- Email: [email protected]
Laparoscopically-Assisted Removal of a Large Ovarian Dermoid Cyst
S6
Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159
The removal of large tissue specimens such as the uterus and myomas through laparoscopic incisions has been facilitated by the advent of electronicallypowered morcellating devices over the recent years. Following morcellation during laparoscopic supracervical hysterectomy, careful identification and removal of all tissue fragments is imperative to minimize the risk of iatrogenic endometriosis or post-hysterectomy myomas seeded by morcellated tissue. However, this step may be tedious and inefficient with conventional retrieval through a trocar. We present a novel technique using a ring forceps as a simple and effective method of removing morcellated tissue fragments following laparoscopic supracervical hysterectomy.
of the case, we introduced a blunt-tip inflatable balloon trocar into the suprapubic incision through the Mobius retractor and performed a dermoid cystectomy on the left adnexa without difficulty. The patient did well and was discharged post-operative day #1.
17
The purpose of our video is to demonstrate basic laparoscopic suturing techniques and principles for beginning practioners. Many styles and techniques of suturing exist for laparoscopy. Our style may be an example that can be applied to a learning endoscopic surgeon’s practice. We also discuss advantages and disadvantages to certain techniques developed but most importantly would like the audience to understand the basic principles of laparoscopic suturing.
Video Session 1dEndoscopic Techniques (10:34 AM d 10:42 AM)
Different Approaches to Identifying the Obturator Nerve during Laparoscopic Pelvic Lymphadenectomy Nezhat FR,1 Liu CS,1 de Mello Datta MS.2 1Obstetrics, Gynecology and Reproductive Health, Mount Sinai Medical Center, New York, New York; 2 Department of Obstetrics and Gynecology, St. Luke’s Roosevelt, New York, New York Objective: To describe three anatomic approaches to identify the obturator nerve during laparoscopic pelvic lymphadenectomy Methods: Three approaches to identifying the obturator nerve during laparoscopic pelvic lymphadenectomy performed by a single experienced laparoscopic gynecologic oncologist are displayed. Results: The three approaches illustrated include a medial, lateral, and posterior approach. Conclusion: When performing laparoscopic pelvic lymphadenectomy, it is essential to know the anatomy, perform a careful dissection, and to be aware of potentially aberrant anatomy. In cases where obturator nerve identification is challenging, these alternate surgical approaches may be implemented to facilitate safe laparoscopic pelvic lymphadenectomy.
18
Video Session 1dEndoscopic Techniques (10:43 AM d 10:51 AM)
Principles and Practical Applications of Electrosurgery in Laparoscopy Kingston AJ, Lyons SD, Abbott JA, Vancaillie TG. Department of Endo-Gynaecology, Royal Hospital for Women, Randwick, NSW, Australia Monopolar electrosurgery remains a popular energy choice in laparoscopic surgery. The aim of this video is to highlight theoretical electrosurgical principles as they relate to practical applications of monopolar electrosurgery. We briefly trace the history of electrosurgical development and the engineering innovations that have made monopolar energy inherently safe. The efficacy and versatility of this modality is further emphasized though a series of instructive surgical video clips.
19
Video Session 1dEndoscopic Techniques (10:52 AM d 10:59 AM)
Laparoscopically-Assisted Removal of a Large Ovarian Dermoid Cyst DiSciullo AJ, Rosenblatt PL, Ferzandi TR. Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, Massachusetts This video illustrates an interesting approach for removal of a large dermoid and ovarian torsion using both laparoscopic and mini-laparotomy techniques, allowing the patient to undergo a minimally invasive procedure rather than traditional open laparotomy. While using a 5 mm umbilical and two 5 mm lower quadrant ports, we used a 3e4 cm suprapubic incision that accommodated a MobiusÒ Elastic Abdominal Retractor. With the retractor in place, we introduced a cholecystectomy trocar connected to suction e thus allowing decompression of the large dermoid. After achieving adequate exposure to the pelvic cavity, the torsed ovary was ligated with the laparoscopic instruments and the specimen was easily removed via the Mobius retractor. For the remainder
20
Video Session 1dEndoscopic Techniques (11:00 AM d 11:08 AM)
Basic Laparoscopic Suturing Techniques Cholkeri-Singh A, Miller CE. OB/Gyn at Lutheran General Hospital, The Advanced Gynecologic Surgery Institute, Park Ridge, Illinois
21
Video Session 1dEndoscopic Techniques (11:09 AM d 11:17 AM)
Laparoscopic Treatment of Dermoid Cyst Hudgens JL, Justice T, Yeung PP, Shwayder JM, Levine R, Pasic R. Obstetrics and Gynecology, University of Louisville, Louisville, Kentucky The purpose of this video is to present an overview of dermoid cyst and treatment with laparoscopy. This video will discuss the etiology, epidemiology, and radiographic findings of dermoid cyst. The surgical portion of this video will explain cystectomy techniques, the management of cyst rupture, and removal with an endoscopic bag. Five cases will be presented; four cystectomies and one complete oophorectomy were performed. In one case the patient was fourteen weeks in gestation with a twelve centimeter dermoid cyst which was found at routine perinatal ultrasound. Rupture occurred in two of the four cases in which a cystectomy was performed. There were no other intra-operative or postoperative complications.
22
Video Session 1dEndoscopic Techniques (11:18 AM d 11:25 AM)
Laparoscopic Treatment of Pelvic Congestion Syndrome Nassif J,1 Zacharopoulou C,1 Thoma V,2 Wattiez A.1 1Gynecology Department, IRCAD/EITS, Strasbourg, Bas Rhin, France; 2Obstetrics and Gynecology, Hautepierre Hospital, Strasbourg, Bas Rhin, France Surgical treatment for pelvic congestion syndrome is still controversial. We suggest that in patient’s selection and good surgical techniques are important factor for treatment’s success. We present a short video showing three operative laparocscopic techniques: 1. Simple round ligament plicature: its indication is distal atrophy of the round ligament associated with a normal proximal part and uterine retroversion. 2. Retrouterine round ligaments plicature: this tecnique is used for proximal atrophy of the round ligament with a normal distal part and for uterine retroflexion. 3. Anterior fixation of round ligaments to the aponeurosis: it is indicated in distal atrophy of the round ligament with a normal proximal part and for uterine retroversion. These techniques are easy to learn and perform. Dyspareunia and chronic pelvic pain is dramatically reduced postoperatively, but there is no effect on dysmenorrhea.
23
Plenary Session 4dEndoscopic Techniques (11:35 AM d 11:45 AM)
Ultrasound Estimation of Residual Pelvic Fluid Using Two Types of Drains at Laparoscopy: A RCT Chan KK,1,2 Welsh A,1,2 Abbott JA.1,2 1Women and Children’s Health, University of New South Wales, Randwick, NSW, Australia; 2Department
Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159
The removal of large tissue specimens such as the uterus and myomas through laparoscopic incisions has been facilitated by the advent of electronicallypowered morcellating devices over the recent years. Following morcellation during laparoscopic supracervical hysterectomy, careful identification and removal of all tissue fragments is imperative to minimize the risk of iatrogenic endometriosis or post-hysterectomy myomas seeded by morcellated tissue. However, this step may be tedious and inefficient with conventional retrieval through a trocar. We present a novel technique using a ring forceps as a simple and effective method of removing morcellated tissue fragments following laparoscopic supracervical hysterectomy.
of the case, we introduced a blunt-tip inflatable balloon trocar into the suprapubic incision through the Mobius retractor and performed a dermoid cystectomy on the left adnexa without difficulty. The patient did well and was discharged post-operative day #1.
17
The purpose of our video is to demonstrate basic laparoscopic suturing techniques and principles for beginning practioners. Many styles and techniques of suturing exist for laparoscopy. Our style may be an example that can be applied to a learning endoscopic surgeon’s practice. We also discuss advantages and disadvantages to certain techniques developed but most importantly would like the audience to understand the basic principles of laparoscopic suturing.
Video Session 1dEndoscopic Techniques (10:34 AM d 10:42 AM)
Different Approaches to Identifying the Obturator Nerve during Laparoscopic Pelvic Lymphadenectomy Nezhat FR,1 Liu CS,1 de Mello Datta MS.2 1Obstetrics, Gynecology and Reproductive Health, Mount Sinai Medical Center, New York, New York; 2 Department of Obstetrics and Gynecology, St. Luke’s Roosevelt, New York, New York Objective: To describe three anatomic approaches to identify the obturator nerve during laparoscopic pelvic lymphadenectomy Methods: Three approaches to identifying the obturator nerve during laparoscopic pelvic lymphadenectomy performed by a single experienced laparoscopic gynecologic oncologist are displayed. Results: The three approaches illustrated include a medial, lateral, and posterior approach. Conclusion: When performing laparoscopic pelvic lymphadenectomy, it is essential to know the anatomy, perform a careful dissection, and to be aware of potentially aberrant anatomy. In cases where obturator nerve identification is challenging, these alternate surgical approaches may be implemented to facilitate safe laparoscopic pelvic lymphadenectomy.
18
Video Session 1dEndoscopic Techniques (10:43 AM d 10:51 AM)
Principles and Practical Applications of Electrosurgery in Laparoscopy Kingston AJ, Lyons SD, Abbott JA, Vancaillie TG. Department of Endo-Gynaecology, Royal Hospital for Women, Randwick, NSW, Australia Monopolar electrosurgery remains a popular energy choice in laparoscopic surgery. The aim of this video is to highlight theoretical electrosurgical principles as they relate to practical applications of monopolar electrosurgery. We briefly trace the history of electrosurgical development and the engineering innovations that have made monopolar energy inherently safe. The efficacy and versatility of this modality is further emphasized though a series of instructive surgical video clips.
19
Video Session 1dEndoscopic Techniques (10:52 AM d 10:59 AM)
Laparoscopically-Assisted Removal of a Large Ovarian Dermoid Cyst DiSciullo AJ, Rosenblatt PL, Ferzandi TR. Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, Massachusetts This video illustrates an interesting approach for removal of a large dermoid and ovarian torsion using both laparoscopic and mini-laparotomy techniques, allowing the patient to undergo a minimally invasive procedure rather than traditional open laparotomy. While using a 5 mm umbilical and two 5 mm lower quadrant ports, we used a 3e4 cm suprapubic incision that accommodated a MobiusÒ Elastic Abdominal Retractor. With the retractor in place, we introduced a cholecystectomy trocar connected to suction e thus allowing decompression of the large dermoid. After achieving adequate exposure to the pelvic cavity, the torsed ovary was ligated with the laparoscopic instruments and the specimen was easily removed via the Mobius retractor. For the remainder
20
Video Session 1dEndoscopic Techniques (11:00 AM d 11:08 AM)
Basic Laparoscopic Suturing Techniques Cholkeri-Singh A, Miller CE. OB/Gyn at Lutheran General Hospital, The Advanced Gynecologic Surgery Institute, Park Ridge, Illinois
21
Video Session 1dEndoscopic Techniques (11:09 AM d 11:17 AM)
Laparoscopic Treatment of Dermoid Cyst Hudgens JL, Justice T, Yeung PP, Shwayder JM, Levine R, Pasic R. Obstetrics and Gynecology, University of Louisville, Louisville, Kentucky The purpose of this video is to present an overview of dermoid cyst and treatment with laparoscopy. This video will discuss the etiology, epidemiology, and radiographic findings of dermoid cyst. The surgical portion of this video will explain cystectomy techniques, the management of cyst rupture, and removal with an endoscopic bag. Five cases will be presented; four cystectomies and one complete oophorectomy were performed. In one case the patient was fourteen weeks in gestation with a twelve centimeter dermoid cyst which was found at routine perinatal ultrasound. Rupture occurred in two of the four cases in which a cystectomy was performed. There were no other intra-operative or postoperative complications.
22
Video Session 1dEndoscopic Techniques (11:18 AM d 11:25 AM)
Laparoscopic Treatment of Pelvic Congestion Syndrome Nassif J,1 Zacharopoulou C,1 Thoma V,2 Wattiez A.1 1Gynecology Department, IRCAD/EITS, Strasbourg, Bas Rhin, France; 2Obstetrics and Gynecology, Hautepierre Hospital, Strasbourg, Bas Rhin, France Surgical treatment for pelvic congestion syndrome is still controversial. We suggest that in patient’s selection and good surgical techniques are important factor for treatment’s success. We present a short video showing three operative laparocscopic techniques: 1. Simple round ligament plicature: its indication is distal atrophy of the round ligament associated with a normal proximal part and uterine retroversion. 2. Retrouterine round ligaments plicature: this tecnique is used for proximal atrophy of the round ligament with a normal distal part and for uterine retroflexion. 3. Anterior fixation of round ligaments to the aponeurosis: it is indicated in distal atrophy of the round ligament with a normal proximal part and for uterine retroversion. These techniques are easy to learn and perform. Dyspareunia and chronic pelvic pain is dramatically reduced postoperatively, but there is no effect on dysmenorrhea.
23
Plenary Session 4dEndoscopic Techniques (11:35 AM d 11:45 AM)
Ultrasound Estimation of Residual Pelvic Fluid Using Two Types of Drains at Laparoscopy: A RCT Chan KK,1,2 Welsh A,1,2 Abbott JA.1,2 1Women and Children’s Health, University of New South Wales, Randwick, NSW, Australia; 2Department