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Laparoscopic Mitrofanoff: Appendicovesicostomy Following Radical Vulvectomy
Abstracts / Journal of Minimally Invasive Gynecology 20 (2013) S1–S49 traction. Singley forceps were used to remove multiple stone fragments through the urethral defect. Urethral closure was performed in two layers with absorbable sutures. Cystourethroscopy showed bilateral ureteral patency after the procedure. A Foley catheter was left in place and removed after a normal voiding cystogram 10 days post operatively. 61
Video Session 2dUrogynecology (12:14 PM d 12:21 PM)
A Refined Technique for Anti-Incontinence Surgery Using Monarc Bosque VA, Rivero JA, Angulo AC, Araujo MD, Esposito CT. Ginecologia, Centro Medico Docente La Trinidad, La Trinidad, El Hatillo, Miranda, Venezuela The Monarc procedure offers an effective and safe treatment with a minimally invasive approach in patients with incontinence due to hypermobility and intrinsic urethral deficiency. This sling provides a midurethral support and mimicking the function of the pubocervical fascia. The erosion rate is estimated to be 0,7 a 1,3 %. the different causes that could explained this erosion are under investigation but some of the reason can be attributed to: incomplete vaginal incision, incorrect suture technique, local infection and rejection of the material. Another important aspect, is the size of the vaginal incision in order to guarantee the correct position of the sling in the mid portion of the urethra.
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Video Session 2dUrogynecology (12:22 PM d 12:30 PM)
Laparoscopic Excision of Sacrocolpopexy Mesh Chamsy D, Lee T. Minimally Invasive Gynecologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Mesh complications, such as infection and erosion, are more common following transvaginal mesh placement. They are however also encountered following abdominal and laparoscopic sacrocolpopexy. Laparoscopic excision of sacrocolpopexy mesh is a challenging procedure even in the hands of experienced surgeons, as synthetic mesh causes surrounding tissue fibrosis which can distort pelvic anatomy and put vital organs at risk of injury. This video presentation is compiled from 3 laparoscopic sacrocolpopexy excision procedures done for different indications. We will illustrate various challenges that surgeons can potentially encounter when excising mesh. We will also demonstrate surgical maneuvers and techniques to facilitate mesh excision and prevent potential complications. 63
Video Session 2dUrogynecology (12:31 PM d 12:39 PM)
Laparoscopic Mitrofanoff: Appendicovesicostomy Following Radical Vulvectomy Puntambekar S, Puntambekar S, Joshi S, Desai R, Telang M. Galaxy CARE Laparoscopy Institute, Pune, Maharashtra, India The Mitrofanoff procedure creates a conduit to the bladder, through which patients with a sensitive, absent or traumatized urethra can perform clean intermittent catheterization (CIC). We describe a case of laparoscopic Mitrofanoff procedure using reversed appendix to form a conduit. Objectives: To study feasibility of performing laparoscopic Mitrofanoff procedure in a patient post vulvectomy with urethrectomy using reversed appendix. Material and methods: 55-year-old woman with vulval cancer. Wide local excision with uretherectomy done. The appendix with its blood supply, disconnected from its base. One end inserted into the bladder, the other end brought out from the abdominal wall near the anterior superior iliac spine so that the patient can perform CIC. Bladder neck closure after two weeks. Results: Supra pubic cystostomy was removed after a week. Patient was continent and able to perform CIC after two weeks. Conclusion: The Mitrofanoff procedure with the use of reverse appendix is a technically feasible procedure.
Video Session 2dUrogynecology (12:40 PM d 12:48 PM)
Burch Colposuspension: A Non-Mesh Option for Anti-Incontinence Surgery Tunitsky-Bitton E, Kow N, Walters MD, Paraiso MFR. Obstetrics & Gynecology, Cleveland Clinic, Cleveland, Ohio Burch colposuspension has long been recognized as an effective surgical procedure for stress urinary incontinence. Traditionally described as an open procedure, this surgery can be performed utilizing a minimally invasive approach. When compared to the open procedures, laparoscopic Burch colposuspension has been shown to equally effective. The minimally invasive approach offers additional benefits, such as low perioperative complication rates, shorter hospital stay and faster return to daily activities. In light of the recent FDA warning, patients are increasingly interested in non-graft options both for treatment of primary and recurrent stress urinary incontinence. Therefore, Burch colposuspension remains an effective treatment of primary and recurrent incontinence. The objectives of this video are to illustrate anatomy pertinent for the Burch colposuspension procedure and to describe technical aspects of this surgery when performed by minimally invasive approaches. 65
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Video Session 2dUrogynecology (12:49 PM d 12:57 PM)
Rectovaginal Fistula Repair Techniques Nosti PA, Sokol AI. Obstetrics & Gynecology, Division of Female Pelvic Medicine & Reconstructive Surgery, Medstar Washington Hospital Center/ Georgetown University, Washington, District of Columbia Objective: The purpose of this video is to demonstrate two techniques for transperineal rectovaginal fistula (RVF) repair. We will also illustrate the use of a Martius flap to reinforce an RVF repair in a patient with Crohn’s disease. Description: The surgical approach to the repair of RVF is dependent upon the location and size of the fistula as well as the tissue quality. The key steps of RVF repair include wide mobilization of tissue planes, complete excision of fistulous track, multilayer tension-free closure and when applicable, sphincter repair. Conclusion: To successfully repair RVFs, the surgeon must identify the size and location of the fistula tract and its association to the sphincter. Inclusion of a Martius flap may improve outcomes in patients with poor tissue quality. In all cases, the surgeon must achieve a multilayer tension-free closure. 66 Abstract Withdrawn 67
Plenary 3dHysteroscopy (2:15 PM d 2:24 PM)
Nickel Sensibilization after Essure Sterilization Non Item Anymore? Vleugels MPH,1 van Eindhoven HWF.2 1OB/Gyn, Riverland Hospital Tiel, Malden, Gelderland, Netherlands; 2OB/Gyn, Isala Clinics, Zwolle, Gelderland, Netherlands Study Objective: Evaluation of nickel sensibilization after Essure sterilization. Design: Prospective descriptive cohort study of the impact of Essure sterilization on the nickel patch test before and three months after Essure procedure. Setting: Two Dutch non academic training hospitals in a multicenter setting. Patients: 132 healthy females, with a wish for permanent sterilization. Intervention: All patients received two patches 72 hours before Essure sterilization; one with a nickel solution in 5% petrolatum and one control patch. Reactions on the patch test were scored according the criteria for contact dermatitis (Devos 2002) and
Video Session 2dUrogynecology (12:14 PM d 12:21 PM)
A Refined Technique for Anti-Incontinence Surgery Using Monarc Bosque VA, Rivero JA, Angulo AC, Araujo MD, Esposito CT. Ginecologia, Centro Medico Docente La Trinidad, La Trinidad, El Hatillo, Miranda, Venezuela The Monarc procedure offers an effective and safe treatment with a minimally invasive approach in patients with incontinence due to hypermobility and intrinsic urethral deficiency. This sling provides a midurethral support and mimicking the function of the pubocervical fascia. The erosion rate is estimated to be 0,7 a 1,3 %. the different causes that could explained this erosion are under investigation but some of the reason can be attributed to: incomplete vaginal incision, incorrect suture technique, local infection and rejection of the material. Another important aspect, is the size of the vaginal incision in order to guarantee the correct position of the sling in the mid portion of the urethra.
64
Video Session 2dUrogynecology (12:22 PM d 12:30 PM)
Laparoscopic Excision of Sacrocolpopexy Mesh Chamsy D, Lee T. Minimally Invasive Gynecologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Mesh complications, such as infection and erosion, are more common following transvaginal mesh placement. They are however also encountered following abdominal and laparoscopic sacrocolpopexy. Laparoscopic excision of sacrocolpopexy mesh is a challenging procedure even in the hands of experienced surgeons, as synthetic mesh causes surrounding tissue fibrosis which can distort pelvic anatomy and put vital organs at risk of injury. This video presentation is compiled from 3 laparoscopic sacrocolpopexy excision procedures done for different indications. We will illustrate various challenges that surgeons can potentially encounter when excising mesh. We will also demonstrate surgical maneuvers and techniques to facilitate mesh excision and prevent potential complications. 63
Video Session 2dUrogynecology (12:31 PM d 12:39 PM)
Laparoscopic Mitrofanoff: Appendicovesicostomy Following Radical Vulvectomy Puntambekar S, Puntambekar S, Joshi S, Desai R, Telang M. Galaxy CARE Laparoscopy Institute, Pune, Maharashtra, India The Mitrofanoff procedure creates a conduit to the bladder, through which patients with a sensitive, absent or traumatized urethra can perform clean intermittent catheterization (CIC). We describe a case of laparoscopic Mitrofanoff procedure using reversed appendix to form a conduit. Objectives: To study feasibility of performing laparoscopic Mitrofanoff procedure in a patient post vulvectomy with urethrectomy using reversed appendix. Material and methods: 55-year-old woman with vulval cancer. Wide local excision with uretherectomy done. The appendix with its blood supply, disconnected from its base. One end inserted into the bladder, the other end brought out from the abdominal wall near the anterior superior iliac spine so that the patient can perform CIC. Bladder neck closure after two weeks. Results: Supra pubic cystostomy was removed after a week. Patient was continent and able to perform CIC after two weeks. Conclusion: The Mitrofanoff procedure with the use of reverse appendix is a technically feasible procedure.
Video Session 2dUrogynecology (12:40 PM d 12:48 PM)
Burch Colposuspension: A Non-Mesh Option for Anti-Incontinence Surgery Tunitsky-Bitton E, Kow N, Walters MD, Paraiso MFR. Obstetrics & Gynecology, Cleveland Clinic, Cleveland, Ohio Burch colposuspension has long been recognized as an effective surgical procedure for stress urinary incontinence. Traditionally described as an open procedure, this surgery can be performed utilizing a minimally invasive approach. When compared to the open procedures, laparoscopic Burch colposuspension has been shown to equally effective. The minimally invasive approach offers additional benefits, such as low perioperative complication rates, shorter hospital stay and faster return to daily activities. In light of the recent FDA warning, patients are increasingly interested in non-graft options both for treatment of primary and recurrent stress urinary incontinence. Therefore, Burch colposuspension remains an effective treatment of primary and recurrent incontinence. The objectives of this video are to illustrate anatomy pertinent for the Burch colposuspension procedure and to describe technical aspects of this surgery when performed by minimally invasive approaches. 65
62
S21
Video Session 2dUrogynecology (12:49 PM d 12:57 PM)
Rectovaginal Fistula Repair Techniques Nosti PA, Sokol AI. Obstetrics & Gynecology, Division of Female Pelvic Medicine & Reconstructive Surgery, Medstar Washington Hospital Center/ Georgetown University, Washington, District of Columbia Objective: The purpose of this video is to demonstrate two techniques for transperineal rectovaginal fistula (RVF) repair. We will also illustrate the use of a Martius flap to reinforce an RVF repair in a patient with Crohn’s disease. Description: The surgical approach to the repair of RVF is dependent upon the location and size of the fistula as well as the tissue quality. The key steps of RVF repair include wide mobilization of tissue planes, complete excision of fistulous track, multilayer tension-free closure and when applicable, sphincter repair. Conclusion: To successfully repair RVFs, the surgeon must identify the size and location of the fistula tract and its association to the sphincter. Inclusion of a Martius flap may improve outcomes in patients with poor tissue quality. In all cases, the surgeon must achieve a multilayer tension-free closure. 66 Abstract Withdrawn 67
Plenary 3dHysteroscopy (2:15 PM d 2:24 PM)
Nickel Sensibilization after Essure Sterilization Non Item Anymore? Vleugels MPH,1 van Eindhoven HWF.2 1OB/Gyn, Riverland Hospital Tiel, Malden, Gelderland, Netherlands; 2OB/Gyn, Isala Clinics, Zwolle, Gelderland, Netherlands Study Objective: Evaluation of nickel sensibilization after Essure sterilization. Design: Prospective descriptive cohort study of the impact of Essure sterilization on the nickel patch test before and three months after Essure procedure. Setting: Two Dutch non academic training hospitals in a multicenter setting. Patients: 132 healthy females, with a wish for permanent sterilization. Intervention: All patients received two patches 72 hours before Essure sterilization; one with a nickel solution in 5% petrolatum and one control patch. Reactions on the patch test were scored according the criteria for contact dermatitis (Devos 2002) and