Laparoscopic Diverticular Abscess With Drainage

Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253 doing saline distention of the ruptured cyst. In addition, we used millimeter by millimeter dissection, push and spread, and grasp and tenting dissection techniques. The video presents the feasibility of cyst dissection in patients with distorted pelvic anatomy by using the recommended dissection techniques and re-establishing the anatomic landmarks. 516 Laparoscopic Management of Multiple Submucousal Fibroids 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 Uterine fibroids affect as many as 80% of women during their lifetime. Often surgical management, either myomectomy or hysterectomy, is required for the treatment of uterine fibroids. These procedures could be performed via a laparotomy or utilizing minimally invasive surgical (MIS) approach. Myomectomy via hysteroscopy is the other option especially at submucousal fibroids, however laparoscopic management may be more beneficial with multiple submucousal fibroids. A 33-year-old woman with chronic pelvic pain and heavy menstrual bleeding resistant to medical therapy was referred to our clinic. At sonographic examination, more than 20 submucous fibroids with the size of 2 to 6 cm were observed. We performed laparoscopic myomectomy and removed more than 10 fibroids type 0-2 without any complication. Diagnostic hysteroscopy was performed postoperatively and 3 months later and endometrium was observed well established.

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uterine prolapse. The cure rate of which was published as high as 77-98% objectively. However, the complex procedures and the complications of the mesh hold the gynecologist back. In this video, we introduced a novel procedure, laparoscopic sacro-hystero-pexy for a 75-year-old female with obstetric history of G6P6 and pelvic organ prolapse. The polypropylene mesh was replaced by Mersilene tape. Laparoscopic Sacrohysteropexy is a feasible procedure. In a case series study with 33 patients involved published recently (JMIG, 2014), the cure rate of laparoscopic sacrohysteropexy is 100% during 6-30 months follow-up. Further largescale studies are needed for evaluation the safety and outcome. 520 Pneumo-Bag Morcellation Technique Ritter CE. MIS Gynecology, Greater Baltimore Medical Center, Towson, Maryland This video shows a reproducible technique of uterine fibroid morcellation in a large containment bag. The bag is placed through an umbilical single-port trocar. Once the specimen is contained, the bag opening is exteriorized through the umbilical port. Bag insufflation is created from side-wall to side-wall using 20 mm pressure . The pneum-bag efficiently retracts bowel away from the operative site. A 5 mm side-port is placed with a bladed, ballooned trocar to maintain a pneumo-seal. With a side-port camera, an umbilical morcellator is used with excellent visualization to morcellate the specimen efficiently and safely. All small chips are contained in the bag during the procedure. When removing the bag at the end of the procedure, the side-port balloon is deflated at the level of the umbilicus preventing any potential spillage from the side port entry.

517 521 Excision of Ectopic Adrenocortical Tissue During Laparoscopy for Pelvic Endometriosis Ferrero S,1 Vellone V,2 Biscaldi E,3 Ghirardi V,1 Bizzarri N.1 1Department of Obstetrics and Gynecology, IRCCS AOU San Martino - IST, University of Genova, Genova, GE, Italy; 2Deparment of Surgical and Diagnostic Sciences, IRCCS AOU San Martino - IST, University of Genova, Genova, GE, Italy; 3Department of Radiology, Galliera Hospital, Genova, GE, Italy A 32-year-old woman with suspected endometriosis underwent pelvic magnetic resonance imaging, which revealed a solid nodule adjacent to the right infundibulopelvic ligament with ambiguous signal not typical for endometriosis. In the axial T2-weighted fast recovery fast spin-echo image, the nodule was iso-hypointense. Laparoscopy confirmed the presence of a 1 cm distinct, soft, round, yellow retroperitoneal nodule at level of right infundibulopelvic ligament. The nodule was completely excised as first surgical action, then deep endometriosis was excised. Histology revealed that the nodule was an ectopic adrenal gland; this diagnosis was confirmed by the immunohistochemical staining (MelanA and Cromogranin A were positive while CD10 and cytokeratin 7 were negative). Ectopic adrenal tissue is thought to arise when clusters of cells separate from, or arise outside, the main body of the adrenal cortex, and then adhere to, or become associated with, the gonad or adjacent tissues. 518 Laparoscopic Repair of Rupture of Inferior Vena Cava Shi R, Tang B. Nanjing Medical University, Changzhou, Jiang Su, China Lymph node cleaning the inferior vena cava injury, laparoscopic repair. 519 Introduction of a Novel Laparoscopic Sacro-Hystero-Pexy for Uterine Prolapse Kuo H, Wu K, Lee C. Division of Gynecologic Endoscopy, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan Laparoscopic sacrocolpopexy, using a polypropylene mesh to attach the vaginal wall and anchor it to sacral promontory, has been applied for

Laparoscopic Excision of Extensive Endometriosis Infiltrating Ureter, Bladder, Recto-Sgimoid, Pelvic Sidewall and Repair of Injury to the External Iliac and Aberrant Obturator Vein Lam A, Almotrafi TA, Mangot M. Gynecology/Minimal Invasive Surgery, Centre for Advanced Reproductive Endosurgery, Sydney, NSW, Australia A case report of laparoscopic excision of extensive endometriosis infiltrating ureter, bladder, recto-sgimoid, pelvic sidewall and repair of injury to the external iliac and aberrant obturator vein in a 30 years old woman presenting with primary infertility, severe left iliac fossa pain, dysuria and dyschezia. The extensive infiltrative endometriosis caused severe distortion and obliteration of normal pelvic sidewall anatomy due to severe fibrosis resulting in injury to the external iliac vein and aberrant obturator vessel. After attempts to control the injury proved unsuccessful by vascular clips, the injury was able to be repaired using intracorporeal sutures. The remaining para-vesical, peri-ureteric and recto-sigmoid endometriosis was able to be excised successfully. Postoperatively, the patient made an uneventful recovery. While major vascular injuries during laparoscopy often require conversion to laparotomy, with appropriate surgical training, systematic response and effectivel suturing, it is possible to manage certain injuries to major vessels laparoscopically. 522 Laparoscopic Diverticular Abscess With Drainage Bossert FR, Parsons LC, Tsaltas T. Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, Chattanooga, Tennessee Evaluation and drainage of diverticular abscess at time of LAVH with subsequent evaluation for bowel fistula or communication. 523 Management of Iatrogenic Bleeder in Laparoscopy Kang S. HEBEI Tumor Hospital, HEBEI Medical University, Shijiazhuang, HeBei, China