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Laparoscopic Restaging Surgery in Patients With Unexpected Uterine Cancer
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Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
We perform the cerclage at the level of internal cervical os, medial to the uterine vessels, with minimal dissection in vascular area. 538 Endoscopic Inguinal Lymphadenectomy in Vulvar Cancer Hua K, Ding J. The Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China This video shows endoscopic inguinal lymphadenectomy in vulvar cancer. The patient was 72 years old, and was admitted for ‘‘vulvar excrescence for 3 month’’. On gynecologic examination, a 5*4*4cm mass located at the right labium majus pudendi and the clitoris. The pathology of lumpectomy showed it was invasive differentiated squamous cell carcinoma. And the patient underwent Radical vulvectomy and bilateral endoscopic inguinal lymphadenectomy. The video showed the left side Inguinal Lymphadenectomy. Conclusion: Endoscopic inguinal lymph node dissection in patients with vulvar cancer is a safe and feasible technique. 539 Robotic-Assisted Laparoscopic Nerve Sparing Radical Hysterectomy Xu H, Chen Y, Wang Y, Liang Z. Obstetrics & Gynecology, Southwest Hospital, Third Military Medical University, Chongqing, China The endo wrist and 3D visualization makes robotic surgery amazing. Here is a Robotic Nerve Sparing Radical Hysterectomy, para aortic and pelvic lymphadenectomy for cervical cancer. After incision the peritoneum with the monopolar, make a better exposure of blood vessels (such as aorta, common iliac artery/vein, inferior vena cava, inferior mesenteric artery...etc.), ureter and superior hypogastric nerve, and then dissect the lymph nodes. Try our best to avoid the injuries of these important organs. 540 Laparoscopic Residual Parametrial Resection and Mesh Excision Zhang Z. Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China The patient was 50 years old. She has been performed vaginal hysterectomy and laparoscopic sacrocolpopexy because of uterine prolapse and myoma in Dec. 2014. The final pathological result showed cervical adenocarcinoma with lymph-vascular space involvement (LVSI). The patient received two cycles of neoadjuvant chemotherapy. The regimen consisted of: Taxol 240 mg and carboplatin 500mg. After chemotherapy, the patient has been performed laparoscopic pelvic lymphadnectomy, para-aortic lymphadnectomy. The whole procedure has three parts, 1) mesh excision; 2) lymphadnectomy; 3) ureters were identified bilaterally and separated with in-house forceps. The ureteral tunnels were dissected up to the ureteral orifice and freed from their beds. The ureters were separated from their median attachments to the peritoneum and then unroofed to the point of their insertion into the bladder by rightangle separate nips, Hem-o-loks (544250, Teleflex Medical) and metallic hemaclips (LIGACLIP, Ethicon Endo-Surgery) without any energy equipment. 541 Laparoscopic Restaging Surgery in Patients With Unexpected Uterine Cancer Lee W,1 Choi J,1 Bae J,1 Koh A,1 Jung U,2 Ko J.3 1Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Republic of Korea; 2Department of Obstetrics and Gynecology, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea; 3Department of Obstetrics and Gynecology, Kangwon National University Hospital, Chuncheon, Kangwon-do, Republic of Korea
A 65-year-old Korean woman presented to our hospital with lower abdominal pain. She underwent laparoscopic low anterior resection and left salpingo-oophorectomy due to sigmoid colon cancer and left ovarian cyst. Abdominal CT scans showed a 7-cm sized myoma with necrosis. There was no hypermetabolic lesion on PET scan. On July 28, 2014, she underwent total laparoscopic hysterectomy with right salpingooophorectomy with vaginal uterine morcellation. The biopsy showed undifferentiated uterine sarcoma with greater than 50% of myometrial invasion. We performed laparoscopic restaging surgery including washing cytology, right salpingo-oophorectomy, bilateral pelvic lymphadenectomy and para-aortic lymphadenectomy on August 18, 2014. The final histopathological report showed that malignant cells were not observed in cytology and harvested pelvic and para-aortic lymph node. Final FIGO stage was determined as IB. After surgery, she did not receive adjuvant treatment and she is alive without evidence of disease recurrence at last follow up. 542
Video Posters – Pelvic Pain
Pelvic Congestion Syndrome Balica AC,1 Nassiri N,2 Horne J,1 Egan S,1 Wang XK.3 1Ob/Gyn and Reproduction Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; 2Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; 3Graduate School of Biomedical Sciences, Rutgers, The State University of New Jersey, New Brunswick, New Jersey The video abstract present a clinical case of pelvic congestion syndrome, common symptoms, radiological diagnosis and coil embolization treatment. 543 Vestibulectomy With Vaginal Advancement for Treatment of Vestibulodynia Vilasagar S, Carrillo JF, Foster DC. Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York This video demonstrates a surgical approach for treatment of vestibulodynia. Vestibulectomy with vaginal advancement has been reported to have a success rate of 80-88%; it can be performed when other treatment modalities including vulvar care measures, neuromodulators, biofeedback/physical therapy, and cognitive behavioral therapy do not adequately treat pain symptoms. The painful vestibular tissue and hymeneal ring are excised, taking care not to include vaginal tissue in the resected specimen. The vaginal flap graft is mobilized and advanced downward to cover the defect from the resected tissue. It is important to ensure that this mobilization is secured in a tension-free manner. The patient who underwent this procedure in our video was painfree 6 weeks post-procedure and did not experience any complications. 544 Robotic Excision of Migrated Inguinal Hernia Mesh into the Paravesical Space Petrikovets A,1 Shapiro A,1 Shakiba K.2 1Department of Obstetrics, Gynecology, and Women’s Health, Rutgers New Jersey Medical School, Newark, New Jersey; 2Department of Obstetrics and Gynecology, Hackensack University Medical Center, Hackensack, New Jersey Laparoscopic inguinal herniorrhaphy with mesh is an increasingly prevalent procedure and has been associated with mesh complications. Case reports have documented complications associated with mesh erosion into the bladder, bowel, femoral vessels, and, in this case, the paravesical space, resulting in pelvic pain. Patients often seek gynecologic and urologic care given the nature of their complaints. Providers must be vigilent of complications associated with this procedure so diagnoses can be made in a timely fashion. This video/case report presents a patient who presented with pelvic pain after a laparoscopic inguinal hernia repair with mesh and was treated for other disease processes prior to the diagnosis of a migrated inguinal hernia mesh. In our experience, the robotic exploration is beneficial due to fine dissection that can be performed using a
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
We perform the cerclage at the level of internal cervical os, medial to the uterine vessels, with minimal dissection in vascular area. 538 Endoscopic Inguinal Lymphadenectomy in Vulvar Cancer Hua K, Ding J. The Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China This video shows endoscopic inguinal lymphadenectomy in vulvar cancer. The patient was 72 years old, and was admitted for ‘‘vulvar excrescence for 3 month’’. On gynecologic examination, a 5*4*4cm mass located at the right labium majus pudendi and the clitoris. The pathology of lumpectomy showed it was invasive differentiated squamous cell carcinoma. And the patient underwent Radical vulvectomy and bilateral endoscopic inguinal lymphadenectomy. The video showed the left side Inguinal Lymphadenectomy. Conclusion: Endoscopic inguinal lymph node dissection in patients with vulvar cancer is a safe and feasible technique. 539 Robotic-Assisted Laparoscopic Nerve Sparing Radical Hysterectomy Xu H, Chen Y, Wang Y, Liang Z. Obstetrics & Gynecology, Southwest Hospital, Third Military Medical University, Chongqing, China The endo wrist and 3D visualization makes robotic surgery amazing. Here is a Robotic Nerve Sparing Radical Hysterectomy, para aortic and pelvic lymphadenectomy for cervical cancer. After incision the peritoneum with the monopolar, make a better exposure of blood vessels (such as aorta, common iliac artery/vein, inferior vena cava, inferior mesenteric artery...etc.), ureter and superior hypogastric nerve, and then dissect the lymph nodes. Try our best to avoid the injuries of these important organs. 540 Laparoscopic Residual Parametrial Resection and Mesh Excision Zhang Z. Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China The patient was 50 years old. She has been performed vaginal hysterectomy and laparoscopic sacrocolpopexy because of uterine prolapse and myoma in Dec. 2014. The final pathological result showed cervical adenocarcinoma with lymph-vascular space involvement (LVSI). The patient received two cycles of neoadjuvant chemotherapy. The regimen consisted of: Taxol 240 mg and carboplatin 500mg. After chemotherapy, the patient has been performed laparoscopic pelvic lymphadnectomy, para-aortic lymphadnectomy. The whole procedure has three parts, 1) mesh excision; 2) lymphadnectomy; 3) ureters were identified bilaterally and separated with in-house forceps. The ureteral tunnels were dissected up to the ureteral orifice and freed from their beds. The ureters were separated from their median attachments to the peritoneum and then unroofed to the point of their insertion into the bladder by rightangle separate nips, Hem-o-loks (544250, Teleflex Medical) and metallic hemaclips (LIGACLIP, Ethicon Endo-Surgery) without any energy equipment. 541 Laparoscopic Restaging Surgery in Patients With Unexpected Uterine Cancer Lee W,1 Choi J,1 Bae J,1 Koh A,1 Jung U,2 Ko J.3 1Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Republic of Korea; 2Department of Obstetrics and Gynecology, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea; 3Department of Obstetrics and Gynecology, Kangwon National University Hospital, Chuncheon, Kangwon-do, Republic of Korea
A 65-year-old Korean woman presented to our hospital with lower abdominal pain. She underwent laparoscopic low anterior resection and left salpingo-oophorectomy due to sigmoid colon cancer and left ovarian cyst. Abdominal CT scans showed a 7-cm sized myoma with necrosis. There was no hypermetabolic lesion on PET scan. On July 28, 2014, she underwent total laparoscopic hysterectomy with right salpingooophorectomy with vaginal uterine morcellation. The biopsy showed undifferentiated uterine sarcoma with greater than 50% of myometrial invasion. We performed laparoscopic restaging surgery including washing cytology, right salpingo-oophorectomy, bilateral pelvic lymphadenectomy and para-aortic lymphadenectomy on August 18, 2014. The final histopathological report showed that malignant cells were not observed in cytology and harvested pelvic and para-aortic lymph node. Final FIGO stage was determined as IB. After surgery, she did not receive adjuvant treatment and she is alive without evidence of disease recurrence at last follow up. 542
Video Posters – Pelvic Pain
Pelvic Congestion Syndrome Balica AC,1 Nassiri N,2 Horne J,1 Egan S,1 Wang XK.3 1Ob/Gyn and Reproduction Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; 2Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; 3Graduate School of Biomedical Sciences, Rutgers, The State University of New Jersey, New Brunswick, New Jersey The video abstract present a clinical case of pelvic congestion syndrome, common symptoms, radiological diagnosis and coil embolization treatment. 543 Vestibulectomy With Vaginal Advancement for Treatment of Vestibulodynia Vilasagar S, Carrillo JF, Foster DC. Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York This video demonstrates a surgical approach for treatment of vestibulodynia. Vestibulectomy with vaginal advancement has been reported to have a success rate of 80-88%; it can be performed when other treatment modalities including vulvar care measures, neuromodulators, biofeedback/physical therapy, and cognitive behavioral therapy do not adequately treat pain symptoms. The painful vestibular tissue and hymeneal ring are excised, taking care not to include vaginal tissue in the resected specimen. The vaginal flap graft is mobilized and advanced downward to cover the defect from the resected tissue. It is important to ensure that this mobilization is secured in a tension-free manner. The patient who underwent this procedure in our video was painfree 6 weeks post-procedure and did not experience any complications. 544 Robotic Excision of Migrated Inguinal Hernia Mesh into the Paravesical Space Petrikovets A,1 Shapiro A,1 Shakiba K.2 1Department of Obstetrics, Gynecology, and Women’s Health, Rutgers New Jersey Medical School, Newark, New Jersey; 2Department of Obstetrics and Gynecology, Hackensack University Medical Center, Hackensack, New Jersey Laparoscopic inguinal herniorrhaphy with mesh is an increasingly prevalent procedure and has been associated with mesh complications. Case reports have documented complications associated with mesh erosion into the bladder, bowel, femoral vessels, and, in this case, the paravesical space, resulting in pelvic pain. Patients often seek gynecologic and urologic care given the nature of their complaints. Providers must be vigilent of complications associated with this procedure so diagnoses can be made in a timely fashion. This video/case report presents a patient who presented with pelvic pain after a laparoscopic inguinal hernia repair with mesh and was treated for other disease processes prior to the diagnosis of a migrated inguinal hernia mesh. In our experience, the robotic exploration is beneficial due to fine dissection that can be performed using a