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Laparoscopic Wedge Resection of Adenomyosis
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S109–S127
S125
tricks to optimise its use compared to the classical rectal probe and rectal catheter.
robotic capability to meet consumer demands. The robotic camera holder provides a steady surgeon controlled image.
433
436
Video Session 13dNew Instrumentation and Techniques (9:05 AM d 9:12 AM)
Laparoscopic Vaginal Cuff Closure with Uni- and Bi-Directional Barbed Suture Siedhoff MT, Yunker AC, Steege JF. Division of Advanced Laparoscopy and Pelvic Pain, University of North Carolina, Chapel Hill, North Carolina Several reports have suggested that vaginal cuff dehiscence occurs more frequently after laparoscopic, as opposed to other types of hysterectomy. To address the problem in our practice, we began using barbed suture for closure and have not experienced this complication in over 200 cases. We also have noticed reduced rates of bleeding and cuff cellulitis. This video demonstrates laparoscopic cuff closure with both the V-Loc 180 Absorbable Wound Closure Device (Covidien) and Quill SRS (Angiotech). The former has one needle, barbs in a single direction, and a loop at the end of the suture. Quill is doublearmed with barbs that change direction in the middle of the suture. By holding in the tissue, barbed suture obviates the need to tie knots laparoscopically and represents an inexpensive alternative to single-use suturing devices. The technique is easy to learn and takes less than ten minutes to complete.
434
Video Session 13dNew Instrumentation and Techniques (9:13 AM d 9:20 AM)
Terumo Precision-Drive Articulating Instrument To Facilitate Gynecologic Laparoscopy Milad M, Pavone ME. Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois The Terumo Precision-Drive Articulating Instrument is designed to provide motorized rotation and articulation for endoscopic suture placement, knot tying, dissection and mono and bi-polar electrosurgery. Over the past two years, we applied the Terumo Precision-Drive Articulating Instrument to 6 female pigs of medium weight followed by 4 cadaveric dissections. The new device optimizes dissection, desiccation, suturing and knot tying during common gynecologic procedures. A reduction number of ports and time involved for the more difficult maneuvers was also noted. Accurate suture placement even with posterior myomectomy repair was seen. The Terumo Precision-Drive Articulating Instrument is a simple and effective alternative to both conventional and robotically assisted gynecologic procedures providing both articulation and rotation via a hand activated device. It is available within the operating room setting, on short notice and optimizes needle placement and knot tying.
435
Video Session 13dNew Instrumentation and Techniques (9:21 AM d 9:29 AM)
Solo Laparoscopic Supracervical Hysterectomy with VIKY Robotic Assistance Rosenfield RB. Gynecology, Pearl Women’s Center, Portland, Oregon This video demonstrates a Solo technique of Laparoscopic Supracervical Hysterectomy. A robotic camera holder and uterine positioning system are used to eliminate the need for a surgical assistant and skilled scrub tech. The patient is morbidly obese with a large fibroid uterus. The surgery is performed by one surgeon, completely solo (i.e. the primary surgeon performed this case with no assistance). The scrub tech set up the instruments but did not touch the patient during the operation. With a uterine positioning system, uterine manipulation was performed by the surgeon, eliminating need for a skilled assistant. In a world of increasing health care cost and technology, eliminating the need for a surgical assistant can possibly lead to cost effective solutions. Many hospitals cannot afford more expensive robotic systems, but desire
Video Session 13dNew Instrumentation and Techniques (9:30 AM d 9:35 AM)
Laparoscopic Salpingo-Oopherectomy Assisted with Cul-de-Sac Trocar Shapiro A, DiSciullo A. OB/Gyn, Mount Auburn Hospital, Cambridge, Massachusetts This video demonstrates a laparoscopic salpingo-oophorectomy utilizing only 5 mm abdominal ports and a cul-de-sac trocar to assist with specimen extraction. The patient in this case is perimenopausal, and was found to have a 6 cm complex adnexal mass on ultrasound. After removing the right adnexa, a long 15mm cul-de-sac trocar is introduced under direct visualization. Using an endoscopic bag, the specimen is retrieved. Due to distendability of the vaginal wall, the specimen is extracted intact and with ease. The vaginal entry is then closed laparoscopically. We believe that foregoing the 10mm abdominal port reduces post-operative pain and the chance of internal herniation.
437
Video Session 13dNew Instrumentation and Techniques (9:36 AM d 9:44 AM)
Laparoscopic Neovagina Procedure with Graft Rardin CR, Washington BB, Wohlrab KJ. Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island Iatrogenic obliteration of the vagina can be a challenging situation. The Davydov-Adamyan type procedure is one that has been described, where the peritoneum is anastomosed to the vaginal remnant, and a high peritoneal pursestring suture creates a neovagina composed of peritoneum. Howeverm some practitioners are concerned that the peritoneal pursestring suture is not string enough to reliably prevent evisceration. This modification involves using a biologic graft to extend the length of the vagina; peritoneal pursestring sutures are then used to provide apical support as well as peritoneal vascular support. Thus, security and safety are enhanced while the neovagina undergoes epithelialization.
438
Video Session 13dNew Instrumentation and Techniques (9:45 AM d 9:53 AM)
Minimally Invasive Management an Advanced Abdominal Pregnancy Raff GJ, Rothenberg JM, Golichowski AM. Ob/Gyn, Indiana University School of Medicine, Indianapolis, Indiana Abdominal pregnancy is an extremely rare but serious obstetric condition. It is associated with increased maternal mortality. The standard treatment is surgical interruption of the pregnancy. In this video we demonstrate the laparoscopic management of a 17-week gestation secondary abdominal pregnancy. We review the incidence, maternal and infant mortality rates, and differentiate between primary and secondary abdominal pregnancies as described by Studdiford. Our target audiences are advanced laparoscopists at tertiary referral centers who are likely to have these patients referred to them for further management. We demonstrate a safe minimally invasive alternative to the traditional exploratory laparotomy approach. 439
Video Session 13dNew Instrumentation and Techniques (9:54 AM d 10:00 AM)
Laparoscopic Wedge Resection of Adenomyosis Istre O, Suzuki Y. Ob/Gyn, BWH Harvard Medical School, Boston, Massachusetts Introduction: adenomyosis is a smooth muscle cells and endometriosic tissue, typically originating within the uterus. Methods: These patients usually
S126
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S109–S127
present with monthly pain due to embedded blood in the adenomyotic cyst. Results: Diagnosis is established on transvaginal ultrasound and this also will guide you choosing the correct management approach. This video shows ultrasound pictures MRI and present laparoscopic wedge resection. Conclusion: Adenomyomis uteri is rare, however ultrasound detect the clinical situation and guide the endoscopic approach.
440
Video Session 14dOncology (9:00 AM d 9:10 AM)
Uterine Artery Sparing Robotic Radical Trachelectomy and Pelvic Lymphadenectomy in Patients with Early-Stage Cervical Cancer Lee YS, Chong GO, Hong DG, Park NY, Park IS. Kyungpook National University, Daegu, Korea This video demonstrate techniques of fertility sparing operation for cervical cancer patient, uterine artery sparing total laparoscopic radical trachelectomy using by da Vinci Robotic system. The first Objectives of this video is to demonstrate techniques about both uterine artery sparing result in better blood flow to endometrium, the second is to display adequate dissection line of isthmus, the third is nerve sparing method for better quality of life in young patient. Last is robotic re-anastomosis technique. This case is 27 years old single women, cervical cancer stage IB1 adenocarcinoma. Right uterine artery is preserved but deeper uterine veins are identified and dissected by fine delicate robotic bipolar forceps and scissors. We can preserve right uterine artery to isthmic area which divide descending and ascending branches. And then we can preserve inferior hypogastric plexus and hypogastric nerve. This type of complex operations can be by Robotic system more easily.
promise as it provides all the advantages of minimally invasive surgery without compromising on oncological margins and surgical safety.
443
Reduced Port Surgery: Single Port Access TAH/BSO/Staging for Endometrial Cancer King SA,1 Green M,1 Curcillo PG.2 1Gynecologic Oncology, Drexel University College of Medicine, Philadelphia, Pennsylvania; 2Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania Since April 2007, we have performed over 300 Single Port Access (SPA) procedures. Although single port procedures have been performed in gynecology for over twenty years, there has been a strong interest in further developoing this field over the past two years. Single Port Access has been developed as a platform utilizing standard instrumentation, trocars and nearly identical dissection techniques to multiport laparosocpy. These focuses have allowed us to take this technique from simple oophorectomies to staging procedures with TAH/BSO and lymph node dissections for the same or less instrument costs than standard multiport procedures. In addition, focus on standard famlar instruments has allowed this technique to be taught and reproduced by other surgeons. Our video of a staging procedure for endometrial cancer allows us to demonstrate the technique of access, principles of triangulation and dissection for a single port hysterectomy, oophorectomy and node dissection. 444
441
Video Session 14dOncology (9:11 AM d 9:19 AM)
Laparoscopic Primary Cytoreduction of Advanced Ovarian Cancer Nezhat FR, Brown DN, DeNoble SM, Saharia PC. Minimally Invasive Gynecologic & Robotic Surgery, Obstertics & Gynecology, St Luke’sRoosevelt Hospital Center, New York, New York; Surgery, Winthrop University Hospital, Mineola, New York This is a case of a 61 y/o who originally presented as a referral for the evaluation of a 6 cm adnexal mass. Ultrasound evaluation revealed a 6.5 x 5.2 x 2.7 cm complex left ovarian cyst. The patients CA-125 level was 263 U/mL. The patient was counseled on her findings and was subsequently taken to the operating room where she underwent laparoscopic primary ovarian cancer cytoreduction in the form of radical hysterectomy, bilateral salpingo-oophorectomy, pelvic mass resection, anterior and posterior culdectomy, omentectomy, posterior exenteration, with end to end rectosigmoid anastomosis.The following film is a demonstration of the technique of laparoscopic primary cytoreduction of advanced ovarian cancer.
442
Video Session 14dOncology (9:20 AM d 9:28 AM)
Robotic Vault Excision, Parametrectomy and Pelvic Lymphadenectomy for Carcinoma Cervix Puntambekar SP, Joshi SN, Rayate NV, Agarwal GA, Deshmukh AV, Rajamanickam S. Minimally Invasive Oncology, Galaxy Care Laparoscopy Institute, Pune, Maharashtra, India A 44 year old lady underwent vaginal hysterectomy for dysfunctional uterine bleeding at a community hospital. Histopathology showed Stage Ib1 squamous cell carcinoma. She underwent robotic completion radical hysterectomy which included vault excision, parametrial resection and ilioobturator lymph node dissection using DaVinci three arm Surgical robot. The ureters were first identified and dissected till their insertion into the bladder. The vagina was dissected from the bladder anteriorly and the rectum posteriorly. Parametrectomy and pelvic lymphadenectomy was done. Operative time was 150 minutes. Docking time was 10 minutes. Blood loss was 50 ml. Vaginal cuff recsected was 2.5 cm. The dissected margins were free. The parametrium measured 2.5 cm. Lymph nodal yield was 18. No drains were used. Robotic assisted surgery in such circumstances holds
Video Session 14dOncology (9:29 AM d 9:37 AM)
Video Session 14dOncology (9:38 AM d 9:45 AM)
Nerve Sparing Radical Hysterectomy Choi CH, Park H-S, Kim MK, Song T-J, Lee Y-Y, Kim T-J, Lee J-W, Kim BG, Bae D-S. Obstetrics and Gynecology, Samsung Medical Center, Seoul, Korea With the concept of the improvement of quality of life in the field of surgical oncology, recent studies have questioned the place of radical hysterectomy (RH) in the treatment of cervical carcinoma due to a high rate of long-term postoperative complications involving the pelvic autonomic nerve system. It has been demonstrated that RH frequently causes bladder dysfunction, anorectal mobility disorders, and sexual dissatisfaction in cervical cancer survivors due to surgical trauma involving the sympathetic and parasympathetic branches of the autonomous innervation of the pelvic organs. Herein, procedures of nerve-sparing RH will be presented. 445
Video Session 14dOncology (9:46 AM d 9:53 AM)
Laparoscopic Radical Vaginal Hysterectomy with Lymphadenectomy for Patient with Cervical Cancer IB2 Choi JS, Lee JH, Son CE, Jeon SW, Bae JW, Hong JH. Obstetrics and Gynecology, Kangbuk Samsung Hospital, Seoul, Korea There are a lot of arguments to treat for patients with cervical cancer FIGO stage IB2. However, the primary surgery is main treatment modality in my hospital. After surgery, we decide the adjuvant therapy for patients. The objectve of my videoclip is to present the feasibility of laparoscopic radical vaginal hysterectomy with lymphadenectomy, and both ovarian transposition in patients with cervical cancer stage IB2. 446
Video Session 14dOncology (9:54 AM d 10:02 AM)
Robotics in Gynecologic Oncology – ‘‘The Good, the Bad, & the Ugly’’ Brown DN, DeNoble SM, Nezhat FR. Minimally Invasive Gynecologic & Robotic Surgery, Obstetrics & Gynecology, St Luke’s-Roosevelt Hospital Center, New York, New York New developments in surgical instrumentation have made technological feasibility of performing complicated laparoscopy more practical.
S125
tricks to optimise its use compared to the classical rectal probe and rectal catheter.
robotic capability to meet consumer demands. The robotic camera holder provides a steady surgeon controlled image.
433
436
Video Session 13dNew Instrumentation and Techniques (9:05 AM d 9:12 AM)
Laparoscopic Vaginal Cuff Closure with Uni- and Bi-Directional Barbed Suture Siedhoff MT, Yunker AC, Steege JF. Division of Advanced Laparoscopy and Pelvic Pain, University of North Carolina, Chapel Hill, North Carolina Several reports have suggested that vaginal cuff dehiscence occurs more frequently after laparoscopic, as opposed to other types of hysterectomy. To address the problem in our practice, we began using barbed suture for closure and have not experienced this complication in over 200 cases. We also have noticed reduced rates of bleeding and cuff cellulitis. This video demonstrates laparoscopic cuff closure with both the V-Loc 180 Absorbable Wound Closure Device (Covidien) and Quill SRS (Angiotech). The former has one needle, barbs in a single direction, and a loop at the end of the suture. Quill is doublearmed with barbs that change direction in the middle of the suture. By holding in the tissue, barbed suture obviates the need to tie knots laparoscopically and represents an inexpensive alternative to single-use suturing devices. The technique is easy to learn and takes less than ten minutes to complete.
434
Video Session 13dNew Instrumentation and Techniques (9:13 AM d 9:20 AM)
Terumo Precision-Drive Articulating Instrument To Facilitate Gynecologic Laparoscopy Milad M, Pavone ME. Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois The Terumo Precision-Drive Articulating Instrument is designed to provide motorized rotation and articulation for endoscopic suture placement, knot tying, dissection and mono and bi-polar electrosurgery. Over the past two years, we applied the Terumo Precision-Drive Articulating Instrument to 6 female pigs of medium weight followed by 4 cadaveric dissections. The new device optimizes dissection, desiccation, suturing and knot tying during common gynecologic procedures. A reduction number of ports and time involved for the more difficult maneuvers was also noted. Accurate suture placement even with posterior myomectomy repair was seen. The Terumo Precision-Drive Articulating Instrument is a simple and effective alternative to both conventional and robotically assisted gynecologic procedures providing both articulation and rotation via a hand activated device. It is available within the operating room setting, on short notice and optimizes needle placement and knot tying.
435
Video Session 13dNew Instrumentation and Techniques (9:21 AM d 9:29 AM)
Solo Laparoscopic Supracervical Hysterectomy with VIKY Robotic Assistance Rosenfield RB. Gynecology, Pearl Women’s Center, Portland, Oregon This video demonstrates a Solo technique of Laparoscopic Supracervical Hysterectomy. A robotic camera holder and uterine positioning system are used to eliminate the need for a surgical assistant and skilled scrub tech. The patient is morbidly obese with a large fibroid uterus. The surgery is performed by one surgeon, completely solo (i.e. the primary surgeon performed this case with no assistance). The scrub tech set up the instruments but did not touch the patient during the operation. With a uterine positioning system, uterine manipulation was performed by the surgeon, eliminating need for a skilled assistant. In a world of increasing health care cost and technology, eliminating the need for a surgical assistant can possibly lead to cost effective solutions. Many hospitals cannot afford more expensive robotic systems, but desire
Video Session 13dNew Instrumentation and Techniques (9:30 AM d 9:35 AM)
Laparoscopic Salpingo-Oopherectomy Assisted with Cul-de-Sac Trocar Shapiro A, DiSciullo A. OB/Gyn, Mount Auburn Hospital, Cambridge, Massachusetts This video demonstrates a laparoscopic salpingo-oophorectomy utilizing only 5 mm abdominal ports and a cul-de-sac trocar to assist with specimen extraction. The patient in this case is perimenopausal, and was found to have a 6 cm complex adnexal mass on ultrasound. After removing the right adnexa, a long 15mm cul-de-sac trocar is introduced under direct visualization. Using an endoscopic bag, the specimen is retrieved. Due to distendability of the vaginal wall, the specimen is extracted intact and with ease. The vaginal entry is then closed laparoscopically. We believe that foregoing the 10mm abdominal port reduces post-operative pain and the chance of internal herniation.
437
Video Session 13dNew Instrumentation and Techniques (9:36 AM d 9:44 AM)
Laparoscopic Neovagina Procedure with Graft Rardin CR, Washington BB, Wohlrab KJ. Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island Iatrogenic obliteration of the vagina can be a challenging situation. The Davydov-Adamyan type procedure is one that has been described, where the peritoneum is anastomosed to the vaginal remnant, and a high peritoneal pursestring suture creates a neovagina composed of peritoneum. Howeverm some practitioners are concerned that the peritoneal pursestring suture is not string enough to reliably prevent evisceration. This modification involves using a biologic graft to extend the length of the vagina; peritoneal pursestring sutures are then used to provide apical support as well as peritoneal vascular support. Thus, security and safety are enhanced while the neovagina undergoes epithelialization.
438
Video Session 13dNew Instrumentation and Techniques (9:45 AM d 9:53 AM)
Minimally Invasive Management an Advanced Abdominal Pregnancy Raff GJ, Rothenberg JM, Golichowski AM. Ob/Gyn, Indiana University School of Medicine, Indianapolis, Indiana Abdominal pregnancy is an extremely rare but serious obstetric condition. It is associated with increased maternal mortality. The standard treatment is surgical interruption of the pregnancy. In this video we demonstrate the laparoscopic management of a 17-week gestation secondary abdominal pregnancy. We review the incidence, maternal and infant mortality rates, and differentiate between primary and secondary abdominal pregnancies as described by Studdiford. Our target audiences are advanced laparoscopists at tertiary referral centers who are likely to have these patients referred to them for further management. We demonstrate a safe minimally invasive alternative to the traditional exploratory laparotomy approach. 439
Video Session 13dNew Instrumentation and Techniques (9:54 AM d 10:00 AM)
Laparoscopic Wedge Resection of Adenomyosis Istre O, Suzuki Y. Ob/Gyn, BWH Harvard Medical School, Boston, Massachusetts Introduction: adenomyosis is a smooth muscle cells and endometriosic tissue, typically originating within the uterus. Methods: These patients usually
S126
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S109–S127
present with monthly pain due to embedded blood in the adenomyotic cyst. Results: Diagnosis is established on transvaginal ultrasound and this also will guide you choosing the correct management approach. This video shows ultrasound pictures MRI and present laparoscopic wedge resection. Conclusion: Adenomyomis uteri is rare, however ultrasound detect the clinical situation and guide the endoscopic approach.
440
Video Session 14dOncology (9:00 AM d 9:10 AM)
Uterine Artery Sparing Robotic Radical Trachelectomy and Pelvic Lymphadenectomy in Patients with Early-Stage Cervical Cancer Lee YS, Chong GO, Hong DG, Park NY, Park IS. Kyungpook National University, Daegu, Korea This video demonstrate techniques of fertility sparing operation for cervical cancer patient, uterine artery sparing total laparoscopic radical trachelectomy using by da Vinci Robotic system. The first Objectives of this video is to demonstrate techniques about both uterine artery sparing result in better blood flow to endometrium, the second is to display adequate dissection line of isthmus, the third is nerve sparing method for better quality of life in young patient. Last is robotic re-anastomosis technique. This case is 27 years old single women, cervical cancer stage IB1 adenocarcinoma. Right uterine artery is preserved but deeper uterine veins are identified and dissected by fine delicate robotic bipolar forceps and scissors. We can preserve right uterine artery to isthmic area which divide descending and ascending branches. And then we can preserve inferior hypogastric plexus and hypogastric nerve. This type of complex operations can be by Robotic system more easily.
promise as it provides all the advantages of minimally invasive surgery without compromising on oncological margins and surgical safety.
443
Reduced Port Surgery: Single Port Access TAH/BSO/Staging for Endometrial Cancer King SA,1 Green M,1 Curcillo PG.2 1Gynecologic Oncology, Drexel University College of Medicine, Philadelphia, Pennsylvania; 2Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania Since April 2007, we have performed over 300 Single Port Access (SPA) procedures. Although single port procedures have been performed in gynecology for over twenty years, there has been a strong interest in further developoing this field over the past two years. Single Port Access has been developed as a platform utilizing standard instrumentation, trocars and nearly identical dissection techniques to multiport laparosocpy. These focuses have allowed us to take this technique from simple oophorectomies to staging procedures with TAH/BSO and lymph node dissections for the same or less instrument costs than standard multiport procedures. In addition, focus on standard famlar instruments has allowed this technique to be taught and reproduced by other surgeons. Our video of a staging procedure for endometrial cancer allows us to demonstrate the technique of access, principles of triangulation and dissection for a single port hysterectomy, oophorectomy and node dissection. 444
441
Video Session 14dOncology (9:11 AM d 9:19 AM)
Laparoscopic Primary Cytoreduction of Advanced Ovarian Cancer Nezhat FR, Brown DN, DeNoble SM, Saharia PC. Minimally Invasive Gynecologic & Robotic Surgery, Obstertics & Gynecology, St Luke’sRoosevelt Hospital Center, New York, New York; Surgery, Winthrop University Hospital, Mineola, New York This is a case of a 61 y/o who originally presented as a referral for the evaluation of a 6 cm adnexal mass. Ultrasound evaluation revealed a 6.5 x 5.2 x 2.7 cm complex left ovarian cyst. The patients CA-125 level was 263 U/mL. The patient was counseled on her findings and was subsequently taken to the operating room where she underwent laparoscopic primary ovarian cancer cytoreduction in the form of radical hysterectomy, bilateral salpingo-oophorectomy, pelvic mass resection, anterior and posterior culdectomy, omentectomy, posterior exenteration, with end to end rectosigmoid anastomosis.The following film is a demonstration of the technique of laparoscopic primary cytoreduction of advanced ovarian cancer.
442
Video Session 14dOncology (9:20 AM d 9:28 AM)
Robotic Vault Excision, Parametrectomy and Pelvic Lymphadenectomy for Carcinoma Cervix Puntambekar SP, Joshi SN, Rayate NV, Agarwal GA, Deshmukh AV, Rajamanickam S. Minimally Invasive Oncology, Galaxy Care Laparoscopy Institute, Pune, Maharashtra, India A 44 year old lady underwent vaginal hysterectomy for dysfunctional uterine bleeding at a community hospital. Histopathology showed Stage Ib1 squamous cell carcinoma. She underwent robotic completion radical hysterectomy which included vault excision, parametrial resection and ilioobturator lymph node dissection using DaVinci three arm Surgical robot. The ureters were first identified and dissected till their insertion into the bladder. The vagina was dissected from the bladder anteriorly and the rectum posteriorly. Parametrectomy and pelvic lymphadenectomy was done. Operative time was 150 minutes. Docking time was 10 minutes. Blood loss was 50 ml. Vaginal cuff recsected was 2.5 cm. The dissected margins were free. The parametrium measured 2.5 cm. Lymph nodal yield was 18. No drains were used. Robotic assisted surgery in such circumstances holds
Video Session 14dOncology (9:29 AM d 9:37 AM)
Video Session 14dOncology (9:38 AM d 9:45 AM)
Nerve Sparing Radical Hysterectomy Choi CH, Park H-S, Kim MK, Song T-J, Lee Y-Y, Kim T-J, Lee J-W, Kim BG, Bae D-S. Obstetrics and Gynecology, Samsung Medical Center, Seoul, Korea With the concept of the improvement of quality of life in the field of surgical oncology, recent studies have questioned the place of radical hysterectomy (RH) in the treatment of cervical carcinoma due to a high rate of long-term postoperative complications involving the pelvic autonomic nerve system. It has been demonstrated that RH frequently causes bladder dysfunction, anorectal mobility disorders, and sexual dissatisfaction in cervical cancer survivors due to surgical trauma involving the sympathetic and parasympathetic branches of the autonomous innervation of the pelvic organs. Herein, procedures of nerve-sparing RH will be presented. 445
Video Session 14dOncology (9:46 AM d 9:53 AM)
Laparoscopic Radical Vaginal Hysterectomy with Lymphadenectomy for Patient with Cervical Cancer IB2 Choi JS, Lee JH, Son CE, Jeon SW, Bae JW, Hong JH. Obstetrics and Gynecology, Kangbuk Samsung Hospital, Seoul, Korea There are a lot of arguments to treat for patients with cervical cancer FIGO stage IB2. However, the primary surgery is main treatment modality in my hospital. After surgery, we decide the adjuvant therapy for patients. The objectve of my videoclip is to present the feasibility of laparoscopic radical vaginal hysterectomy with lymphadenectomy, and both ovarian transposition in patients with cervical cancer stage IB2. 446
Video Session 14dOncology (9:54 AM d 10:02 AM)
Robotics in Gynecologic Oncology – ‘‘The Good, the Bad, & the Ugly’’ Brown DN, DeNoble SM, Nezhat FR. Minimally Invasive Gynecologic & Robotic Surgery, Obstetrics & Gynecology, St Luke’s-Roosevelt Hospital Center, New York, New York New developments in surgical instrumentation have made technological feasibility of performing complicated laparoscopy more practical.