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Laparoscopic Trachelectomy with Cervical Fibroid and Endometriosis
S90 294
Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S71–S90 Video Session 9d Laparoscopy (4:08 PM d 4:16 PM)
Laparoscopic Trachelectomy with Cervical Fibroid and Endometriosis Deimling T, Harkins G, Davies M. Minimally Invasive Gyn Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania Laparoscpic Trachelectomy is a safe and successful minimally invasive surgical technique for patients who may have continued pain or bleeding after prior supracervical hysterectomy. We present a case of a patient referred with a ‘‘pelvic mass’’ three years after Laparoscopic Supracervical Hysterectomy (LSH) at an outside institutuion. The patient noticed increasing pain, and cyclic bleeding in the months prior to her referal. Physical exam noted a bulbous, enlarged cervical stump consistent with the mass seen by ultrasound. Pap smear was normal. At the time of laparoscopy for evalution and planned trachelectomy, she was found to have a large fibroid growing from the apex of her cervix and extensive pelvic adhsions and endometriosis. A parasitic myoma was also disected and removed from the left pelvic preitoneum. This video was accepted prior by the World Symposium on Endometriosis, March 2011. 295
Video Session 9d Laparoscopy (4:17 PM d 4:25 PM)
How To Cope with Difficulties in TLH Fujiwara K, Nagase T, Kanao H, Ando M. Obstetrics & Gynecology, Kurashiki Medical Center, Kurashiki, Okayama, Japan Sometimes it is difficult to complete a TLH procedure in cases of adhesion due to endometriosis or anatomical distortion due to large and cervical myomas. Our purpose is to consider how to complete TLH in such difficult cases by referring to the basics of our standard procedure. With cervical myoma, a myomectomy can correct anatomical distortion, enabling safer and easier TLH. In endometriosis cases, ureteral injury can occur due to adhesion and anatomical distortion. To remedy this we initially identify and isolate the ureter and denudate the ureteral tunnel to track its course. These steps help us overcome difficulties during the operation for a safe TLH procedure. In our experience, a retrograde approach to the vagina is useful in cul-de-sac adhesion. We have performed complete TLH in 99% of cases. With these techniques it is possible to complete TLH safely even in difficult cases.
Study’s objective: After caesarean section 60-70% of all patients have a defect in the uterine scar. It is defined as a triangular anechogenic space at the site of the CS scar. It is associated with post menstrual spotting 34% of these women. Spotting due to a niche is not responding to hormonal therapy and is associated with cyclic pain and reduced quality of life. Result: This video shows a patient pain and bleeding. A complete defect in the uterine scar as well as very dense adhesion from the anterior part of the uterus to the abdominal wall, Preoperative ultrasound, hysteroscopy and laparoscopic repair is presented in this video Conclusion: It’s of importance to be aware of this condition in patient with change in menstrual pattern and pain after CS. This condition can be repaired both with hysteroscopy or laparoscopy. The different clinical pictures as well as their treatment is discussed.
298
Case Report: LESS for Huge Ovarian Tumor Kay N,1 Chang Y.2 1E-Da Hospital, Kaohsiung County, Taiwan; 2 Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan We report a case of LESS (Laparo-Endoscopic single-site surgery) for huge ovarian tumor in a young woman. Case report A 22 year-old woman (nullipara) came to our department due to palpable abdominal mass. Transabdominal sonography revealed a huge pelvic mass with multiseptate and 26.6 x 16.6cm in size. The report of CT was a huge low density cystic left adenxal mass without lymphadenopathy or ascites. Tumor markers were all within the normal range. The patient underwent LESS with the other accessory port. We aspirated the tumor content through the LESS port. After minimizing the tumor size, we performed laparoscopic surgery for LSO with endobag for prevention of tumor spillage. The final pathology was borderline mucinous cystadenoma. Discussion LESS is an advanced minimal invasive surgery and a feasible method for huge ovarian tumor in young-aged women under strict preoperative assessment.
299 296
Video Session 9d Laparoscopy (4:26 PM d 4:34 PM)
Laparoscopic Excision of Ovarian Remnant Gomaa M, King L, Nezhat C. Gynecology, Center for Minimally Invasive and Robotic Surgery, Palo Alto, California Objectives: To demonstrate the safety and feasibility of laparoscopic complete excision of ovarian remnant. Method: Video presentation of a case report. This is a 39 year old G0who had total abdominal hysterectomy and bilateral salpingoophrectomy for endometriosis. She presented with recurrent pelvic pain. An Ultrasound revealed a pelvic mass that is suspicious for ovarian remnant. Results: In this case we were able to perform complete excision of the ovarian remnant with good margin. Excellent ureteral dissection was performed laparoscopically and safely with co2 laser. The patient was discharged home the same day. There was no intraoperative or post operative complication. Pt was doing well for sixteen months after surgery. Conclusions: Complete resection of ovarian remnant laparoscopicaly in experienced hands using CO2 laser can be accomplished safely. 297
Video Session 9d Laparoscopy (4:35 PM d 4:40 PM)
Laparoscopic Repair of Uterine Scar after C Section Istre O, Springborg H. Minimally Invasive Gynecology, Private Hospital Hamlet, Copenhagen, Denmark
Video Session 9d Laparoscopy (4:41 PM d 4:47 PM)
Video Session 10d Laparoscopy (3:20 PM d 3:27 PM)
Single-Port Laparoscopy ‘‘Tips and Techniques’’ Carvalho L, Flyckt R, Escobar P, Falcone T. Cleveland Clinic, Cleveland, Ohio Our aims are to: 1st-Review abdominal wall anatomy with focus on the umbilical region. 2nd-Describe single Port devices and their set-up. 3rdDemostrate different types of Single-Port Systems. 4th-Discuss the advantages and disadvantages of Single Port Laparoscopic surgery.
300
Video Session 10d Laparoscopy (3:28 PM d 3:33 PM)
Single Port Surgery for Removal of an Adnexal Cyst Catenacci M, Jarjoura P. OB/GYN, The Cleveland Clinic Foundation, Cleveland, Ohio Laparoscopic single-site surgery is becoming increasing popular in gynecological surgery. However, the technique is still relatively new and many gynecologists have not incorporated single-site surgery into their practice. The purpose of this video is to demonstrate a single port surgery that would be appropriate for the beginner single-site surgeon. The instrumentation that is needed is reviewed. Tips for patient positioning and port placement are also reviewed. The removal of a large paraovarian cyst is demonstrated.
Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S71–S90 Video Session 9d Laparoscopy (4:08 PM d 4:16 PM)
Laparoscopic Trachelectomy with Cervical Fibroid and Endometriosis Deimling T, Harkins G, Davies M. Minimally Invasive Gyn Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania Laparoscpic Trachelectomy is a safe and successful minimally invasive surgical technique for patients who may have continued pain or bleeding after prior supracervical hysterectomy. We present a case of a patient referred with a ‘‘pelvic mass’’ three years after Laparoscopic Supracervical Hysterectomy (LSH) at an outside institutuion. The patient noticed increasing pain, and cyclic bleeding in the months prior to her referal. Physical exam noted a bulbous, enlarged cervical stump consistent with the mass seen by ultrasound. Pap smear was normal. At the time of laparoscopy for evalution and planned trachelectomy, she was found to have a large fibroid growing from the apex of her cervix and extensive pelvic adhsions and endometriosis. A parasitic myoma was also disected and removed from the left pelvic preitoneum. This video was accepted prior by the World Symposium on Endometriosis, March 2011. 295
Video Session 9d Laparoscopy (4:17 PM d 4:25 PM)
How To Cope with Difficulties in TLH Fujiwara K, Nagase T, Kanao H, Ando M. Obstetrics & Gynecology, Kurashiki Medical Center, Kurashiki, Okayama, Japan Sometimes it is difficult to complete a TLH procedure in cases of adhesion due to endometriosis or anatomical distortion due to large and cervical myomas. Our purpose is to consider how to complete TLH in such difficult cases by referring to the basics of our standard procedure. With cervical myoma, a myomectomy can correct anatomical distortion, enabling safer and easier TLH. In endometriosis cases, ureteral injury can occur due to adhesion and anatomical distortion. To remedy this we initially identify and isolate the ureter and denudate the ureteral tunnel to track its course. These steps help us overcome difficulties during the operation for a safe TLH procedure. In our experience, a retrograde approach to the vagina is useful in cul-de-sac adhesion. We have performed complete TLH in 99% of cases. With these techniques it is possible to complete TLH safely even in difficult cases.
Study’s objective: After caesarean section 60-70% of all patients have a defect in the uterine scar. It is defined as a triangular anechogenic space at the site of the CS scar. It is associated with post menstrual spotting 34% of these women. Spotting due to a niche is not responding to hormonal therapy and is associated with cyclic pain and reduced quality of life. Result: This video shows a patient pain and bleeding. A complete defect in the uterine scar as well as very dense adhesion from the anterior part of the uterus to the abdominal wall, Preoperative ultrasound, hysteroscopy and laparoscopic repair is presented in this video Conclusion: It’s of importance to be aware of this condition in patient with change in menstrual pattern and pain after CS. This condition can be repaired both with hysteroscopy or laparoscopy. The different clinical pictures as well as their treatment is discussed.
298
Case Report: LESS for Huge Ovarian Tumor Kay N,1 Chang Y.2 1E-Da Hospital, Kaohsiung County, Taiwan; 2 Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan We report a case of LESS (Laparo-Endoscopic single-site surgery) for huge ovarian tumor in a young woman. Case report A 22 year-old woman (nullipara) came to our department due to palpable abdominal mass. Transabdominal sonography revealed a huge pelvic mass with multiseptate and 26.6 x 16.6cm in size. The report of CT was a huge low density cystic left adenxal mass without lymphadenopathy or ascites. Tumor markers were all within the normal range. The patient underwent LESS with the other accessory port. We aspirated the tumor content through the LESS port. After minimizing the tumor size, we performed laparoscopic surgery for LSO with endobag for prevention of tumor spillage. The final pathology was borderline mucinous cystadenoma. Discussion LESS is an advanced minimal invasive surgery and a feasible method for huge ovarian tumor in young-aged women under strict preoperative assessment.
299 296
Video Session 9d Laparoscopy (4:26 PM d 4:34 PM)
Laparoscopic Excision of Ovarian Remnant Gomaa M, King L, Nezhat C. Gynecology, Center for Minimally Invasive and Robotic Surgery, Palo Alto, California Objectives: To demonstrate the safety and feasibility of laparoscopic complete excision of ovarian remnant. Method: Video presentation of a case report. This is a 39 year old G0who had total abdominal hysterectomy and bilateral salpingoophrectomy for endometriosis. She presented with recurrent pelvic pain. An Ultrasound revealed a pelvic mass that is suspicious for ovarian remnant. Results: In this case we were able to perform complete excision of the ovarian remnant with good margin. Excellent ureteral dissection was performed laparoscopically and safely with co2 laser. The patient was discharged home the same day. There was no intraoperative or post operative complication. Pt was doing well for sixteen months after surgery. Conclusions: Complete resection of ovarian remnant laparoscopicaly in experienced hands using CO2 laser can be accomplished safely. 297
Video Session 9d Laparoscopy (4:35 PM d 4:40 PM)
Laparoscopic Repair of Uterine Scar after C Section Istre O, Springborg H. Minimally Invasive Gynecology, Private Hospital Hamlet, Copenhagen, Denmark
Video Session 9d Laparoscopy (4:41 PM d 4:47 PM)
Video Session 10d Laparoscopy (3:20 PM d 3:27 PM)
Single-Port Laparoscopy ‘‘Tips and Techniques’’ Carvalho L, Flyckt R, Escobar P, Falcone T. Cleveland Clinic, Cleveland, Ohio Our aims are to: 1st-Review abdominal wall anatomy with focus on the umbilical region. 2nd-Describe single Port devices and their set-up. 3rdDemostrate different types of Single-Port Systems. 4th-Discuss the advantages and disadvantages of Single Port Laparoscopic surgery.
300
Video Session 10d Laparoscopy (3:28 PM d 3:33 PM)
Single Port Surgery for Removal of an Adnexal Cyst Catenacci M, Jarjoura P. OB/GYN, The Cleveland Clinic Foundation, Cleveland, Ohio Laparoscopic single-site surgery is becoming increasing popular in gynecological surgery. However, the technique is still relatively new and many gynecologists have not incorporated single-site surgery into their practice. The purpose of this video is to demonstrate a single port surgery that would be appropriate for the beginner single-site surgeon. The instrumentation that is needed is reviewed. Tips for patient positioning and port placement are also reviewed. The removal of a large paraovarian cyst is demonstrated.