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Laparoscopic Ovarian Transposition in a Case With Mullerian Anomaly: Providing a Chance for Successful Oocyte Retrieval and Subsequent Pregnancy
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Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
402 Resection of Diaphragmatic Endometriosis Presenting With Full Thickness Fenestrations Fatehchehr S,1 Gouldman J,2 Sinervo K.1 1Center for Endometriosis Care, Atlanta, Georgia; 2Northside Hospital, Atlanta, Georgia Introduction: Diaphragm endometriosis is rare SYMPTOMS [1,2,3] Asymptomatic chest pain RUQ pain chronic shoulder pain May/not related menstruation Thoracic endometriosis endometriosis Syndrome Catamenial pneumothorax Hemothorax Hemoptysis Presence of intrathoracic endometriotic nodules Average age: 35 years Up to 80% of patients have concomitant pelvic endometriosis [4] First described by Brews in 1954 [5] Involvement of the right side of the diaphragm occurs significantly more frequently than does involvement of the left or both sides [6] Conclusion Multidisciplinary Minimally invasive approach with laparoscopy in conjunction with thoracoscopy is recommended in diagnosis and treatment of the diaphragmatic endometriosis as well as minimizing the likelyhood of recurrence. The stapler can be used safely for adequate excision and repair of the diaphragmatic endometriosis when it is feasible.
perform some procedures such as oocyte retrieval due to failed visualization. Laparoscopic transposition of ovaries into the pelvic cavity may allow clinican to proceed with a succesfull and safe oocyte retrieval procedure. A 23 year-old nulliparous woman suffering from primary infertility was referred due to failed visualization of ovaries. Following confirmation of congenital Mullerian anomaly (ESHRE/ESGE: U3b, C0, V0; Complete Bicorporeal uterus with normal cervix), laparoscopic ovarian transposition was decided to recover pelvic anatomy. Bilateral ovaries were tracted downwards into the pelvic cavity and fixed with sacro-uterine ligaments to provide a better access during oocyte retrieval procedure. One month later, uneventful oocyte retrieval was performed following ovarian stimulation. Two embryos were transferred to each uterine cavity in subsequent frozen-thaw cycle. Currently, 19th week of single ongoing pregnancy is confirmed.
405 FDA Approved Tissue Extraction – Instrumentation and Techniques Salvay H. Ob/Gyn, Palo Alto Medical Foundation, Santa Cruz, California The FDA limitations on Power Morcellation continue to be a source of controversy. Open Extraction is an excellent alternative for these times. We will demonstrate 4 different techniques for tissue extraction and demonstrate a recently FDA approved contained extraction system that protects the skin incision and avoids tissue dissemination.
406
403
Video Session 12 - Laparoscopy (3:20 PM - 5:00 PM)
Laparoscopic Repair of a Post-Operative Para-Umbilical Incisional Hernia El Hachem L,1,2 Gretz HF III,1,2 Barr R,1 Mathews S,1,2 Chuang LC,1,2 Gordon M.1 1Minimally Invasive Gynecology, White Plains Hospital Center, White Plains, New York; 2Minimally Invasive Gynecology, Icahn School of Medicine at Mount Sinai, New York, New York This video demonstrates a technique for laparoscopic repair of a paraumbilical incisional hernia. Port-site hernia is a rare but potentially serious complication of laparoscopic or robotic surgery. The incidence increases with the size of the incision and the presence of additional risk factors for fascial weakening. Proper closure of the fascial defect is necessary to reduce this occurrence. We report the case of a 71 year-old patient who underwent laparoscopic debulking for ovarian cancer and presented 2 years later with a symptomatic umbilical incisional hernia of 6 cm. The different steps of the laparoscopic repair of the hernia using a round polypropylene mesh are described and include: port placement, lysis of adhesions, delineation of the fascial defect margins, proper positioning of the mesh and fixation of the mesh using tacks.
Standardization of Technical Procedures in Colposacropexia Laparoscopic Gynecological Endoscopy at Santa Casa De Misericordia De S~ao Paulo Costa ASC, Ferruzzi CM, Matuoka ML, Maekawa MM, Ohara F, Abdalla-Ribeiro HSA, Aldrighi JM, Ribeiro PAAG. Obstetrics and Gynecology, Santa Casa De Misericordia De Sao Paulo, Sao Paulo, Brazil Introduction: The apical prolapses is a common condition that entails big impact on quality of life. In 80 years-old pacients with genital prolapses, 11% have a cirurgial indication, and the reoperation risk is about 29%. The laparoscopic colposacropexia is considered the treatment for apical prolapsed due its low morbidity rate, lower recurrence rates and anatomical restauration capacity. This is a complex procedure that has a long learning curve and that is done by a small number of surgeons and because of that, the standardization is needed to be reproducible. Objective: Standardize the laparoscopic colposacropexia technique, held at Santa Casa de Misericordia de Sao Paulo. Conclusion: The standardization of the laparoscopic colposacropexia technique systematizes solutions for complex surgeries but it remains the treatment for apical prolapse.
407
404 Laparoscopic Ovarian Transposition in a Case With Mullerian Anomaly: Providing a Chance for Successful Oocyte Retrieval and Subsequent Pregnancy Pabuccu R, Pabuccu EG. Obstetrics and Gynecology, Ufuk University School of Medicine, Ankara, Turkey Anatomic displacement of ovaries that are observed in congenital Mullerian anomalies, not only contributes to infertility, but also limits clinicians to
Laparoscopic Rectovaginal Fistula Repair Joshi S, Gadkari Y, Kumar D, Katdare N, Parikh H. Galaxy Care Laparoscopy Institute, Pune, Maharashtra, India The objective is to demonstrate laparoscopic repair of rectovaginal fistula in a post hysterectomy patient. Detailed explanation and demonstration of each step of the surgery is shown using the video attached below. Our patient was a known case of diabetes mellitus type II and hypertension with history of faecal discharge from the vagina. Vaginal examination revealed a fistulous tract between the posterior vaginal wall and rectum.
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
402 Resection of Diaphragmatic Endometriosis Presenting With Full Thickness Fenestrations Fatehchehr S,1 Gouldman J,2 Sinervo K.1 1Center for Endometriosis Care, Atlanta, Georgia; 2Northside Hospital, Atlanta, Georgia Introduction: Diaphragm endometriosis is rare SYMPTOMS [1,2,3] Asymptomatic chest pain RUQ pain chronic shoulder pain May/not related menstruation Thoracic endometriosis endometriosis Syndrome Catamenial pneumothorax Hemothorax Hemoptysis Presence of intrathoracic endometriotic nodules Average age: 35 years Up to 80% of patients have concomitant pelvic endometriosis [4] First described by Brews in 1954 [5] Involvement of the right side of the diaphragm occurs significantly more frequently than does involvement of the left or both sides [6] Conclusion Multidisciplinary Minimally invasive approach with laparoscopy in conjunction with thoracoscopy is recommended in diagnosis and treatment of the diaphragmatic endometriosis as well as minimizing the likelyhood of recurrence. The stapler can be used safely for adequate excision and repair of the diaphragmatic endometriosis when it is feasible.
perform some procedures such as oocyte retrieval due to failed visualization. Laparoscopic transposition of ovaries into the pelvic cavity may allow clinican to proceed with a succesfull and safe oocyte retrieval procedure. A 23 year-old nulliparous woman suffering from primary infertility was referred due to failed visualization of ovaries. Following confirmation of congenital Mullerian anomaly (ESHRE/ESGE: U3b, C0, V0; Complete Bicorporeal uterus with normal cervix), laparoscopic ovarian transposition was decided to recover pelvic anatomy. Bilateral ovaries were tracted downwards into the pelvic cavity and fixed with sacro-uterine ligaments to provide a better access during oocyte retrieval procedure. One month later, uneventful oocyte retrieval was performed following ovarian stimulation. Two embryos were transferred to each uterine cavity in subsequent frozen-thaw cycle. Currently, 19th week of single ongoing pregnancy is confirmed.
405 FDA Approved Tissue Extraction – Instrumentation and Techniques Salvay H. Ob/Gyn, Palo Alto Medical Foundation, Santa Cruz, California The FDA limitations on Power Morcellation continue to be a source of controversy. Open Extraction is an excellent alternative for these times. We will demonstrate 4 different techniques for tissue extraction and demonstrate a recently FDA approved contained extraction system that protects the skin incision and avoids tissue dissemination.
406
403
Video Session 12 - Laparoscopy (3:20 PM - 5:00 PM)
Laparoscopic Repair of a Post-Operative Para-Umbilical Incisional Hernia El Hachem L,1,2 Gretz HF III,1,2 Barr R,1 Mathews S,1,2 Chuang LC,1,2 Gordon M.1 1Minimally Invasive Gynecology, White Plains Hospital Center, White Plains, New York; 2Minimally Invasive Gynecology, Icahn School of Medicine at Mount Sinai, New York, New York This video demonstrates a technique for laparoscopic repair of a paraumbilical incisional hernia. Port-site hernia is a rare but potentially serious complication of laparoscopic or robotic surgery. The incidence increases with the size of the incision and the presence of additional risk factors for fascial weakening. Proper closure of the fascial defect is necessary to reduce this occurrence. We report the case of a 71 year-old patient who underwent laparoscopic debulking for ovarian cancer and presented 2 years later with a symptomatic umbilical incisional hernia of 6 cm. The different steps of the laparoscopic repair of the hernia using a round polypropylene mesh are described and include: port placement, lysis of adhesions, delineation of the fascial defect margins, proper positioning of the mesh and fixation of the mesh using tacks.
Standardization of Technical Procedures in Colposacropexia Laparoscopic Gynecological Endoscopy at Santa Casa De Misericordia De S~ao Paulo Costa ASC, Ferruzzi CM, Matuoka ML, Maekawa MM, Ohara F, Abdalla-Ribeiro HSA, Aldrighi JM, Ribeiro PAAG. Obstetrics and Gynecology, Santa Casa De Misericordia De Sao Paulo, Sao Paulo, Brazil Introduction: The apical prolapses is a common condition that entails big impact on quality of life. In 80 years-old pacients with genital prolapses, 11% have a cirurgial indication, and the reoperation risk is about 29%. The laparoscopic colposacropexia is considered the treatment for apical prolapsed due its low morbidity rate, lower recurrence rates and anatomical restauration capacity. This is a complex procedure that has a long learning curve and that is done by a small number of surgeons and because of that, the standardization is needed to be reproducible. Objective: Standardize the laparoscopic colposacropexia technique, held at Santa Casa de Misericordia de Sao Paulo. Conclusion: The standardization of the laparoscopic colposacropexia technique systematizes solutions for complex surgeries but it remains the treatment for apical prolapse.
407
404 Laparoscopic Ovarian Transposition in a Case With Mullerian Anomaly: Providing a Chance for Successful Oocyte Retrieval and Subsequent Pregnancy Pabuccu R, Pabuccu EG. Obstetrics and Gynecology, Ufuk University School of Medicine, Ankara, Turkey Anatomic displacement of ovaries that are observed in congenital Mullerian anomalies, not only contributes to infertility, but also limits clinicians to
Laparoscopic Rectovaginal Fistula Repair Joshi S, Gadkari Y, Kumar D, Katdare N, Parikh H. Galaxy Care Laparoscopy Institute, Pune, Maharashtra, India The objective is to demonstrate laparoscopic repair of rectovaginal fistula in a post hysterectomy patient. Detailed explanation and demonstration of each step of the surgery is shown using the video attached below. Our patient was a known case of diabetes mellitus type II and hypertension with history of faecal discharge from the vagina. Vaginal examination revealed a fistulous tract between the posterior vaginal wall and rectum.