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Laparoscopic Removal of the Essure Sterilization Device: Tips and Tricks
Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252 451 Laparoscopic Lateral Transposition of the Ovaries Rosen L,1 El Hachem L,2 Hoan K,1 Mathews S,1 Chuang LT,1 Gretz HF.1 1 Obstetrics and Gynecology, Mount Sinai Medical Center, New York, New York; 2Obstetrics and Gynecology, Lebanese American University, Beirut, Lebanon This video demonstrates the technique for laparoscopic lateral transposition of the ovaries. For patients diagnosed with malignancy, pelvic radiation therapy is associated with loss of ovarian function in more than 50% of cases with subsequent menopausal symptoms, loss of fertility, osteoporosis and cardiovascular disease. To decrease this likelihood, ovarian transposition may be offered to women of reproductive age with malignancy and planned pelvic radiotherapy. Here, we describe a laparoscopic ovarian transposition in a 31-year old female with locally advanced rectal carcinoma prior to starting radiotherapy. Key steps involve: performing a salpingectomy, dividing the utero-ovarian ligament, incising the peritoneum lateral to the infundibulopelvic ligament, dissecting the paracolic gutter, pediculization of the infundibulopelvic ligament, mobilizing the ovary above the pelvic brim, suturing it to the sidewall, marking the ovarian final position using metallic clips. When performed laparoscopically, lateral transposition of the ovaries is simple and safe and allows immediate postoperative pelvic irradiation.
From January 2005 to December 2015, 4644 patients underwent total laparoscopic hysterectomy (TLH) at our institute for benign pathology. Six of these patients underwent a reversed order TLH. We start with the initial isolation of the uterine artery and ureter to avoid urinary tract injury during the transection of the supporting tissue of the uterus. The duration of the procedure is not prolonged when compared with the standard order of the TLH procedure. The uterine weight ranged from 996gs – 4545gs. Our reversed ligament division strategy means that all supporting structures can be dissected in view without the placement of addition camera ports, making the surgery safer and more complete. 455 Laparoscopic Resection of Interstitial Ectopic Pregnancy with Placenta Percreta Samura TL, Vilkins A, Hendessi P. Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts Interstitial ectopic pregnancies occur in a more distensible portion of the fallopian tube. This location allows them to reach greater gestational ages and makes them high risk for hemorrhage. We present a case of a large interstitial ectopic pregnancy that was complicated by a placenta percreta. The patient was successfully treated via laparoscopic wedge resection. The purposes of this video are to 1) describe a laparoscopic wedge resection and 2) demonstrate management of a more complex ectopic pregnancy.
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Transvesical Bladder Fibroid Resection Saadi JM, Ubertazzi EP, Pavan LI, Noll F. Urogynecology, Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
Laparoscopic Management of Cesarean Scar Ectopic Pregnancy Yu X, Tovar R. University of Kentucky, Lexington, Kentucky
Bladder leiomyoma is a rare benign tumor and depends on its location the diagnosis could be difficult. different approaches to resect it have been reported like abdominal, laparoscopic, and transurethral. We present a case report of We present a case report of a 46 years old woman who presents for the last past years with urinary symptoms. A 4cm bladder mass that was misdiagnosed several times with cystoscopy because its location (bladder neck, in hour 6). The diagnosis was made with bladder ultrasound, dynamic MRI. Minimal invasive approach was proposed, transvesical laparoscopy without the need of cystostomy, removing the specimen transurethral. The pathologic diagnosis was leiomyoma of the bladder. 453 Laparoscopic Removal of the Essure Sterilization Device: Tips and Tricks Casey JN, Yunker AC. Minimally Invasive Gynecology and Pelvic Pain, Vanderbilt Medical Center, Nashville, Tennessee Laparoscopic removal of the EssureÒ device is a safe and effective procedure. While there are several approaches to its removal, attention to specifics related to preoperative imaging, expected radiographic findings, and intraoperative device selection will allow for improved efficiency and operative outcomes. By taking advantage of specific energy sources and transection technique, the procedure can routinely be completed in 15 minutes from initial trocar entry to final trocar removal, with complete removal of all coils. 454 Hysterectomy Techniques for Huge Fibroids- Starting with Paracervical Ligaments Andou M, Kanno K, Shirane A, Yanai S, Nakajima S. Gynecology, Kurashiki Medical Center, Kurashiki-shi, Okayama-ken, Japan We describe our reversed ligament division strategy technique for management of the division of the adnexal ligament in cases where accessibility to this ligament is made extremely difficult by anatomical distortion, obstruction and limitations of camera placement due to huge fibroids.
S147
Study Objective: Laparoscopic management of cesarean scar ectopic pregnancy. Design: Video presentation. Setting: University academic medical center. Patient: 31 yo G2P1011 with a Mirena IUD in place who was diagnosed of cesarean scar ectopic pregnancy. Intervention: Laparoscopic removal of cesarean scar ectopic pregnancy. Measurements and Main Results: A transvaginal ultrasound was used to diagnose the cesarean scar ectopic pregnancy. Laparoscopy with the assistance of cystoscopy was used to remove the ectopic pregnancy with careful dissection. IUD was removed. Pathology confirmed that the specimen was gestational tissue. Total serum b-hcg was followed post operatively until it is normalized. Conclusion: Laparoscopy can be used safely to remove the ectopic pregnancy. Cystoscopy can be utilized to assist the dissection to prevent bladder injury.
457 Abstract Withdrawn 458 Laparoscopic Placement of Pre-Conception Cervical Cerclage Pineda Rivas M, Rattray D, Thiel J. Division of Obstetrics and Gynecology and Reproductive Sciences, University of Saskatchewan, Regina, Saskatchewan, Canada In this video we present the case of a 34 year old woman that required a trans-abdominal cerclage based on her obstetrical history. The risks and benefits of a laparoscopic cerclage over a trans-vaginal cerclage are presented. In addition, we demonstrate the laparoscopic placement of a cerclage at the cervico-isthmic junction using the Leyland technique. Given the benefits of a laparoscopic cerclage over a trans-vaginal cerclage, more randomized studies are needed to determine if we should expand the indications for laparoscopic cerclages.
From January 2005 to December 2015, 4644 patients underwent total laparoscopic hysterectomy (TLH) at our institute for benign pathology. Six of these patients underwent a reversed order TLH. We start with the initial isolation of the uterine artery and ureter to avoid urinary tract injury during the transection of the supporting tissue of the uterus. The duration of the procedure is not prolonged when compared with the standard order of the TLH procedure. The uterine weight ranged from 996gs – 4545gs. Our reversed ligament division strategy means that all supporting structures can be dissected in view without the placement of addition camera ports, making the surgery safer and more complete. 455 Laparoscopic Resection of Interstitial Ectopic Pregnancy with Placenta Percreta Samura TL, Vilkins A, Hendessi P. Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts Interstitial ectopic pregnancies occur in a more distensible portion of the fallopian tube. This location allows them to reach greater gestational ages and makes them high risk for hemorrhage. We present a case of a large interstitial ectopic pregnancy that was complicated by a placenta percreta. The patient was successfully treated via laparoscopic wedge resection. The purposes of this video are to 1) describe a laparoscopic wedge resection and 2) demonstrate management of a more complex ectopic pregnancy.
452
456
Transvesical Bladder Fibroid Resection Saadi JM, Ubertazzi EP, Pavan LI, Noll F. Urogynecology, Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
Laparoscopic Management of Cesarean Scar Ectopic Pregnancy Yu X, Tovar R. University of Kentucky, Lexington, Kentucky
Bladder leiomyoma is a rare benign tumor and depends on its location the diagnosis could be difficult. different approaches to resect it have been reported like abdominal, laparoscopic, and transurethral. We present a case report of We present a case report of a 46 years old woman who presents for the last past years with urinary symptoms. A 4cm bladder mass that was misdiagnosed several times with cystoscopy because its location (bladder neck, in hour 6). The diagnosis was made with bladder ultrasound, dynamic MRI. Minimal invasive approach was proposed, transvesical laparoscopy without the need of cystostomy, removing the specimen transurethral. The pathologic diagnosis was leiomyoma of the bladder. 453 Laparoscopic Removal of the Essure Sterilization Device: Tips and Tricks Casey JN, Yunker AC. Minimally Invasive Gynecology and Pelvic Pain, Vanderbilt Medical Center, Nashville, Tennessee Laparoscopic removal of the EssureÒ device is a safe and effective procedure. While there are several approaches to its removal, attention to specifics related to preoperative imaging, expected radiographic findings, and intraoperative device selection will allow for improved efficiency and operative outcomes. By taking advantage of specific energy sources and transection technique, the procedure can routinely be completed in 15 minutes from initial trocar entry to final trocar removal, with complete removal of all coils. 454 Hysterectomy Techniques for Huge Fibroids- Starting with Paracervical Ligaments Andou M, Kanno K, Shirane A, Yanai S, Nakajima S. Gynecology, Kurashiki Medical Center, Kurashiki-shi, Okayama-ken, Japan We describe our reversed ligament division strategy technique for management of the division of the adnexal ligament in cases where accessibility to this ligament is made extremely difficult by anatomical distortion, obstruction and limitations of camera placement due to huge fibroids.
S147
Study Objective: Laparoscopic management of cesarean scar ectopic pregnancy. Design: Video presentation. Setting: University academic medical center. Patient: 31 yo G2P1011 with a Mirena IUD in place who was diagnosed of cesarean scar ectopic pregnancy. Intervention: Laparoscopic removal of cesarean scar ectopic pregnancy. Measurements and Main Results: A transvaginal ultrasound was used to diagnose the cesarean scar ectopic pregnancy. Laparoscopy with the assistance of cystoscopy was used to remove the ectopic pregnancy with careful dissection. IUD was removed. Pathology confirmed that the specimen was gestational tissue. Total serum b-hcg was followed post operatively until it is normalized. Conclusion: Laparoscopy can be used safely to remove the ectopic pregnancy. Cystoscopy can be utilized to assist the dissection to prevent bladder injury.
457 Abstract Withdrawn 458 Laparoscopic Placement of Pre-Conception Cervical Cerclage Pineda Rivas M, Rattray D, Thiel J. Division of Obstetrics and Gynecology and Reproductive Sciences, University of Saskatchewan, Regina, Saskatchewan, Canada In this video we present the case of a 34 year old woman that required a trans-abdominal cerclage based on her obstetrical history. The risks and benefits of a laparoscopic cerclage over a trans-vaginal cerclage are presented. In addition, we demonstrate the laparoscopic placement of a cerclage at the cervico-isthmic junction using the Leyland technique. Given the benefits of a laparoscopic cerclage over a trans-vaginal cerclage, more randomized studies are needed to determine if we should expand the indications for laparoscopic cerclages.