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Laparoscopic Findings and Pitfalls for the Treatment of Rectal Endometriosis
S98
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S90–S108
Surgical system was employed to perform the dissection by a PGY-IV resident. Result: Patient underwent the procedure without any complications. EBL 200 cc. Total operative time was 150 minutes. Patient had complete resolution of pelvic pain post-operatively. Conclusion: With the increased visualization and precise dissection capability of the robotic surgical system, pelvic sidewall dissection can be performed safely and effectively for significant pelvic adhesive disease.
329
Video Session 9dLaparoscopic Management of Endometriosis and Pelvic Pain (4:13 PM d 4:20 PM)
Total Laparoscopic Hysterectomy with Bowel Resection Veeraswamy A, Lewis M, Kotikela S, Nezhat C. Center for Minimally Invasive Surgery, Palo Alto, California; Stanford Hospital & Clinics, Palo Alto, California Patient is in her 40s G2 P2 reffered with H/O endometriosis with bowel involvement. Presented with Chronic pelvic pain, dysmenorrhea, with painful bowel movements associated with hematochezia & narrow stools. Prior h/o of LSC X 2 for treatment of endometriosis, cesarean section X 2. Pre-op evaluation- complex right adnexal cyst and multicystic left ovary. CT scan in addition documented thickening of the sigmoid colon. On colonoscopy external pressure @23cms from anal verge with brownish discoloration ofmucosa and nodularity, hard to pass beyond the point. Biopsy of colonic mucosa -melanosis coli. On Laparoscopy severe bowel intestinal adhesions with stricture of the bowel was noted.Culdesac completely obliterated. Part of right adenexa visualized and the left adnexa was enclosed in bowel adhesions.
330
Video Session 9dLaparoscopic Management of Endometriosis and Pelvic Pain (4:21 PM d 4:29 PM)
Hernia Uterine Inguinale: An Uncommon Cause of Pelvic Pain in the Adult Female Patient Mandel DC,1 Beste T,1 Hope W.2 1Dept of Ob/Gyn Residency Program, New Hanover Regional Medical Center, Wilmington, North Carolina; 2 Dept of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina Hernia Uterine Inguinale (HUI) is a rare inguinal hernia that contains uterine tissue. It is most commonly reported in the phenotypically normal male infant, presenting with asymptomatic, palpable inguinal mass. It is rarely seen in the female gender in either child or adult, and has not been reported as a cause of pelvic pain. Methods: Case Report/Literature Review. Results: We present a 24yo female with chronic pelvic pain and pelvic mass. Laparoscopy revealed HUI of a rudimentary uterine horn, and excision conferred pain resolution. HUI is rare with only 12 cases previously reported in the female gender, few of these in adults. Conclusions: HUI has not previously been reported as a cause of pelvic pain. Due to the emotional/financial burden of chronic pelvic pain, HUI should be considered as a possible etiology. Radiologic imaging and laparoscopy as useful adjuncts in diagnosis and treatment of pelvic pain caused by HUI.
331
Video Session 9dLaparoscopic Management of Endometriosis and Pelvic Pain (4:30 PM d 4:38 PM)
Laparoscopic Technique for Removal of a Retroperitoneal Pubic Bone Mucinous Cystadenoma Catenacci M, Goldberg JM. OB/GYN, Cleveland Clinic Foundation, Cleveland, Ohio A retroperitoneal cyst can be misdiagnosed as adnexal in origin during both pre-operative exam and ultrasonography. MRI and CT scan can be used to help better characterize these cysts, however, these imaging modalities
may also be misleading. Diagnosis of a retroperitoneal cyst may not be made until the time of surgery. If encountered, removal is warranted for pathologic diagnosis. We have demonstrated in this video and interesting case of a retroperitoneal pubic bone mucinous cystadenoma originally thought to be adnexal in origin during pre-operative evaluation. The patient underwent a diagnostic laparoscopy for chronic right lower quadrant pain and suspected right hydrosalpinx. However, adnexal structures were normal on operative inspection, and a retroperitoneal bulge was found. The cystic mass was removed and the patient recovered well from surgery. This video demonstrates the laparoscopic technique for removal of a retroperitoneal pubic bone mass.
332
Video Session 9dLaparoscopic Management of Endometriosis and Pelvic Pain (4:39 PM d 4:47 PM)
Laparoscopic Findings and Pitfalls for the Treatment of Rectal Endometriosis Abrao MS, Podgaec S, Bellelis P, Dias Junior JA, Averbach M. Hospital Sı´rio Libaneˆs (HSL), Sa˜o Paulo, SP, Brazil Endometriosis is a frequent disease. The rectal envolviment occurs in about 6-30% of the cases. This video shows the laparoscopic approach of rectal endometriosis, showing the most commom types of lesions and how to address them.
333
Video Session 9dLaparoscopic Management of Endometriosis and Pelvic Pain (4:48 PM d 4:55 PM)
Surgical Strategy for the Treatment of Deep Endometriosis Barata S, Nassif J, Gabriel B, Trompoukis P, Wattiez A. Gynecology, IRCAD/EITS, Strasbourg, Bas Rhin, France Deep endometriosis is characterized by infiltrated lesions in the retroperitoneal space or in pelvic organs wall. Usually it gives anatomical distortion of the pelvis, retraction and adhesions. Surgical treatment of deep endometriosis is not an easy procedure and should be performed by surgeons which know all the disease and how to deal with it. For a good surgical treatment of deep endometriosis, we think that we must have a surgical strategy in order to remove all the endometriotic lesions as possible to obtain the relief of the symptoms. In this video we show our surgical strategy for treatment of deep endometriosis. We present all our surgical steps and the reasons of each one.
334
Video Session 9dLaparoscopic Management of Endometriosis and Pelvic Pain (4:56 PM d 5:04 PM)
Robotic Assisted Laparoscopic Segmental Bladder Resection for Infiltrative Endometriosis Nezhat C, Lewis M, Veeraswamy A, Kotikela S. Center for Minimally Invasive and Robotic Surgery, Palo Alto, California Bladder involvement accounts for ninety percent of urinary tract endometriosis. Recognition is often delayed and without surgical management can lead to urinary obstruction and incontinence. This video demonstrates robotic assisted laparoscopic segmental bladder resection for infiltrative endometriosis. 335
Video Session 9dLaparoscopic Management of Endometriosis and Pelvic Pain (5:05 PM d 5:13 PM)
Laparoscopic Excision of Ovarian Remnant: Two Cases Demonstrating Ligation of the Uterine Artery at Its Origin Arden D, Lee T. Division of Minimally Invasive Gynecologic Surgery in the Department of Obstetrics, Gynecology and Reproductive Sciences,
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S90–S108
Surgical system was employed to perform the dissection by a PGY-IV resident. Result: Patient underwent the procedure without any complications. EBL 200 cc. Total operative time was 150 minutes. Patient had complete resolution of pelvic pain post-operatively. Conclusion: With the increased visualization and precise dissection capability of the robotic surgical system, pelvic sidewall dissection can be performed safely and effectively for significant pelvic adhesive disease.
329
Video Session 9dLaparoscopic Management of Endometriosis and Pelvic Pain (4:13 PM d 4:20 PM)
Total Laparoscopic Hysterectomy with Bowel Resection Veeraswamy A, Lewis M, Kotikela S, Nezhat C. Center for Minimally Invasive Surgery, Palo Alto, California; Stanford Hospital & Clinics, Palo Alto, California Patient is in her 40s G2 P2 reffered with H/O endometriosis with bowel involvement. Presented with Chronic pelvic pain, dysmenorrhea, with painful bowel movements associated with hematochezia & narrow stools. Prior h/o of LSC X 2 for treatment of endometriosis, cesarean section X 2. Pre-op evaluation- complex right adnexal cyst and multicystic left ovary. CT scan in addition documented thickening of the sigmoid colon. On colonoscopy external pressure @23cms from anal verge with brownish discoloration ofmucosa and nodularity, hard to pass beyond the point. Biopsy of colonic mucosa -melanosis coli. On Laparoscopy severe bowel intestinal adhesions with stricture of the bowel was noted.Culdesac completely obliterated. Part of right adenexa visualized and the left adnexa was enclosed in bowel adhesions.
330
Video Session 9dLaparoscopic Management of Endometriosis and Pelvic Pain (4:21 PM d 4:29 PM)
Hernia Uterine Inguinale: An Uncommon Cause of Pelvic Pain in the Adult Female Patient Mandel DC,1 Beste T,1 Hope W.2 1Dept of Ob/Gyn Residency Program, New Hanover Regional Medical Center, Wilmington, North Carolina; 2 Dept of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina Hernia Uterine Inguinale (HUI) is a rare inguinal hernia that contains uterine tissue. It is most commonly reported in the phenotypically normal male infant, presenting with asymptomatic, palpable inguinal mass. It is rarely seen in the female gender in either child or adult, and has not been reported as a cause of pelvic pain. Methods: Case Report/Literature Review. Results: We present a 24yo female with chronic pelvic pain and pelvic mass. Laparoscopy revealed HUI of a rudimentary uterine horn, and excision conferred pain resolution. HUI is rare with only 12 cases previously reported in the female gender, few of these in adults. Conclusions: HUI has not previously been reported as a cause of pelvic pain. Due to the emotional/financial burden of chronic pelvic pain, HUI should be considered as a possible etiology. Radiologic imaging and laparoscopy as useful adjuncts in diagnosis and treatment of pelvic pain caused by HUI.
331
Video Session 9dLaparoscopic Management of Endometriosis and Pelvic Pain (4:30 PM d 4:38 PM)
Laparoscopic Technique for Removal of a Retroperitoneal Pubic Bone Mucinous Cystadenoma Catenacci M, Goldberg JM. OB/GYN, Cleveland Clinic Foundation, Cleveland, Ohio A retroperitoneal cyst can be misdiagnosed as adnexal in origin during both pre-operative exam and ultrasonography. MRI and CT scan can be used to help better characterize these cysts, however, these imaging modalities
may also be misleading. Diagnosis of a retroperitoneal cyst may not be made until the time of surgery. If encountered, removal is warranted for pathologic diagnosis. We have demonstrated in this video and interesting case of a retroperitoneal pubic bone mucinous cystadenoma originally thought to be adnexal in origin during pre-operative evaluation. The patient underwent a diagnostic laparoscopy for chronic right lower quadrant pain and suspected right hydrosalpinx. However, adnexal structures were normal on operative inspection, and a retroperitoneal bulge was found. The cystic mass was removed and the patient recovered well from surgery. This video demonstrates the laparoscopic technique for removal of a retroperitoneal pubic bone mass.
332
Video Session 9dLaparoscopic Management of Endometriosis and Pelvic Pain (4:39 PM d 4:47 PM)
Laparoscopic Findings and Pitfalls for the Treatment of Rectal Endometriosis Abrao MS, Podgaec S, Bellelis P, Dias Junior JA, Averbach M. Hospital Sı´rio Libaneˆs (HSL), Sa˜o Paulo, SP, Brazil Endometriosis is a frequent disease. The rectal envolviment occurs in about 6-30% of the cases. This video shows the laparoscopic approach of rectal endometriosis, showing the most commom types of lesions and how to address them.
333
Video Session 9dLaparoscopic Management of Endometriosis and Pelvic Pain (4:48 PM d 4:55 PM)
Surgical Strategy for the Treatment of Deep Endometriosis Barata S, Nassif J, Gabriel B, Trompoukis P, Wattiez A. Gynecology, IRCAD/EITS, Strasbourg, Bas Rhin, France Deep endometriosis is characterized by infiltrated lesions in the retroperitoneal space or in pelvic organs wall. Usually it gives anatomical distortion of the pelvis, retraction and adhesions. Surgical treatment of deep endometriosis is not an easy procedure and should be performed by surgeons which know all the disease and how to deal with it. For a good surgical treatment of deep endometriosis, we think that we must have a surgical strategy in order to remove all the endometriotic lesions as possible to obtain the relief of the symptoms. In this video we show our surgical strategy for treatment of deep endometriosis. We present all our surgical steps and the reasons of each one.
334
Video Session 9dLaparoscopic Management of Endometriosis and Pelvic Pain (4:56 PM d 5:04 PM)
Robotic Assisted Laparoscopic Segmental Bladder Resection for Infiltrative Endometriosis Nezhat C, Lewis M, Veeraswamy A, Kotikela S. Center for Minimally Invasive and Robotic Surgery, Palo Alto, California Bladder involvement accounts for ninety percent of urinary tract endometriosis. Recognition is often delayed and without surgical management can lead to urinary obstruction and incontinence. This video demonstrates robotic assisted laparoscopic segmental bladder resection for infiltrative endometriosis. 335
Video Session 9dLaparoscopic Management of Endometriosis and Pelvic Pain (5:05 PM d 5:13 PM)
Laparoscopic Excision of Ovarian Remnant: Two Cases Demonstrating Ligation of the Uterine Artery at Its Origin Arden D, Lee T. Division of Minimally Invasive Gynecologic Surgery in the Department of Obstetrics, Gynecology and Reproductive Sciences,