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Multidisciplinary Approach to Resection of Deeply Infiltrative Endometriosis Using the Robotic Platform
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Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201 Virtual Posters – Session 1 (9:45 AM - 10:45 AM) 10:03 AM – STATION E
Laparoscopic Management of Partial Bladder Resection in Deep Infiltrating Endometriosis Misirlioglu S,1 Eraslan A,1 Boza A,2 Yildiz Oguz S,1 Urman B,3 Taskiran C3. 1Department of Ob/Gyn, VKF Koc University Hospital, Istanbul, Turkey; 2Department of Ob/Gyn, VKF American Hospital, Istanbul, Turkey; 3Department of Ob/Gyn, VKF Koc University School of Medicine, Istanbul, Turkey Urinary tract endometriosis (UTE) is a rare form of deep infiltrating endometriosis. It may involve different sites of the bladder, most frequently the base and the dome, with various grade of infiltration. Bladder nodules typically coexists with other localizations of deep pelvic endometriosis, resulting in a wide variety of abdominal and urinary symptoms that may be overlooked by clinicians. In this report, A 32 years old woman was admitted with urinary storage symptoms and severe pelvic pain. On pelvic MRI, suspected endometriosis infiltration was detected. Laparoscopic evaluation was suggested and partial bladder resection was performed.Multidisciplinary approach is required in the advanced stage cases for favourable outcomes.
340
Virtual Posters – Session 1 (9:45 AM - 10:45 AM) 10:03 AM – STATION F
Laparoscopic Treatment of Bladder Endometriosis: Outcomes on 223 Patients Treated in an Endometriosis Unit Clarizia R,1 Roviglione G,1 Bruni F,1 Mautone D,1 Caleffi G,2 Ceccaroni M1. 1Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy; 2 Department of Urology, Sacred Heart Hospital, International School of Surgical Anatomy, Negrar, Verona, Italy Study Objective: To asses feasibility and effectiveness of laparoscopic treatment of anterior compartment endometriosis. Design: retrospective analysis. Setting: Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona - Italy. Patients: 223 women treated for bladder endometriosis from January 2004 to April 2015 in our Department. Intervention: Bladder wall opening and resection was obtained using bipolar scissors, monopolar hook or combined energy and ultrasound devices. After bladder opening, distance of the excision margins from both ureteral hostia was visualized and ureteral double-J catheter was considered if less 2 cm. The bladder then was closed by double-layer intra-corporeal laparoscopic running suture using Vicryl 3/0. At the end of the procedure, the bladder was filled with 240– 300 ml of a 0.9 % NaCl solution, for watertight closure testing. Measurements and Main Results: Median duration of surgery was 251 minutes. Mean hospital stay was 9,5 days. There were no intraoperative complications related to the urinary phase. Median intraoperative blood loss was 111 milliliters. Suture leakage was reported at cystography in 7 cases (3,1%), in no case surgical correction was performed, in all these patients the catheter was maintained up to 20 days with complete heal of the leakage. Median follow-up was 55,5 months At the 1,6 and 12 months follow-up visit 218 patients (98.75%) reported complete resolution of symptoms, only 5 patients (2.24%) reported persistent symptoms of urinary tract. The rate of recurrence at 12 months of follow-up is 2.9%.
Conclusion: laparoscopic eradication of bladder endometriosis proved, in our experience, to be a safe and effective approach in the resolution of symptoms reported at 12 months, and with a rate of relapse of 2.9%. The laparoscopic approach to bladder endometriosis should be considered, as the only radical ablative treatment when performed in reference centers and in expert surgical hands.
341
Virtual Posters – Session 1 (9:45 AM - 10:45 AM) 10:03 AM – STATION G
Multidisciplinary Approach to Resection of Deeply Infiltrative Endometriosis Using the Robotic Platform Tyan P, Abi Khalil E, Moawad G. Obstetrics and Gynecology, George Washington University Hospital, Washington, District of Columbia We present a multidisciplinary surgical approach using the robotic platform to resect deeply infiltrative endometriosis. Case: 47-year-old with a four-year history of pelvic pain, dysuria, dyspareunia, dyschezia and dysmenorrhea failing medical therapy. Pelvic MRI showed bladder endometrioma in addition to rectovaginal endometriosis. We describe procedures done by specialty. Urology: Cystoscopy and lighted stents placement due to the proximity of the lesion to the trigone area. Intentional cystotomy and resection of the bladder section involved with endometriosis followed by watertight closure. Gynecology: Dissection of the retroperitoneal space with development of the pararectal and paravesical space. Ligation of the uterine artery at its origin. Dissection of the bladder off of the lower uterine segment. Total hysterectomy. Colorectal: Mobilization of the rectum and dissection the obliterated rectovaginal space. Opening of the presacral space and mobilization the rectosigmoid from its attachment. Full transection and reanastomosis of the rectum section involved with endometriosis.
342
Virtual Posters – Session 1 (9:45 AM - 10:45 AM) 10:03 AM – STATION H
Perioperative Outcomes Following Robotic Versus Laparoscopic Management of Endometriomas Tam J, Meislin R, Keltz J, Shin JH. Minimally Invasive Gynecology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York Study Objective: To compare perioperative outcomes for robotic versus conventional laparoscopic management of endometriomas. Design: Retrospective cohort study. Setting: Academic tertiary care hospital. Patients: Women undergoing laparoscopic or robotic cystectomy or oophorectomy with pathology proven endometriomas. Intervention: Perioperative outcomes among patients who had robotic or laparoscopic cystectomy or oophorectomy for endometriomas Measurements and Main Results: A chart review was performed from January 2015 to December 2016 for women who underwent a laparoscopic or robotic ovarian cystectomy or oophorectomy for endometriomas. All cases included in the analysis had pathology proven disease. A total of 65 patients (11 robotic and 54 conventional) were identified. The two groups were comparable in terms of age, body mass index, parity, cyst size, and prior surgery. There were no significant differences in operative time, estimated blood loss, postoperative pain score, and stage of endometriosis. 12 patients had a change in procedure from the intended procedure, 2 robotic and 10 conventional. There were three postoperative infections and one inferior epigastric injury in the conventional group. In the robotic group there was one deep vein thrombosis and one postoperative infection.
Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201 Virtual Posters – Session 1 (9:45 AM - 10:45 AM) 10:03 AM – STATION E
Laparoscopic Management of Partial Bladder Resection in Deep Infiltrating Endometriosis Misirlioglu S,1 Eraslan A,1 Boza A,2 Yildiz Oguz S,1 Urman B,3 Taskiran C3. 1Department of Ob/Gyn, VKF Koc University Hospital, Istanbul, Turkey; 2Department of Ob/Gyn, VKF American Hospital, Istanbul, Turkey; 3Department of Ob/Gyn, VKF Koc University School of Medicine, Istanbul, Turkey Urinary tract endometriosis (UTE) is a rare form of deep infiltrating endometriosis. It may involve different sites of the bladder, most frequently the base and the dome, with various grade of infiltration. Bladder nodules typically coexists with other localizations of deep pelvic endometriosis, resulting in a wide variety of abdominal and urinary symptoms that may be overlooked by clinicians. In this report, A 32 years old woman was admitted with urinary storage symptoms and severe pelvic pain. On pelvic MRI, suspected endometriosis infiltration was detected. Laparoscopic evaluation was suggested and partial bladder resection was performed.Multidisciplinary approach is required in the advanced stage cases for favourable outcomes.
340
Virtual Posters – Session 1 (9:45 AM - 10:45 AM) 10:03 AM – STATION F
Laparoscopic Treatment of Bladder Endometriosis: Outcomes on 223 Patients Treated in an Endometriosis Unit Clarizia R,1 Roviglione G,1 Bruni F,1 Mautone D,1 Caleffi G,2 Ceccaroni M1. 1Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy; 2 Department of Urology, Sacred Heart Hospital, International School of Surgical Anatomy, Negrar, Verona, Italy Study Objective: To asses feasibility and effectiveness of laparoscopic treatment of anterior compartment endometriosis. Design: retrospective analysis. Setting: Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona - Italy. Patients: 223 women treated for bladder endometriosis from January 2004 to April 2015 in our Department. Intervention: Bladder wall opening and resection was obtained using bipolar scissors, monopolar hook or combined energy and ultrasound devices. After bladder opening, distance of the excision margins from both ureteral hostia was visualized and ureteral double-J catheter was considered if less 2 cm. The bladder then was closed by double-layer intra-corporeal laparoscopic running suture using Vicryl 3/0. At the end of the procedure, the bladder was filled with 240– 300 ml of a 0.9 % NaCl solution, for watertight closure testing. Measurements and Main Results: Median duration of surgery was 251 minutes. Mean hospital stay was 9,5 days. There were no intraoperative complications related to the urinary phase. Median intraoperative blood loss was 111 milliliters. Suture leakage was reported at cystography in 7 cases (3,1%), in no case surgical correction was performed, in all these patients the catheter was maintained up to 20 days with complete heal of the leakage. Median follow-up was 55,5 months At the 1,6 and 12 months follow-up visit 218 patients (98.75%) reported complete resolution of symptoms, only 5 patients (2.24%) reported persistent symptoms of urinary tract. The rate of recurrence at 12 months of follow-up is 2.9%.
Conclusion: laparoscopic eradication of bladder endometriosis proved, in our experience, to be a safe and effective approach in the resolution of symptoms reported at 12 months, and with a rate of relapse of 2.9%. The laparoscopic approach to bladder endometriosis should be considered, as the only radical ablative treatment when performed in reference centers and in expert surgical hands.
341
Virtual Posters – Session 1 (9:45 AM - 10:45 AM) 10:03 AM – STATION G
Multidisciplinary Approach to Resection of Deeply Infiltrative Endometriosis Using the Robotic Platform Tyan P, Abi Khalil E, Moawad G. Obstetrics and Gynecology, George Washington University Hospital, Washington, District of Columbia We present a multidisciplinary surgical approach using the robotic platform to resect deeply infiltrative endometriosis. Case: 47-year-old with a four-year history of pelvic pain, dysuria, dyspareunia, dyschezia and dysmenorrhea failing medical therapy. Pelvic MRI showed bladder endometrioma in addition to rectovaginal endometriosis. We describe procedures done by specialty. Urology: Cystoscopy and lighted stents placement due to the proximity of the lesion to the trigone area. Intentional cystotomy and resection of the bladder section involved with endometriosis followed by watertight closure. Gynecology: Dissection of the retroperitoneal space with development of the pararectal and paravesical space. Ligation of the uterine artery at its origin. Dissection of the bladder off of the lower uterine segment. Total hysterectomy. Colorectal: Mobilization of the rectum and dissection the obliterated rectovaginal space. Opening of the presacral space and mobilization the rectosigmoid from its attachment. Full transection and reanastomosis of the rectum section involved with endometriosis.
342
Virtual Posters – Session 1 (9:45 AM - 10:45 AM) 10:03 AM – STATION H
Perioperative Outcomes Following Robotic Versus Laparoscopic Management of Endometriomas Tam J, Meislin R, Keltz J, Shin JH. Minimally Invasive Gynecology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York Study Objective: To compare perioperative outcomes for robotic versus conventional laparoscopic management of endometriomas. Design: Retrospective cohort study. Setting: Academic tertiary care hospital. Patients: Women undergoing laparoscopic or robotic cystectomy or oophorectomy with pathology proven endometriomas. Intervention: Perioperative outcomes among patients who had robotic or laparoscopic cystectomy or oophorectomy for endometriomas Measurements and Main Results: A chart review was performed from January 2015 to December 2016 for women who underwent a laparoscopic or robotic ovarian cystectomy or oophorectomy for endometriomas. All cases included in the analysis had pathology proven disease. A total of 65 patients (11 robotic and 54 conventional) were identified. The two groups were comparable in terms of age, body mass index, parity, cyst size, and prior surgery. There were no significant differences in operative time, estimated blood loss, postoperative pain score, and stage of endometriosis. 12 patients had a change in procedure from the intended procedure, 2 robotic and 10 conventional. There were three postoperative infections and one inferior epigastric injury in the conventional group. In the robotic group there was one deep vein thrombosis and one postoperative infection.