Laparoscopic Cerclage in Pregnancy

Laparoscopic Cerclage in Pregnancy

S80 Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S69–S89 underwent LH were compared by non-parametric statistical analysis with th...

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S80

Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S69–S89

underwent LH were compared by non-parametric statistical analysis with those who submitted to LM. Measurements and Main Results: Women who underwent LH were older, had higher parity and were less likely to suffer infertility than those who chose LM. Median LH operative time of 223 minutes [214-241]) was longer than for LM (188 minutes [154-238], p=0.02). However, we found no difference between the 2 groups in terms of blood loss, hospital stay and short-term complications. Similar morbidity and impact on QOL resulted from both procedures. Conclusion: LM is a viable option to LH, with shorter operative time and similar morbidity and impact on QOL for women with symptomatic leiomyomas who want conservative surgery.

achieve pregnancy through more traditional, cost-effective and highly successful treatments. Our experience with both IVF-ET and tubal reconstructive surgery has definitely taught us that the first approach to tubal factor infertility should be surgical, at which time the tubes can be either repaired or removed. Cases of hydrosalpinges (as seen in this presentation) should be treated by fimbrioplasty, preferably laparoscopically, in all cases where preservation of mucosal integrity is demonstrated during surgery, irrespective of size, anatomic distortion, or presence of extensive pelvic adhesions. In our hands, laparoscopic fimbrioplasty in properly selected cases, consistently produces pregnancy rates that equal or exceed those attained by IVF-ET. 263

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Open Communications 16dHysterectomy (3:09 PM d 3:14 PM)

Retrospective Analysis of 283 Consecutive Cases of Total Laparoscopic Hysterectomies for Uteri Weighting More Than 500g Roviglione G,1 Ceccaroni M,1 Clarizia R,1,2 Bruni F,1 Pontrelli G,3 Minelli L.3 1Gynecologic Oncology Division, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy; 2 Obsterics and Gynecology, University of Naples ‘‘Federico II’’, Naples, Italy; 3Obstetrics and Gynecology, European School of Gynecologic Endoscopy, Sacred Heart Hospital, Negrar, Verona, Italy Study Objective: To assess the efficacy and safety of Total Laparoscopic Hysterectomy (TLH) in case of uteri weighting more than 500g. Design: Retrospective analysis of 1532 consecutive cases of TLH performed in European Gynaecology Endoscopy School, Sacred Heart Hospital of Negrar, Verona, Italy, from January 2003 to April 2010. Setting: Inpatient operations with CO2 laparoscopy with laparoscopic bipolar coagulation of uterine vessels and vaginal extraction of the uterus. Patients: Two hundred eighty three women (median age 48 yrs, range 3180) undergone TLH with uterus weighting more than 500g. Intervention: Total Laparoscopic Hysterectomy +/- mono-bilateral adnexectomy. Measurements and Main Results: Of the 283 patients analyzed, the median weight was 787g, with a range of 510-3030g. Nine procedures (3%) were converted to laparotomy for technical difficulties. Median Estimated Blood Loss was 210ml (Range 10-2400ml) whereas median Operative Time was 140 min (Range 45-480min). Intra-operative complications occurred in 11 patients (3,8%) of which 5 patients had hemorrhage and 4 lesion to the bladder or ureter. Morcellation of the uterus was usually performed laparoscopically while in 24 cases (8,4%) it was performed vaginally. 99,2% of TLH were performed for benign indications. Median hospital stay was 4,2 days (range 2-10). Postoperative early minor complications occurred in 16.2%, late complications in 8,8%; full well-being recovery was recorded in all 283 patients who came to the 4-week follow-up. Conclusion: With expert hands, adequate technique and instrumentation, TLH has shown to be a safe and effective treatment even in case of enlarged uterus, avoiding laparotomic incision in almost all cases, with clear benefits for the patients.

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Video Session 7dInfertility Surgery and Surgery during Pregnancy (2:15 PM d 2:23 PM)

Laparoscopic Fimbrioplasty Song JY,1,2,3,4 Rana N,4 Rotman C.4 1Women’s Health, TLC Medical Group, S.C., St. Charles, Illinois; 2Minimally Invasive Surgery, Delnor Hospital, Geneva, Illinois; 3Obstetrics and Gynecology, Rush University Medical Center, Chicago, Illinois; 4Oak Brook Institute of Endoscopy, Chicago, Illinois The introduction of IVF-ET resulted in a worldwide decline of tubal reconstructive surgery. A ‘‘why bother’’ attitude towards surgery has unfortunately resulted in scores of patients not being given the chance to

Video Session 7dInfertility Surgery and Surgery during Pregnancy (2:24 PM d 2:32 PM)

Overcoming the Surgical Challenges of Laparoscopic Tubal Anastomosis Song JY,1,2,3,4 Sueldo C,4 Rotman C.4 1Women’s Health, TLC Medical Group, S.C., St. Charles, Illinois; 2Minimally Invasive Surgery, Delnor Hospital, Geneva, Illinois; 3Obstetrics and Gynecology, Rush University Medical Center, Chicago, Illinois; 4Oak Brook Institute of Endoscopy, Chicago, Illinois The introduction of a tubal stent via cannulation has greatly facilitated the performance of our laparoscopic tubal anastomosis. This method however, requires retrograde introduction of an atraumatic grasper to pull the stent through the distal segment to complete the cannulation. This step can be challenging when dealing with a long and tortuous distal segment. We describe a new technique of cannulating the distal segment with a new instrumentation which has shown to be highly successful in our last 50 cases. A laparoscopic tubal anastomosis is performed showing side-by-side, our standard and new technique. 264

Video Session 7dInfertility Surgery and Surgery during Pregnancy (2:33 PM d 2:41 PM)

Laparoscopic Cerclage in Pregnancy Askari R, Ghomi A. Gynecology-Obstetrics, University at Buffalo, SUNY, Buffalo, New York A patient with incompetent cervix at 12 weeks gestation, in whom a vaginal cerclage is not technically possible, is ill advised, and an opportunity for an interval laparoscopic trans-abdominal cervical cerclage (LTCC) is missed. The patient is then faced with a decision to undergo a LTCC during pregnancy. Indications for transabdominal cerclage have been described in detail, with the two most common being a severely foreshortened cervix disallowing trans-vaginal cerclage and previous failed trans-vaginal cerclage in prior pregnancy. The indications remain the same for the laparoscopic approach to trans-abdominal cerclage. Laparoscopic cerclage offers the benefits of reduced hospital stay and a faster recovery. Although the basic concept of performing LTCC remains the same during pregnancy as opposed to as an interval procedure, the gravid uterus and the absence of a trans-cervical uterine manipulator poses unique challenges. We herein present and describe the technique for a LTCC in pregnancy.

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Video Session 7dInfertility Surgery and Surgery during Pregnancy (2:42 PM d 2:45 PM)

Severe Asherman’s Syndrome and Amenorrhea Myers EM, Hurst B. OBGYN Reproductive Endocrinology, Carolinas Medical Center, Charlotte, North Carolina In patients with Asherman’s syndrome, standardized postoperative treatment after hysteroscopic lysis of adhesions with sequential use of an intrauterine foley balloon and copper intrauterine device may increase pregnancy rates.