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Minimal Blood Loss in Robotic Assisted Laparoscopic Myomectomy: Bulldog Clamp for Temporary Ligation of Uterine Arteries and Uteroovarian Vessels
S66 Open Communications 17: Laparoscopy (11:00 AM − 12:45 PM) 11:00 AM Laparoscopic Excision of Obturator Nerve Schwannoma Nihlani H,1,* Shetty T,2 Goel A,1 Puntambekar SP1. 1Galaxy Care Laparoscopy Institute Pvt. Ltd, Pune, India; 2Galaxy Care Laparoscopic Institute Pvt. Ltd, Pune, India *Corresponding author. Video Objective: Obturator nerve schwannomas are extremely rare with only 11 cases being reported in the English-language literature. The preoperative diagnosis is difficult due to non-specific symptoms and atypical imaging findings. The excision of an obturator nerve schwannoma is a challenging task because of the narrow obturator fossa which is surrounded by vital structures and it is important to preserve the nerve to prevent any post-operative neurological disorders Setting: A 42 year old married lady presented to us with complaints of pain in the left leg for the past 4 years. The examination was unremarkable and MRI pelvis revealed a 6.1 £ 6.3cm encapsulated retroperitoneal mass on left side with septations and cystic changes and it was displacing the internal iliac vessels medially. Interventions: With the help of laparoscopy, we could achieve a magnified view of the pelvic anatomy and meticulous dissection could be done to enucleate the tumor and preserve the integrity of obturator nerve. The operative time was 40 minutes and there was no blood loss. The post-operative course was uneventful and the patient was discharged after 4 days. On follow-up, the patient did not have any neurological deficits and no bowel, bladder complaints. Conclusion: Thus, laparoscopic surgery can be done with basic knowledge of surgical anatomy of pelvis and it helps in preserving the nerve function and faster recovery.
Open Communications 17: Laparoscopy (11:00 AM − 12:45 PM) 11:07 AM Minimal Blood Loss in Robotic Assisted Laparoscopic Myomectomy: Bulldog Clamp for Temporary Ligation of Uterine Arteries and Uteroovarian Vessels Seifi F,1,* Mutlu L,1 Tierney CH,2 Azodi M1. 1Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT; 2 Obstetrics and Gynecology, Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT *Corresponding author. Video Objective: To demonstrate how to reduce the blood loss in minimally invasive myomectomy, with using laparoscopic Bulldog clamps for ligating the uterine arteries and utero-ovarian vessels Setting: 42 y/o patient with history of infertility, prior abdominal myomectomy, abnormal uterine bleeding with multiple fibroids largest one 6 cm in dimension, who underwent robotic-assisted laparoscopic myomectomy Interventions: Retroperitoneal dissection and ureterolysis were performed to isolate the uterine vessels, then fallopian tubes were isolated from utero-ovarian ligaments bilaterally. Laparoscopic Bulldog clamps were used to temporarily clamp uterine arteries and uteroovarian ligaments. Robotic Myomectomy was performed and total of 13 fibroids were removed. Uterus was repaired with 2-0 V-locks in multiple layers and reconstructed. At the completion of myomectomy the clamps were removed from the vessels. Total of estimated blood loss was 50 cc. Patient was discharged home in less than 24 hours with no complication.
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97 Conclusion: Blood loss in myomectomy is related to location, and numbers of myoma. Clamping the uterine vessels and utero-ovarian can significantly reduce the blood loss. This technique requires retroperitoneal dissection and ureterolysis. Knowledge of anatomy is a master key to success. Open Communications 17: Laparoscopy (11:00 AM − 12:45 PM) 11:14 AM Single-Site Laparoscopy Combined with Hysteroscopy for Large Cesarean Section Diverticulum Arising from Atypical Placental Site Nodule Ding Y,1,2 Zhang X.,3 Hua K,4,* Qiu J,5 Gu Y,6 Lu Z7. 1Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China; 2Obstetrics and Gynecology Hospital, Shanghai, China; 3the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; 4Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China; 5 Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China; 6Gecology, Obstetrics and Gecology Hospital, Fudan University, Shanghai, China; 7Obstetrics and Gecology Hospital, Fudan University, Shanghai, China *Corresponding author. Video Objective: To demonstrate a technique for single-site laparoscopic management combined with hysteroscopy of large cesarean section diverticulum arising from atypical placental site nodule. Setting: Academic teaching hospital. Interventions: The patient underwent single-site laparoscopic excision of a large cesarean section diverticulum arising from atypical placental site nodule. Hysteroscopy was performed before and after surgery. Conclusion: Single-site laparoscopic management combined with hysteroscopy is feasible and safe for the management of CSD. Open Communications 17: Laparoscopy (11:00 AM − 12:45 PM) 11:21 AM Up to 12 Months of Efficacy and Safety of Elagolix Treatment in Women with Heavy Menstrual Bleeding Associated with Uterine Fibroids Schlaff WD,1 Gillispie V,2,* Kim JHJ,3 Owens C,4 Liu R,4 Muneyyirci-Delale O5. 1Thomas Jefferson University, Philadelphia, PA; 2 Ochsner Health System, New Orleans, LA; 3Obstetrics and Gynecology, Columbia University Medical Center, New York, NY; 4AbbVie Inc., North Chicago, IL; 5State University of New York, Brooklyn, NY *Corresponding author. Study Objective: To evaluate the efficacy and safety of elagolix, an oral gonadotropin-releasing hormone antagonist, with hormonal add-back therapy in women with heavy menstrual bleeding (HMB) associated with uterine fibroids (UF) for up to 12-months. Design: Elaris UF-EXTEND, a phase 3 extension study of two pivotal 6month phase 3 studies, Elaris UF-1 and UF-2, evaluated the efficacy and safety of an additional 6-months of treatment (up to 12-months total) with elagolix 300mg twice daily (BID) with add-back therapy (1mg estradiol/ 0.5mg norethindrone acetate [E2/NETA] once daily) and elagolix 300mg BID alone as a reference arm. Setting: Outpatient setting. Patients or Participants: Participants were premenopausal women age 18-51 with HMB (>80mL/cycle menstrual blood loss [MBL]) associated with UF. A total of 433 women who completed the 6-month treatment period in the pivotal studies were enrolled in Elaris UFEXTEND.
Open Communications 17: Laparoscopy (11:00 AM − 12:45 PM) 11:07 AM Minimal Blood Loss in Robotic Assisted Laparoscopic Myomectomy: Bulldog Clamp for Temporary Ligation of Uterine Arteries and Uteroovarian Vessels Seifi F,1,* Mutlu L,1 Tierney CH,2 Azodi M1. 1Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT; 2 Obstetrics and Gynecology, Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT *Corresponding author. Video Objective: To demonstrate how to reduce the blood loss in minimally invasive myomectomy, with using laparoscopic Bulldog clamps for ligating the uterine arteries and utero-ovarian vessels Setting: 42 y/o patient with history of infertility, prior abdominal myomectomy, abnormal uterine bleeding with multiple fibroids largest one 6 cm in dimension, who underwent robotic-assisted laparoscopic myomectomy Interventions: Retroperitoneal dissection and ureterolysis were performed to isolate the uterine vessels, then fallopian tubes were isolated from utero-ovarian ligaments bilaterally. Laparoscopic Bulldog clamps were used to temporarily clamp uterine arteries and uteroovarian ligaments. Robotic Myomectomy was performed and total of 13 fibroids were removed. Uterus was repaired with 2-0 V-locks in multiple layers and reconstructed. At the completion of myomectomy the clamps were removed from the vessels. Total of estimated blood loss was 50 cc. Patient was discharged home in less than 24 hours with no complication.
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97 Conclusion: Blood loss in myomectomy is related to location, and numbers of myoma. Clamping the uterine vessels and utero-ovarian can significantly reduce the blood loss. This technique requires retroperitoneal dissection and ureterolysis. Knowledge of anatomy is a master key to success. Open Communications 17: Laparoscopy (11:00 AM − 12:45 PM) 11:14 AM Single-Site Laparoscopy Combined with Hysteroscopy for Large Cesarean Section Diverticulum Arising from Atypical Placental Site Nodule Ding Y,1,2 Zhang X.,3 Hua K,4,* Qiu J,5 Gu Y,6 Lu Z7. 1Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China; 2Obstetrics and Gynecology Hospital, Shanghai, China; 3the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; 4Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China; 5 Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China; 6Gecology, Obstetrics and Gecology Hospital, Fudan University, Shanghai, China; 7Obstetrics and Gecology Hospital, Fudan University, Shanghai, China *Corresponding author. Video Objective: To demonstrate a technique for single-site laparoscopic management combined with hysteroscopy of large cesarean section diverticulum arising from atypical placental site nodule. Setting: Academic teaching hospital. Interventions: The patient underwent single-site laparoscopic excision of a large cesarean section diverticulum arising from atypical placental site nodule. Hysteroscopy was performed before and after surgery. Conclusion: Single-site laparoscopic management combined with hysteroscopy is feasible and safe for the management of CSD. Open Communications 17: Laparoscopy (11:00 AM − 12:45 PM) 11:21 AM Up to 12 Months of Efficacy and Safety of Elagolix Treatment in Women with Heavy Menstrual Bleeding Associated with Uterine Fibroids Schlaff WD,1 Gillispie V,2,* Kim JHJ,3 Owens C,4 Liu R,4 Muneyyirci-Delale O5. 1Thomas Jefferson University, Philadelphia, PA; 2 Ochsner Health System, New Orleans, LA; 3Obstetrics and Gynecology, Columbia University Medical Center, New York, NY; 4AbbVie Inc., North Chicago, IL; 5State University of New York, Brooklyn, NY *Corresponding author. Study Objective: To evaluate the efficacy and safety of elagolix, an oral gonadotropin-releasing hormone antagonist, with hormonal add-back therapy in women with heavy menstrual bleeding (HMB) associated with uterine fibroids (UF) for up to 12-months. Design: Elaris UF-EXTEND, a phase 3 extension study of two pivotal 6month phase 3 studies, Elaris UF-1 and UF-2, evaluated the efficacy and safety of an additional 6-months of treatment (up to 12-months total) with elagolix 300mg twice daily (BID) with add-back therapy (1mg estradiol/ 0.5mg norethindrone acetate [E2/NETA] once daily) and elagolix 300mg BID alone as a reference arm. Setting: Outpatient setting. Patients or Participants: Participants were premenopausal women age 18-51 with HMB (>80mL/cycle menstrual blood loss [MBL]) associated with UF. A total of 433 women who completed the 6-month treatment period in the pivotal studies were enrolled in Elaris UFEXTEND.