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Laparoscopic Excision of Huge Bladder Base Endometrioma Near Trigone Originated from Cesarean Scar Defect
Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201 with serum CA-125 level in menstruation > 35 IU/mL, had a Δ CA-125 less than 8.5 IU/mL. The specificity of this test was 100%. Comparison of Controls and Patients with DIE in menstrual and mid-cycle phases using 35 IU/ml as a cutoff of CA-125 CA-125 Controls (n=20) DIE (n=34) Total Both negatives a Both positives b Menstrual Positive Only Total
19 0 1 20
5 18 11 34
24 18 12 54
DIE = Deep Infiltrative Endometriosis. a - menstrual and mid-cycle phases (CA-125 <35 IU/ml). b - menstrual and mid-cycle phases (CA-125 >35 IU/ml); (p <.00001). Conclusion: CA-125 may be useful for the diagnosis of deep endometriosis, especially when both are collected during menstruation and in midcycle. Multicentric studies with larger samples should be performed to better evaluate the cost-effectiveness of measuring CA-125 in two different phases of the menstrual cycle.
S113
Bladder endometrioma is relative rare, and may be originated from retrograde menstruation implant, direct extension from uterine adenomyosis, metaplasia, or from iatrogenic route (such as direct invasion from Cesarean section scar defect). We present this unusual case with huge bladder base endometrioma near bladder trigone originated from previous Cesarean scar defect, extended anteriorly and laterally all the way to left inguinal area. After careful development of left retroperitoneal space and complete ureterolysis, bladder trigone was exposed, and entire anterior deep infiltrating endometriosis mass was mobilized. An en-bloc excision (full-thickness partial cystectomy) was performed, removing the left half of bladder (including cutting down the left superior vesical artery), while preserving the trigone area and both ureters. 2-layer watertight suture was applied to repair the bladder wound. Although the bladder had being halved, with small bladder capacity immediately after operation, bladder capacity can reach 350 cc 3 months after the surgery.
337
Virtual Posters – Session 1 (9:45 AM - 10:45 AM) 10:03 AM – STATION C
Laparoscopic Low Anterior Resection for Bowel Endometriosis Using a Natural Orifice Lee CE,1 Leyland NA2. 1Obstetrics, Gynecology & Reproductive Sciences, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; 2 Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada A 31-year-old nulligravid women presented to the minimally invasive gynecology clinic with a longstanding history of dysmenorrhea, dyschezia, and constipation. She had a previous laparoscopic procedure where she was diagnosed with stage IV endometriosis. Following extensive investigations and imaging, a large endometriotic tumor was found involving the rectosigmoid and rectovaginal septum with invasion into the vagina. A preoperative colonoscopy revealed intrinsic compression of the rectosigmoid junction, presumably secondary to the pelvic mass. We demonstrate the feasibility of a laparoscopic low anterior resection of bowel endometriosis using a natural orifice technique.
338
Virtual Posters – Session 1 (9:45 AM - 10:45 AM) 10:03 AM – STATION D
Laparoscopic Management of Abdominal Wall Endometriosis Piszczek C,1 Mittal P,2 Fogelson N3. 1Minimally Invasive Gynecology, Legacy Health System, Portland, Oregon2Radiology, Emory University, Atlanta, Georgia; 3Pearl Surgicenter, Portland, Oregon
335 Abstract Withdrawn
336
Virtual Posters – Session 1 (9:45 AM - 10:45 AM) 10:03 AM – STATION B
Laparoscopic Excision of Huge Bladder Base Endometrioma Near Trigone Originated from Cesarean Scar Defect Sun C-H. Ob/Gyn, Lucina Women & Children Hospital, Kaohsiung City, Kaohsiung, Taiwan
Objective: To demonstrate a case of complex AWE with laparoscopic management. Case: 38 year old G1P1 with persistent left abdominal wall pain following resection of AWE. Patient’s pain started in 2013, three months following a robotic SCH with uncontained power morcellation. A mass overlying the left iliac arty was removed and found to be an endometrioma. Pain continued. A laparotomy with excision of AWE was performed. Pain persisted. The patient presented to our clinic. MRI images read by an expert suggested two sites of AWE, both at sites of robotic ports from the initial hysterectomy. Our video showcases the robotic resection of AWE. Results: Pathology returned with endometriosis at both sites. The patient’s pain resolved following surgery. Conclusion: In this case, the likely mechanism of disease is AWE seeded during uncontained power morcellation. AWE can be managed laparoscopically in select cases. Expert radiology review can increase sensitivity of AWE detection.
19 0 1 20
5 18 11 34
24 18 12 54
DIE = Deep Infiltrative Endometriosis. a - menstrual and mid-cycle phases (CA-125 <35 IU/ml). b - menstrual and mid-cycle phases (CA-125 >35 IU/ml); (p <.00001). Conclusion: CA-125 may be useful for the diagnosis of deep endometriosis, especially when both are collected during menstruation and in midcycle. Multicentric studies with larger samples should be performed to better evaluate the cost-effectiveness of measuring CA-125 in two different phases of the menstrual cycle.
S113
Bladder endometrioma is relative rare, and may be originated from retrograde menstruation implant, direct extension from uterine adenomyosis, metaplasia, or from iatrogenic route (such as direct invasion from Cesarean section scar defect). We present this unusual case with huge bladder base endometrioma near bladder trigone originated from previous Cesarean scar defect, extended anteriorly and laterally all the way to left inguinal area. After careful development of left retroperitoneal space and complete ureterolysis, bladder trigone was exposed, and entire anterior deep infiltrating endometriosis mass was mobilized. An en-bloc excision (full-thickness partial cystectomy) was performed, removing the left half of bladder (including cutting down the left superior vesical artery), while preserving the trigone area and both ureters. 2-layer watertight suture was applied to repair the bladder wound. Although the bladder had being halved, with small bladder capacity immediately after operation, bladder capacity can reach 350 cc 3 months after the surgery.
337
Virtual Posters – Session 1 (9:45 AM - 10:45 AM) 10:03 AM – STATION C
Laparoscopic Low Anterior Resection for Bowel Endometriosis Using a Natural Orifice Lee CE,1 Leyland NA2. 1Obstetrics, Gynecology & Reproductive Sciences, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; 2 Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada A 31-year-old nulligravid women presented to the minimally invasive gynecology clinic with a longstanding history of dysmenorrhea, dyschezia, and constipation. She had a previous laparoscopic procedure where she was diagnosed with stage IV endometriosis. Following extensive investigations and imaging, a large endometriotic tumor was found involving the rectosigmoid and rectovaginal septum with invasion into the vagina. A preoperative colonoscopy revealed intrinsic compression of the rectosigmoid junction, presumably secondary to the pelvic mass. We demonstrate the feasibility of a laparoscopic low anterior resection of bowel endometriosis using a natural orifice technique.
338
Virtual Posters – Session 1 (9:45 AM - 10:45 AM) 10:03 AM – STATION D
Laparoscopic Management of Abdominal Wall Endometriosis Piszczek C,1 Mittal P,2 Fogelson N3. 1Minimally Invasive Gynecology, Legacy Health System, Portland, Oregon2Radiology, Emory University, Atlanta, Georgia; 3Pearl Surgicenter, Portland, Oregon
335 Abstract Withdrawn
336
Virtual Posters – Session 1 (9:45 AM - 10:45 AM) 10:03 AM – STATION B
Laparoscopic Excision of Huge Bladder Base Endometrioma Near Trigone Originated from Cesarean Scar Defect Sun C-H. Ob/Gyn, Lucina Women & Children Hospital, Kaohsiung City, Kaohsiung, Taiwan
Objective: To demonstrate a case of complex AWE with laparoscopic management. Case: 38 year old G1P1 with persistent left abdominal wall pain following resection of AWE. Patient’s pain started in 2013, three months following a robotic SCH with uncontained power morcellation. A mass overlying the left iliac arty was removed and found to be an endometrioma. Pain continued. A laparotomy with excision of AWE was performed. Pain persisted. The patient presented to our clinic. MRI images read by an expert suggested two sites of AWE, both at sites of robotic ports from the initial hysterectomy. Our video showcases the robotic resection of AWE. Results: Pathology returned with endometriosis at both sites. The patient’s pain resolved following surgery. Conclusion: In this case, the likely mechanism of disease is AWE seeded during uncontained power morcellation. AWE can be managed laparoscopically in select cases. Expert radiology review can increase sensitivity of AWE detection.