasma Technology Parsa M. Gynecology, Mark Twain Medical Center, San Andreas, California J-Plasma technology is a new FDA approved multi-modal electrosurgical alternative to traditional mono polar, bipolar, ultrasonic or laser device. Using a helium gas plasma, it allows surgeons to cut, coagulate, fulgurate and dissect tissue with extreme precision and minimal thermal spread to surrounding tissues. The added benefits of precision and minimal lateral and depth of thermal spread may allow surgeons to more aggressively treat endometriosis lesions in close proximity to vital organs. This is a video presentation of safe retroperitoneal dissection of ovarian endometrioma densely adhered to the rectosigmoid colon. 458
Objectives: This video shows how to address profound endometriosis with intestinal invasion. This disease affects 6–10% of women in reproductive age and 40% of the affected woman feature deep endometriosis. Description: This video is an edition of several surgeries and it details the surgery in 3 steps: first the bilateral ureteral dissection, followed by the dissection of the uterosacral ligaments and resection of the lesions from these ligaments, showing just far we can go without of prejudicing the hypogastric plexus (parasympathetic nerve). Then, as the last step, we show how to open and dissect the rectovaginal septum and perform the rectosigmoidectomy. We always approach the lesions from a centripetal way. Conclusion: With the detailing of this surgical tactic in 3 practical steps, we hope to enable new surgeons to learn this procedure and perform it safely.
455 Laparoscopic Resection of Ureter and Bladder Endometriosis Yao S. Ob/Gyn Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China This video is intend to introduce laparoscopic resection of ureter and bladder endometriosis which located in the ureter bladder junction. This endometriotic lesion involve the bladder wall and cause left ureter stenosis. Hydronephrosis was found in the left kindey. Laparoscopic ureterovesical reimplantation and repair of bladder were performed. 456 Double Discoid Resection in Deep Intestinal Endometriosis Kondo W, Ribeiro R, Zomer MT, Hayashi R, Ferreira LR, Martin RL. Gynecology, Sugisawa Medical Center, Curitiba, Parana, Brazil
Single-Port Laparoscopy for Deep Infiltrating Endometriosis Surgery Sendag F,1 Akdemir A,2 Simsek D,2 Oztekin MK.2 1Obstetrics and Gynecology, Acibadem University Atakent Hospital, Istanbul, Atakent, Turkey; 2Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Bornova, Turkey Single-port laparoscopic surgery is an emerging technique and an option for improving the benefits of laparoscopic surgery. On the other hand, the single port laparoscopic surgery has some own challenges. However, despite the challenges, the current topic of interest is the use of single port laparoscopic surgery for the surgical treatment of endometriosis. Besides, initial reports have reported the feasibility of the single port laparoscopic surgery for endometriosis treatment. The use of the more advanced single access ports with single hole such as Octoport, instead of multi-channel single ports has been reported to be more feasible. Moreover, advanced optics such as flexible optics and angled optics are the potential instruments to facilitate the use of single port laparoscopic surgery. Eventually, when the advanced laparoscopic skills of the experienced surgeon merge with the aforementioned instruments, the difficulties and the challenges of single-port laparoscopic surgery will come more implementable. 459 Laparoscopic Deep Infiltrating Endometriosis Surgery With PKS OMNI Aksu S,1 Misirlioglu S,2 Taskiran C,2 Urman B.2 1Obstetrics and Gynaecology, VKF American Hospital, Istanbul, Turkey; 2Obstetrics and Gynaecology, Koc University School of Medicine, Istanbul, Turkey This video presents a laparoscopic deep infiltrating endometriosis which is include bowel and bladder endometriosis. Our case of 39-year-old nulliparous woman. She has suffered of dysmenorrhea, chronic pelvic