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Laparoscopic Management of Complications in Gynecological Laparoscopic Surgery: A 5-Year Experience in a Single Center
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Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159
may hamper its anesthetic effectiveness. A less toxic, long acting anesthetic may be needed for this clinical application. 241
Open Communication Session 8dHysterectomy and Advanced Laparoscopy (4:35 PM d 4:40 PM)
Laparoscopic Management of Complications in Gynecological Laparoscopic Surgery: A 5-Year Experience in a Single Center Choi JS, Kyung MS, Lee JH, Kim JS, Lee JY. Obstetrics and Gynecology, Kangbuk Samsung Hospital, Seoul, Republic of Korea Study Objective: To evaluate the feasibility and efficacy of laparoscopic management of complications without conversion to laparotomy in gynecological laparoscopic surgery. Design: Retrospective clinical study (Canadian Task Force Classification III). Setting: University teaching hospital. Patients: Two thousand six hundred sixty-eight women who underwent gynecological laparoscopic surgeries from March 2003 to February 2008. Intervention: Gynecological laparoscopic surgeries. Measurements and Main Results: We investigated major complications occurred during gynecological laparoscopic surgery. Reviewing their medical records, we reported on types of laparoscopic surgery, types of complication, early recognition of complications, and treatment method of complications. Overall 33 complications (1.24%) occurred in this study. There were 18 bladder injuries (0.67%), six major vessel injuries (0.22%), three bowel injuries (0.11%), three ureteral injuries (0.11%), two diaphragmatic injuries (0.07%), and one intravesical foreign body (0.04%). Thirty-two of 33 complications were successfully repaired laparoscopically. In one case, rectal perforation occurred on 5th day after surgery; Hartmann’s operation followed by colostomy reversal was performed. Conclusion: Laparoscopic management of complications in gynecological laparoscopic surgery is feasible and efficient. 242
Open Communication Session 8dHysterectomy and Advanced Laparoscopy (4:41 PM d 4:46 PM)
Mini-Cornual Excision: A Novel Stepwise Laparoscopic Technique for the Treatment of Cornual Pregnancy Moawad NS,1,2 Dayaratna S,1,2 Mahajan ST.1,2 1Obstetrics and Gynecology, University Hospitals Case Medical Center, MacDonald Women’s Hospital, Cleveland, Ohio; 2Obstetrics and Gynecology, Case Western Reserve University, Cleveland, Ohio
Intervention: Laparoscopic mini-cornual excision, a novel, safe, simple, stepwise approach to the minimally-invasive, definitive treatment of cornual ectopic pregnancy. Initial hemostasis is achieved with dilute vasopressin (10 IU/100 ml Normal Saline) is injected throughout the myometrial capsule, using a spinal needle introduced through the abdominal wall. Cautery is used to make a linear incision along the long axis of the mass. Gestational sac is expressed with blunt and hydrodissection and retrieved with an Endobag. After circumferential bipolar cautery is applied, an elliptical incision is made at the base of the myometrial capsule that is excised. The base is judiciously cauterized. Excellent hemostatsis noted. Procedure completed.
A minimal portion of the uterine cornua is excised, leaving most of the myometrium at the cornua, preserving the cornual architecture and achieving excellent hemostasis. Measurements and Main Results: 2 patients successfully treated with laparoscopic mini-cornual excision, with a mean operative time of 2.25 hours and estimated blood loss of 50 ml. No complications encountered. Patients discharged on the same day. Complete resolution of serum hCG is accomplished. Conclusion: Large cornual pregnancies can safely be managed through a novel stepwise laparoscopic approach, that can be performed simply and efficiently. A review of the pertinent literature is presented, with risks and benefits of different therapeutic modalities and a brief video presentation.
243 Study Objective: To describe a novel stepwise laparoscopic technique for the safe, definitive management of cornual ectopic pregnancy; Laparoscopic mini-cornual excision. Setting: Tertiary care University Women’s Hospital. Patients: 2 patients with large cornual pregnancies, one diagnosed preoperatively on transvaginal ultrasound and one diagnosed intraoperatively during laparoscopy. Both successfully treated laparoscopically with stepwise mini-cornual excision. No complications were encountered. Quantitative beta hCG resolved appropriately in less than two weeks.
Large right cornual pregnancy with a very thin myometrial mantle.
Open Communication Session 8dHysterectomy and Advanced Laparoscopy (4:47 PM d 4:52 PM)
Short and Long Term Outcome of 32 Cases of Complete Genital Prolapse Treated by Laparoscopic Sacrocolpopexy: The Experience of an Expert Surgeon Mercky J,1 Zacharopoulou C,2 Nassif J,2 Wattiez A.2 1Gynecology Department-Strasbourg University Hospitals, Hautepierre University Hospital, Strasbourg, Bas Rhin, France; 2Gynecology Department, IRCAD-EITS, Strasbourg, Bas Rhin, France Study Objective: To evaluate the personal experience of an expert in laparoscopic pelvic floor repair. Design: Retrospective mono-centric analysis. Setting: University Hospital of Strasbourg, France. Patients: 32 women treated by laparoscopy for symptomatic genital prolapse between 2004 and 2007. Intervention: Laparoscopic sacrocolpexy using anterior and posterior meshes with subtotal hysterectomy. Measurements and Main Results: Mean follow-up was 27.5 months. Mean operative time was 110 minutes without perioperative complication or laparotomy conversion. Mean hospitalization stay was 6.2 days. The patients had a mean degree of cystocele and hysterocele of 3 and rectocele of 2, according to the Baden-Walker classification. After 6 months of follow-up, we report a recurrence rate of 10,6% with 2 cases of cystocele and one of elytrocele. Three patients (10,6%) had de novo
Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159
may hamper its anesthetic effectiveness. A less toxic, long acting anesthetic may be needed for this clinical application. 241
Open Communication Session 8dHysterectomy and Advanced Laparoscopy (4:35 PM d 4:40 PM)
Laparoscopic Management of Complications in Gynecological Laparoscopic Surgery: A 5-Year Experience in a Single Center Choi JS, Kyung MS, Lee JH, Kim JS, Lee JY. Obstetrics and Gynecology, Kangbuk Samsung Hospital, Seoul, Republic of Korea Study Objective: To evaluate the feasibility and efficacy of laparoscopic management of complications without conversion to laparotomy in gynecological laparoscopic surgery. Design: Retrospective clinical study (Canadian Task Force Classification III). Setting: University teaching hospital. Patients: Two thousand six hundred sixty-eight women who underwent gynecological laparoscopic surgeries from March 2003 to February 2008. Intervention: Gynecological laparoscopic surgeries. Measurements and Main Results: We investigated major complications occurred during gynecological laparoscopic surgery. Reviewing their medical records, we reported on types of laparoscopic surgery, types of complication, early recognition of complications, and treatment method of complications. Overall 33 complications (1.24%) occurred in this study. There were 18 bladder injuries (0.67%), six major vessel injuries (0.22%), three bowel injuries (0.11%), three ureteral injuries (0.11%), two diaphragmatic injuries (0.07%), and one intravesical foreign body (0.04%). Thirty-two of 33 complications were successfully repaired laparoscopically. In one case, rectal perforation occurred on 5th day after surgery; Hartmann’s operation followed by colostomy reversal was performed. Conclusion: Laparoscopic management of complications in gynecological laparoscopic surgery is feasible and efficient. 242
Open Communication Session 8dHysterectomy and Advanced Laparoscopy (4:41 PM d 4:46 PM)
Mini-Cornual Excision: A Novel Stepwise Laparoscopic Technique for the Treatment of Cornual Pregnancy Moawad NS,1,2 Dayaratna S,1,2 Mahajan ST.1,2 1Obstetrics and Gynecology, University Hospitals Case Medical Center, MacDonald Women’s Hospital, Cleveland, Ohio; 2Obstetrics and Gynecology, Case Western Reserve University, Cleveland, Ohio
Intervention: Laparoscopic mini-cornual excision, a novel, safe, simple, stepwise approach to the minimally-invasive, definitive treatment of cornual ectopic pregnancy. Initial hemostasis is achieved with dilute vasopressin (10 IU/100 ml Normal Saline) is injected throughout the myometrial capsule, using a spinal needle introduced through the abdominal wall. Cautery is used to make a linear incision along the long axis of the mass. Gestational sac is expressed with blunt and hydrodissection and retrieved with an Endobag. After circumferential bipolar cautery is applied, an elliptical incision is made at the base of the myometrial capsule that is excised. The base is judiciously cauterized. Excellent hemostatsis noted. Procedure completed.
A minimal portion of the uterine cornua is excised, leaving most of the myometrium at the cornua, preserving the cornual architecture and achieving excellent hemostasis. Measurements and Main Results: 2 patients successfully treated with laparoscopic mini-cornual excision, with a mean operative time of 2.25 hours and estimated blood loss of 50 ml. No complications encountered. Patients discharged on the same day. Complete resolution of serum hCG is accomplished. Conclusion: Large cornual pregnancies can safely be managed through a novel stepwise laparoscopic approach, that can be performed simply and efficiently. A review of the pertinent literature is presented, with risks and benefits of different therapeutic modalities and a brief video presentation.
243 Study Objective: To describe a novel stepwise laparoscopic technique for the safe, definitive management of cornual ectopic pregnancy; Laparoscopic mini-cornual excision. Setting: Tertiary care University Women’s Hospital. Patients: 2 patients with large cornual pregnancies, one diagnosed preoperatively on transvaginal ultrasound and one diagnosed intraoperatively during laparoscopy. Both successfully treated laparoscopically with stepwise mini-cornual excision. No complications were encountered. Quantitative beta hCG resolved appropriately in less than two weeks.
Large right cornual pregnancy with a very thin myometrial mantle.
Open Communication Session 8dHysterectomy and Advanced Laparoscopy (4:47 PM d 4:52 PM)
Short and Long Term Outcome of 32 Cases of Complete Genital Prolapse Treated by Laparoscopic Sacrocolpopexy: The Experience of an Expert Surgeon Mercky J,1 Zacharopoulou C,2 Nassif J,2 Wattiez A.2 1Gynecology Department-Strasbourg University Hospitals, Hautepierre University Hospital, Strasbourg, Bas Rhin, France; 2Gynecology Department, IRCAD-EITS, Strasbourg, Bas Rhin, France Study Objective: To evaluate the personal experience of an expert in laparoscopic pelvic floor repair. Design: Retrospective mono-centric analysis. Setting: University Hospital of Strasbourg, France. Patients: 32 women treated by laparoscopy for symptomatic genital prolapse between 2004 and 2007. Intervention: Laparoscopic sacrocolpexy using anterior and posterior meshes with subtotal hysterectomy. Measurements and Main Results: Mean follow-up was 27.5 months. Mean operative time was 110 minutes without perioperative complication or laparotomy conversion. Mean hospitalization stay was 6.2 days. The patients had a mean degree of cystocele and hysterocele of 3 and rectocele of 2, according to the Baden-Walker classification. After 6 months of follow-up, we report a recurrence rate of 10,6% with 2 cases of cystocele and one of elytrocele. Three patients (10,6%) had de novo