Laparoscopic Resection of a Retroperitoneal Liposarcoma

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Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S191–S227

immediately during oncology surgery. This video demonstrates how to enter the retroperioneal space for gynecologists and to locate the ureter and the uterine artery. It illustrates easy steps and ends with a difficult case showing the technique of dissection. The laparoscopic GYN surgeon will find this video helpful in getting started in entering this space. We say, ‘‘When the going gets tough; GO RETRO.’’ 701 A Systematic Approach to Laparoscopic Myomectomy Lang TG,1 Shiber L-D,1 Dassel M,2 Pasic R.1 1Ob/Gyn MInimally Invasive Gynecologic Surgery, University of Louisville School of Medicine, Louisville, Kentucky; 2OB/GYN, The University of Utah School of Medicine, Salt Lake City, Utah

Single port laparoscopic surgery for huge ovarian cyst In case of huge ovarian tumor, physicians should consider how to remove it without spillage. So it is hard to do laparoscopy in such a case because the pelvic cavity is narrow and difficult to keep the ovarian mass intact until removal. In this video, we show two cases of huge ovarian tumor doing single port laparoscopic hysterectomy with unilateral/bilateral salpingooophorectomy with SW KIM’s method. SW KIM’s method is the technique to put huge ovarian tumor into the endopouch using specially designed (30x30cm2 sized) endopouch, two conventional laparoscopic needle holders and one laparoscopic grasper. The key point of SW KIM’s method is to remove ovarian tumor without spillage in a single port laparoscopic surgery by putting it into the large endoscopic bag despite narrow space. 705

For patients with symptomatic fibroids and/or infertility who have not completed childbearing, myomectomy is often an option. The laparoscopic approach to myomectomy provides patients with a more rapid recovery and decreased length of hospital stay, as well as equivalent clinical outcomes in comparison to an open procedure. This film presents a technique for laparoscopic myomectomy. A series of steps are demonstrated with surgical footage and detailed discussion, including techniques for hemostasis, dissection using the Harmonic scalpel, chromotubation, layered closure and morcellation. 702 Difficult Uteruses: Tips to Manage Total Laparoscopic Hysterectomy in Patients with Multiple Laparotomies Lawande A, Desai R, Hosamani G, Puntambekar SP. Galaxy Care Laparoscopy Institute, Pune, Maharashtra, India In this video we demonstrate difficult total laparoscopic hysterectomies in patients with previous laparotomies. Tips to tackle these situations and manage laparoscopically without complications or conversion. These were the situations: 1) In post whipple’s procedure - Multiple adhesions of bowel to anterior abdominal wall. 2) Previous 3 LSCS - Uterus firmly plastered to anterior abdominal wall. 3) Following previous 3 laparoscopies and 1 laparotomy in stage IV endometriosis- Loss of pelvic anatomy 4)Previous 2 LSCS - Bladder badly stuck to uterus. Using our oncosurgical experience, sound laparoscopy principles and anatomical knowledge we managed to tackle these situations without conversion. 703 Single Port Laparoscopic Myomectomy Using YS Knot Lee YS, Chong GO, Lee YH, Hong DG. Gynecologic Cancer Center, Kyungpook National University Medical Center, Daegu, Republic of Korea This video demonstrates a single port laparoscopic myomectomy using YS Knot. YS Knot is extracorporeal sliding knot. The advantages of YS Knot are simple, fast, easy to learn and no slip after knot. After vasopressin injection, oblique uterine incision was made, and myoma was enucleated. Traction suture at uterus was done through abdominal wall, and endometrial defect was closed with interrupted suture (1st layer). Myometrial defect was closed by multiple interrupted suture (2nd layer). Horizontal mattress traction suture was made using Hem-o-lok (3rd layer). Seromuscular layer was closed by multiple interrupted suture using YS Knot (4th layer). YS Knot may contribute to overcome the difficulty of intracorporeal suture during single port myomectomy.

Laparoscopic Radical Hysterectomy Liu X, Jiang H. Obstetrics and Gyncology Hospital of Fudan University, Shanghai, China Under general anesthesia, the patient was put in a lithotomy-Trendelenburg position. A 10-mm trocar was introduced through the umbilicus, and the abdominal cavity was insufflated with carbon dioxide and explored for evidence of metastatic disease.One pair of 5-mm trocars was placed symmetrically approximately 4 cm away from the umbilicus, slightly below the horizontal line passing through the umbilicus. Another pair of trocars, one 5 mm and the other 10 mm, was inserted bilaterally at the outer one-third of the iliac spine umbilicus line symmetrically. 706 Laparoscopic Resection of a Retroperitoneal Liposarcoma Liu GY, Kung RC. Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Thank you for giving us the opportunity to present a surgical video of a laparoscopic resection of a retroperitoneal liposarcoma. This 56 year old presented with an enlarging abdominal mass in 2010. Her symptoms included increasing bladder and rectal pressure and a rectal prolapse. Her colonoscopy was normal. She previously had an abdominal myomectomy in 2008, and given this history as well as imaging consistent with a recurrent fibroid, she was consented for a laparoscopic myomectomy. Because the mass extended to the umbilicus and she previously had a ventral hernia repair repaired with mesh, a Palmer’s point entry was performed. The mass was free from the uterus and cervix, and was close to the sigmoid mesentery. Her postoperative course was complicated by a bowel perforation secondary to an obstructive mass in her sigmoid colon. The pathology on both masses returned as liposarcoma. 707 Laparoscopic Concealed Uterine Morcellation Mattingly P, Taylor B. Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, North Carolina This video illustrates a concealed laparoscopic morcellation technique using an endoscopic isolation bag to remove an 800 gm uterus after a laparoscopic supracervical hysterectomy. The FDA has released a statement discouraging open laparoscopic power morcellation because of the concern for spreading an undiagnosed malignancy. The purpose of this video is to demonstrate a technique to perform concealed tissue extraction via power morcellation endoscopically. 708

704 Single Port Accessed Laparoscopic Surgery of Huge Ovarian Tumors Lee J, Yim GW, Nam EJ, Kim S, Kim YT, Kim SW. Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea

Failed Mesh Sacral Colpopexy Resulting in Recurrent Uterine Prolapse Treated Successfully with Laparoscopic Sacral Colpohysteropexy Miklos JR, Moore RD, Chinthakanan O. International Urogynecology Associates, Alpharetta (Atlanta), Georgia