Left Ovarian Transposition of Undescended Ovary with Unicornuate Uterus

S76 Patients or Participants: Premenopausal women between the ages of 25 and 50 with heavy menstrual bleeding secondary to fibroids treated prospectively with transcervical RF ablation; matched hysterectomy and myomectomy procedures of interest for uterine fibroids were identified using appropriate diagnostic and procedural codes. Interventions: Ultrasound-guided transcervical, intrauterine radiofrequency ablation using the Sonata systemÒ performed on up to 10 fibroids per subject; hysterectomy and myomectomy (for the comparative payor data arms). Measurements and Main Results: Mean total payor cost for treatment with the Sonata system and 12-month associated postoperative HCRU ($8,941) were significantly lower than that for hysterectomy ($24,156) or myomectomy ($22,784). Furthermore, the mean payor cost for the 12-month postoperative HCRU associated with Sonata ($143) was significantly lower than that associated with hysterectomy ($699) or myomectomy ($1,444). Finally, Sonata patients had significantly lower costs associated with complications, prescription medication, and radiology studies than either hysterectomy or myomectomy patients. Conclusion: Transcervical RF ablation using the Sonata system is a lowercost alternative to hysterectomy and myomectomy for the treatment of symptomatic uterine fibroids. Open Communications 20: Laparoscopy (2:00 PM − 3:00 PM) 2:21 PM It is not all About Size. Incidence and Implications of Concurrent Endometriosis in Women Undergoing Laparoscopic Surgery for Fibroids Lam AM, Lowe JA*. Centre for Advanced Reproductive Endosurgery, Sydney, NSW, Australia *Corresponding author. Study Objective: To assess the incidence and predictive factors associated with endometriosis co-occurrence in patients having surgery for fibroid pathology. Design: Retrospective observational study of all premenopausal women who underwent fibroid surgery at the Centre for Advanced Reproductive Endosurgery in Sydney, Australia between October 2008 and December 2016. Setting: A single center study from a high volume gynecological practice. Patients or Participants: All premenopausal patients who underwent laparoscopic surgery (hysterectomy or myomectomy) who had histologically confirmed fibroids during the study period. Patients were identified from the database at the single pathology service where all surgical specimens were referred for histological analysis. Interventions: Standardized demographic, clinical history, operative and pathological findings were collected from the electronic medical record. Descriptive statistics were used to describe baseline patient population characteristics as well as the prevalence of endometriosis and factors associated with higher co-occurrence of the two conditions. Measurements and Main Results: 551 women were eligible for inclusion, with a median age of 43 years (range 21-59). 62.4% of the women had a prior pregnancy and 51.1% at least one delivery. 19.8% had previous endometriosis surgery. 61.5% had endometriosis that was identified and treated at the time of the fibroid operation. Factors significantly associated with endometriosis presence included a history of dysmenorrhea (OR 1.92, 95% CI 1.35 -2.72), dyschezia (OR 7.29, 95% CI 1.70 - 31.32) and subfertility (OR 4.44, 95% CI 2.45 − 8.06). Multivariate analysis was undertaken with the aim of establishing a predictive model based on symptomatology however only marginal additional predictive value was gained. Conclusion: There is a significant co-occurrence of endometriosis amongst women undergoing fibroid surgery, particularly those with subfertility, dysmenorrhea and dyschezia. Clinical awareness of this co-occurrence is essential for adequate pre-operative patient counselling and

Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97 strategic surgical planning for women presenting with fibroids. This is especially pertinent for those with subfertility or chronic pelvic pain where symptoms may persist if the endometriosis remains untreated. Open Communications 20: Laparoscopy (2:00 PM − 3:00 PM) 2:28 PM Laparoscopic Management of a Ruptured Interstitial Ectopic Pregnancy Johnson CM,1,* Patel NR,2 Makai GE,1 Huynh TQ1. 1Obstetrics and Gynecology, Christiana Care Health Systems, Newark, DE; 2Medical Education, OB/GYN, TriHealth/Good Samaritan Hospital, Cincinnati, OH *Corresponding author. Video Objective: We demonstrate laparoscopic management of an interstitial ectopic pregnancy with ongoing rupture and describe different techniques for hemostasis. Setting: The patient was a 40 year old G6P2032 found to have a live 10 week interstitial ectopic pregnancy on ultrasound. She had no symptoms or free fluid at the time of diagnosis, and at the start of the surgery had evidence of hemoperitoneum with ongoing rupture. Interventions: We performed a laparoscopic cornual resection and repair using vasopressin, a harmonic scalpel and bipolar device, and multilayer closure with barbed suture. We describe additional methods for hemostasis including a purse string suture and lateral control of the uterine vessels. Conclusion: With a hemodynamically stable patient, ruptured interstitial pregnancy can be managed laparoscopically. Many techniques can help decrease blood loss including using vasopressin, surgical energy devices, compression around the base of the ectopic, and lateral control of the uterine vessels. Open Communications 20: Laparoscopy (2:00 PM − 3:00 PM) 2:35 PM Left Ovarian Transposition of Undescended Ovary with Unicornuate Uterus Sasaki KJ,1,* Miller CE2. 1OBGYN, Advocate Lutheran General Hospital, Park Ridge, IL; 2The Advanced Gynecologic Surgery Institute, Naperville, IL *Corresponding author. Video Objective: To educate the minimally invasive gynecologist on the rare diagnosis of an undescended ovary and to demonstrate a laparoscopic technique for ovarian transposition to facilitate trans-vaginal oocyte monitoring and retrieval. Setting: Community hospital in the suburbs of Chicago. Interventions: Left ovarian transposition and ovarian drilling. Conclusion: Laparoscopic ovarian transposition is a feasible, safe option to facilitate oocyte retrieval in cases of undescended ovaries. Open Communications 20: Laparoscopy (2:00 PM − 3:00 PM) 2:42 PM Surgical Skills Across the Spectrum: Comparing Surgical Skill Based on Surgical Experience Using a Standardized, High-Fidelity Total Laparoscopic Hysterectomy Model Arora C,1,* Menzies A,2 Han ES,1 Lee M,3 Kim JHJ,1 Advincula AP1. 1 Obstetrics and Gynecology, Columbia University Medical Center, New York, NY; 2Obstetrics and Gynecology, Stony Brook University Medical Center, Stony Brook, NY; 3Gastroenterology, Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA *Corresponding author.