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Multidisciplinary Laparoscopic Management of Severe Ureteral Endometriosis with Atrophic Kidney
S140
Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252
and stroma. Although the origin of ACUM is currently unknown, the most common location is a 2-4 cm lateral uterine wall mass at the level of the insertion of the round ligament. Hence it has been hypothesized that gubernaculum dysfunction may be responsible for duplication or persistence of paramesonephric tissue leading to ACUM formation as a new M€ ullerian anomaly. Here, we present two cases that illustrate the laparoscopic ACUM resection in women desiring uterine-sparing surgery.
nephrouretectomy. Postoperatively, symptoms have improved. Patients with ureteral endometriosis usually present with non-specific symptoms. Early recognition and managment is recommended to prevent silent kidney loss. Multidisciplinary collaboration is required for surgical resection of endometriosis for symptomatic relief and to potentially prevent further loss of renal function. 409
407
Video Session 15 - Laparoscopic Surgeries (3:25 PM - 5:05 PM)
Video Session 16 - Urogyn/Pelvic Floor Disorders/Vaginal Surgery (3:25 PM - 5:05 PM)
4:43 PM – GROUP C
3:25 PM – GROUP A
Resident Guide to Successful Interrupted Vaginal Cuff Closure Pollard RR, Petrikovets A. Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio
Subtotal Hysterectomy and Cervicosacropexy Rodriguez VO, Garcia LF, Silva JE, Garza E. Ginecologia y Obstetricia, Tec de Monterrey, Monterrey, Nuevo Leon, Mexico
This video entitled A Resident Guide to Successful Interrupted Vaginal Cuff Closure was made to help as a teaching tool for residents and others learning advanced laparoscopy. The video will detail a methodical, reproducible technique for laparoscopic suturing of the vaginal cuff. However, this technique is also applicable to all tissue types. The video will show both a surgeon view demonstrating the hand movements and position as well as the traditional laparoscopic view.
Uterovaginal prolapse is a common problem with population prevalence of 30-50%. Hysterectomy alone will often fail to prevent pelvic floor disorder that leads to uterovaginal prolapse. Laparoscopic approach has the benefits of improved visualization of pelvic anatomy, shorter hospitalization, less postoperative pain and quicker return to normal activities. The sacrocervicopexy is a procedure similar to sacrocolpopexy but with better outcomes. These results are to be determined by several factors such as the following: post hysterectomy, vaginal cuff may have a reduced vascular supply secondary to scar tissue, which compromise the healing process and lead to erosion. Sacrocervicopexy does not require an anterior extension; less mesh is used compared with sacrocolpopexy. Unfortunately, the probability of erosion increases with the kind of mesh that is employed, although the erosion is seen less when a polypropylene mesh is used rather than another.
408
Video Session 15 - Laparoscopic Surgeries (3:25 PM - 5:05 PM) 4:50 PM – GROUP C
Application of Simple TLH Surgical Technique to the Large Uterus Bortoletto P, Hariton E, Brown DN. Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts While the laparoscopic hysterectomy for the normal sized uterus is well described and routine, the large fibroid uterus poses a unique set of challenges for minimally invasive surgeons. We demonstrate first a simple TLH and then discuss the case of 54 yo post-menopausal women with a symptomatic 16 - 18 week sizes fibroid uterus. We systematically review how application of simplified TLH techniques can be applied to the large uterus. We will highlight optimization of port placement, camera selection, review important anatomical landmarks, and discuss surgical safety zones. This video will serve as a useful teaching tool for both novice and advanced surgeons alike, reviewing basic skills and enhancing their application. 299
Video Session 15 - Laparoscopic Surgeries (3:25 PM - 5:05 PM) 4:57 PM – GROUP C
Multidisciplinary Laparoscopic Management of Severe Ureteral Endometriosis with Atrophic Kidney Po LK,1 Kung R,1 Satkunasivam R,2 Nam R,2 Ashamalla S,3 Kroft J.1 1 Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; 2Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; 3Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Ureteral endometriosis is extremely rare and delayed or failure of diagnosis can lead to renal atrophy and silent loss of the kidney. We present a case of severe left ureteral endometriosis with atrophic kidney and rectosigmoid colon involvement due to delay in recognizing early ureteral endometriosis. She presented with flank and pelvic pain. CT and MRI imaging showed a left ureteric obstruction due to an endometriotic nodule with severe hydroureter, chronic atrophic kidney and luminal narrowing of the rectosigmoid colon. She underwent a laparoscopic resection of endometriosis, ureterolysis, low anterior rectosigmoid resection with primary anastomosis and
410
Video Session 16 - Urogyn/Pelvic Floor Disorders/Vaginal Surgery (3:25 PM - 5:05 PM) 3:32 PM – GROUP A
Laparoscopic Vesicovaginal Fistula Repair: An Extravesical Approach Miklos JR, Moore RD. Department of Urogynecology, Miklos & Moore Urogynecology, Alpharetta, Georgia Introduction: The O’Connor bladder bivalving technique remains the traditional abdominal approach to vesicovaginal fistula repair whether performed via a laparotomy or using a laparoscope. Methods: This video depicts a laparoscopic transperitoneal extravesical approach without invasive bladder bivalving or an omental flap. We first described this laparoscopic extravesical fistula repair technique in 1999. We discuss the step by step procedure adhering to the four basic principles of a VVF repair including: hemostasis, mobilization, a tension free and multi layer closure. Results: We have used this technique on more than 60 non irradiated primary and recurrent vesicovaignal fistula patients with a 98% cure rate. Conclusion: This alternative technique can be performed efficiently and successfully on patients with primary and recurrent fistula s via laparoscopic approach and in this case the actual repair takes less than 60 minutes. 411
Video Session 16 - Urogyn/Pelvic Floor Disorders/Vaginal Surgery (3:25 PM - 5:05 PM) 3:39 PM – GROUP A
Spondylodiscitis Complication: Laparoscopic Removal of Sacral Colpopexy Mesh Parthasarathy KN, Pugh CJ, Villeneuve JB. Obstetrics and Gynecology, Reading Health System, West Reading, Pennsylvania Spondylodiscitis is a rare complication of sacral colpopexy mesh placement for apical pelvic organ prolapse repair. After failing conservative
Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252
and stroma. Although the origin of ACUM is currently unknown, the most common location is a 2-4 cm lateral uterine wall mass at the level of the insertion of the round ligament. Hence it has been hypothesized that gubernaculum dysfunction may be responsible for duplication or persistence of paramesonephric tissue leading to ACUM formation as a new M€ ullerian anomaly. Here, we present two cases that illustrate the laparoscopic ACUM resection in women desiring uterine-sparing surgery.
nephrouretectomy. Postoperatively, symptoms have improved. Patients with ureteral endometriosis usually present with non-specific symptoms. Early recognition and managment is recommended to prevent silent kidney loss. Multidisciplinary collaboration is required for surgical resection of endometriosis for symptomatic relief and to potentially prevent further loss of renal function. 409
407
Video Session 15 - Laparoscopic Surgeries (3:25 PM - 5:05 PM)
Video Session 16 - Urogyn/Pelvic Floor Disorders/Vaginal Surgery (3:25 PM - 5:05 PM)
4:43 PM – GROUP C
3:25 PM – GROUP A
Resident Guide to Successful Interrupted Vaginal Cuff Closure Pollard RR, Petrikovets A. Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio
Subtotal Hysterectomy and Cervicosacropexy Rodriguez VO, Garcia LF, Silva JE, Garza E. Ginecologia y Obstetricia, Tec de Monterrey, Monterrey, Nuevo Leon, Mexico
This video entitled A Resident Guide to Successful Interrupted Vaginal Cuff Closure was made to help as a teaching tool for residents and others learning advanced laparoscopy. The video will detail a methodical, reproducible technique for laparoscopic suturing of the vaginal cuff. However, this technique is also applicable to all tissue types. The video will show both a surgeon view demonstrating the hand movements and position as well as the traditional laparoscopic view.
Uterovaginal prolapse is a common problem with population prevalence of 30-50%. Hysterectomy alone will often fail to prevent pelvic floor disorder that leads to uterovaginal prolapse. Laparoscopic approach has the benefits of improved visualization of pelvic anatomy, shorter hospitalization, less postoperative pain and quicker return to normal activities. The sacrocervicopexy is a procedure similar to sacrocolpopexy but with better outcomes. These results are to be determined by several factors such as the following: post hysterectomy, vaginal cuff may have a reduced vascular supply secondary to scar tissue, which compromise the healing process and lead to erosion. Sacrocervicopexy does not require an anterior extension; less mesh is used compared with sacrocolpopexy. Unfortunately, the probability of erosion increases with the kind of mesh that is employed, although the erosion is seen less when a polypropylene mesh is used rather than another.
408
Video Session 15 - Laparoscopic Surgeries (3:25 PM - 5:05 PM) 4:50 PM – GROUP C
Application of Simple TLH Surgical Technique to the Large Uterus Bortoletto P, Hariton E, Brown DN. Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts While the laparoscopic hysterectomy for the normal sized uterus is well described and routine, the large fibroid uterus poses a unique set of challenges for minimally invasive surgeons. We demonstrate first a simple TLH and then discuss the case of 54 yo post-menopausal women with a symptomatic 16 - 18 week sizes fibroid uterus. We systematically review how application of simplified TLH techniques can be applied to the large uterus. We will highlight optimization of port placement, camera selection, review important anatomical landmarks, and discuss surgical safety zones. This video will serve as a useful teaching tool for both novice and advanced surgeons alike, reviewing basic skills and enhancing their application. 299
Video Session 15 - Laparoscopic Surgeries (3:25 PM - 5:05 PM) 4:57 PM – GROUP C
Multidisciplinary Laparoscopic Management of Severe Ureteral Endometriosis with Atrophic Kidney Po LK,1 Kung R,1 Satkunasivam R,2 Nam R,2 Ashamalla S,3 Kroft J.1 1 Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; 2Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; 3Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Ureteral endometriosis is extremely rare and delayed or failure of diagnosis can lead to renal atrophy and silent loss of the kidney. We present a case of severe left ureteral endometriosis with atrophic kidney and rectosigmoid colon involvement due to delay in recognizing early ureteral endometriosis. She presented with flank and pelvic pain. CT and MRI imaging showed a left ureteric obstruction due to an endometriotic nodule with severe hydroureter, chronic atrophic kidney and luminal narrowing of the rectosigmoid colon. She underwent a laparoscopic resection of endometriosis, ureterolysis, low anterior rectosigmoid resection with primary anastomosis and
410
Video Session 16 - Urogyn/Pelvic Floor Disorders/Vaginal Surgery (3:25 PM - 5:05 PM) 3:32 PM – GROUP A
Laparoscopic Vesicovaginal Fistula Repair: An Extravesical Approach Miklos JR, Moore RD. Department of Urogynecology, Miklos & Moore Urogynecology, Alpharetta, Georgia Introduction: The O’Connor bladder bivalving technique remains the traditional abdominal approach to vesicovaginal fistula repair whether performed via a laparotomy or using a laparoscope. Methods: This video depicts a laparoscopic transperitoneal extravesical approach without invasive bladder bivalving or an omental flap. We first described this laparoscopic extravesical fistula repair technique in 1999. We discuss the step by step procedure adhering to the four basic principles of a VVF repair including: hemostasis, mobilization, a tension free and multi layer closure. Results: We have used this technique on more than 60 non irradiated primary and recurrent vesicovaignal fistula patients with a 98% cure rate. Conclusion: This alternative technique can be performed efficiently and successfully on patients with primary and recurrent fistula s via laparoscopic approach and in this case the actual repair takes less than 60 minutes. 411
Video Session 16 - Urogyn/Pelvic Floor Disorders/Vaginal Surgery (3:25 PM - 5:05 PM) 3:39 PM – GROUP A
Spondylodiscitis Complication: Laparoscopic Removal of Sacral Colpopexy Mesh Parthasarathy KN, Pugh CJ, Villeneuve JB. Obstetrics and Gynecology, Reading Health System, West Reading, Pennsylvania Spondylodiscitis is a rare complication of sacral colpopexy mesh placement for apical pelvic organ prolapse repair. After failing conservative