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Pelvic Anatomy: A Three Minute Primer for the Gynecologic Surgeon
S14
Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S1–S23
knot, extracorporeally tied and slid to the tissue with a knot pusher, is perhaps technically easier but for its requirement of long suture length has limitations to its surgical application. The purpose of this video is to demonstrate a novel technique – employing basic laparoscopic instrument motions – for tying cinch knots entirely intracorporeally as an easily learned alternative to existing knot tying techniques. We further identify the particular suitability of this technique for single incision laparoscopic procedures. 46
Video Session 2d Education (12:31 PM d 12:39 PM)
Surgical Management of Ureteral Injury: A Simulation Training Model Tunitsky-Bitton E,1 Murphy AM,2 Jelovsek JE.1 1Obstetrics, Gynecology & Women’s Health Institute, Cleveland Clinic, Cleveland, Ohio; 2Glickman Urologic Institute, Cleveland Clinic, Cleveland, Ohio To demonstrate an educational tool that can be used for teaching and learning surgical skills for ureteroureterostomy and ureteroneocystostomy techniques. Description: Although 75% of injuries to the lower urinary tract occur during gynecological procedures, gynecology trainees rarely have an opportunity to learn the skills needed to manage ureteral injury. This video demonstrates the design of a simulator that may be used as a supplement to the training of gynecology and urology trainees and may be used to practice key skills required for performing open and roboticassisted ureteroureterostomy and ureteroneocystostomy. Conclusion: It is feasible to develop a simulator to practice ureteral reanastamosis and reimplantation that incorporates tactile and haptic feedback. This model could be incorporated into the surgical curriculum of gynecology and urology training programs and used to teach, practice, or assess surgeons performing these procedures. 47
Video Session 2d Education (12:40 PM d 12:44 PM)
Direct Entry and Trocars Placement: The Way To Do It Safely, Ergonomically, and Esthetically Wattiez A, Vazquez A, Maia S. IRCAD, Strasbourg, France A recent Cochrane review (Ahmad G et al, 2008) concluded that there is no scientific evidence regarding the benefit in terms of security among the different laparoscopic entry techniques. However, the technique of direct trocar entry is faster and cheaper (Zakherah MS, 2010) compared to the entry with a Veress needle, which is probably the most widespread. In this video we try to show some tricks to do the direct entry safely and also esthetic. We also consider that is very important the adequate placement of the accessory trocars to gain ergonomy. The way we do is also shown on this short video. 48
Video Session 2d Education (12:45 PM d 12:53 PM)
Resident Training in Robotic Assisted Gynecologic Surgery Galloway ML,1 Dhanraj DN,2 Ventolini G.3 1Obstetrics and Gynecology, Wright State University Boonshoft School of Medicine, Dayton, Ohio; 2 Obstetrics and Gynecology, Wright State University Boonshoft School of Medicine, Dayton, Ohio; 3Obstetrics and Gynecology, Wright State University Boonshoft School of Medicine, Dayton, Ohio Robotic surgery is one the greatest advances in minimally invasive gynecologic surgery since 2005. The educational concern is how to teach physicians in-training. Currently, most physicians learn this technique through animal or post-graduate simulation courses. There are no established training programs for residents. A longitudinally designed training course was developed to incorporate robotic surgery into the gynecologic surgical portion of the residency. All resident year levels were trained. The training curriculum included knowledge, basic skills, experience, and performance. Evaluation was performed throughout the training. Residents underwent basic skill training related to set up, port
placement, docking, camera control, dexterity, needle manipulation and suturing. All residents showed improvement from onset to four weeks later in evaluated basic skills. Senior residents were able to perform fine tasks of needle manipulation and suturing faster with more precision than junior residents. Senior residents performed supervised robotic cases during their gynecologic surgical rotation. 49
Video Session 2d Education (12:54 PM d 12:57 PM)
Pelvic Anatomy: A Three Minute Primer for the Gynecologic Surgeon Skinner BD, Raff GJ. Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana This brief video is intended to be used as an educational tool for beginning surgeons, or as a review for more experienced surgeons. Relevant pelvic anatomy and pertinent clinical correlations are highlighted. 50
Video Session 2d Education (12:58 PM d 1:04 PM)
Laparoscopic Trachelectomy Veeraswamy A, Lewis M, Kotikela S, Gomaa M, King L, Nezhat C. Center for Minimally Invasive and Robotic Surgery, Palo Alto, California Objectives: To demonstrate the safety of laparoscopic removal of the cervical stump after supracervical hysterectomy in patients with endometriosis. Method: The patient was a 50 year old who underwent supracervical hysterectomy five years before presenting to our clinic. Thereafter, she experienced pelvic pain and, desired definitive surgical treatment. She underwent laparoscopic trachelectomy, bilateral salpingoophorectomy and treatment of endometriosis. We encountered adhesions of bowel to the cervical stump. We were able to lyse these adhesions and excise the endometriotic lesions using the CO2 laser. Results: We encountered minimal blood loss during the case. There were no intraoperative or postoperative complications. At follow-up, the patient noted improvement in her pelvic pain. Conclusions: Laparoscopic trachelectomy can be performed safely by an experienced surgeon. Supracervical hysterectomy is not the preferred method for hysterectomy and in patients with endometriosis as it not infrequently will result in persistent pelvic pain requiring subsequent trachelectomy. 51
Open Communications 1dEndometriosis (2:15 PM d 2:20 PM)
Use of Proteomic Technology To Identify Urine Biomarkers in Patients with and without Endometriosis: A Preliminary Study Liu H, Wang L, Liao M, Lang J. Obstet Gynecol, Peking Unino Medical College Hospital, Beijing, China Study Objective: To investigate the possibility of using the ClinProt technique to find diagnostic markers that are able to discriminate endometriosis patients(EMs) from controls. Design: Prospective case-control study. Setting: University based medical center. Patients: A total of 61 patients suffering from dysmenorrhea and infertility suspected of endometriosis were enrolled into the study. Intervention: Urine sample and patients medical history were collected before laparoscopy. Measurements and Main Results: Urine samples were analyzed by the ClinProt and MALDI-ToF technique to generate protein profiling and coupled LC-MS/MS was used to identify the different protein peeks in protein profiling. At laparoscopy 30 patients were diagnosed as endometriosis and 31 patients were disease free. 76 differently expressed potential biomarkers (P\0.01) were identified. Using ClinproTool software, we established GA algorithm. The combination of five markers lead to an improvement in diagnostic efficacy with specificity and
Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S1–S23
knot, extracorporeally tied and slid to the tissue with a knot pusher, is perhaps technically easier but for its requirement of long suture length has limitations to its surgical application. The purpose of this video is to demonstrate a novel technique – employing basic laparoscopic instrument motions – for tying cinch knots entirely intracorporeally as an easily learned alternative to existing knot tying techniques. We further identify the particular suitability of this technique for single incision laparoscopic procedures. 46
Video Session 2d Education (12:31 PM d 12:39 PM)
Surgical Management of Ureteral Injury: A Simulation Training Model Tunitsky-Bitton E,1 Murphy AM,2 Jelovsek JE.1 1Obstetrics, Gynecology & Women’s Health Institute, Cleveland Clinic, Cleveland, Ohio; 2Glickman Urologic Institute, Cleveland Clinic, Cleveland, Ohio To demonstrate an educational tool that can be used for teaching and learning surgical skills for ureteroureterostomy and ureteroneocystostomy techniques. Description: Although 75% of injuries to the lower urinary tract occur during gynecological procedures, gynecology trainees rarely have an opportunity to learn the skills needed to manage ureteral injury. This video demonstrates the design of a simulator that may be used as a supplement to the training of gynecology and urology trainees and may be used to practice key skills required for performing open and roboticassisted ureteroureterostomy and ureteroneocystostomy. Conclusion: It is feasible to develop a simulator to practice ureteral reanastamosis and reimplantation that incorporates tactile and haptic feedback. This model could be incorporated into the surgical curriculum of gynecology and urology training programs and used to teach, practice, or assess surgeons performing these procedures. 47
Video Session 2d Education (12:40 PM d 12:44 PM)
Direct Entry and Trocars Placement: The Way To Do It Safely, Ergonomically, and Esthetically Wattiez A, Vazquez A, Maia S. IRCAD, Strasbourg, France A recent Cochrane review (Ahmad G et al, 2008) concluded that there is no scientific evidence regarding the benefit in terms of security among the different laparoscopic entry techniques. However, the technique of direct trocar entry is faster and cheaper (Zakherah MS, 2010) compared to the entry with a Veress needle, which is probably the most widespread. In this video we try to show some tricks to do the direct entry safely and also esthetic. We also consider that is very important the adequate placement of the accessory trocars to gain ergonomy. The way we do is also shown on this short video. 48
Video Session 2d Education (12:45 PM d 12:53 PM)
Resident Training in Robotic Assisted Gynecologic Surgery Galloway ML,1 Dhanraj DN,2 Ventolini G.3 1Obstetrics and Gynecology, Wright State University Boonshoft School of Medicine, Dayton, Ohio; 2 Obstetrics and Gynecology, Wright State University Boonshoft School of Medicine, Dayton, Ohio; 3Obstetrics and Gynecology, Wright State University Boonshoft School of Medicine, Dayton, Ohio Robotic surgery is one the greatest advances in minimally invasive gynecologic surgery since 2005. The educational concern is how to teach physicians in-training. Currently, most physicians learn this technique through animal or post-graduate simulation courses. There are no established training programs for residents. A longitudinally designed training course was developed to incorporate robotic surgery into the gynecologic surgical portion of the residency. All resident year levels were trained. The training curriculum included knowledge, basic skills, experience, and performance. Evaluation was performed throughout the training. Residents underwent basic skill training related to set up, port
placement, docking, camera control, dexterity, needle manipulation and suturing. All residents showed improvement from onset to four weeks later in evaluated basic skills. Senior residents were able to perform fine tasks of needle manipulation and suturing faster with more precision than junior residents. Senior residents performed supervised robotic cases during their gynecologic surgical rotation. 49
Video Session 2d Education (12:54 PM d 12:57 PM)
Pelvic Anatomy: A Three Minute Primer for the Gynecologic Surgeon Skinner BD, Raff GJ. Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana This brief video is intended to be used as an educational tool for beginning surgeons, or as a review for more experienced surgeons. Relevant pelvic anatomy and pertinent clinical correlations are highlighted. 50
Video Session 2d Education (12:58 PM d 1:04 PM)
Laparoscopic Trachelectomy Veeraswamy A, Lewis M, Kotikela S, Gomaa M, King L, Nezhat C. Center for Minimally Invasive and Robotic Surgery, Palo Alto, California Objectives: To demonstrate the safety of laparoscopic removal of the cervical stump after supracervical hysterectomy in patients with endometriosis. Method: The patient was a 50 year old who underwent supracervical hysterectomy five years before presenting to our clinic. Thereafter, she experienced pelvic pain and, desired definitive surgical treatment. She underwent laparoscopic trachelectomy, bilateral salpingoophorectomy and treatment of endometriosis. We encountered adhesions of bowel to the cervical stump. We were able to lyse these adhesions and excise the endometriotic lesions using the CO2 laser. Results: We encountered minimal blood loss during the case. There were no intraoperative or postoperative complications. At follow-up, the patient noted improvement in her pelvic pain. Conclusions: Laparoscopic trachelectomy can be performed safely by an experienced surgeon. Supracervical hysterectomy is not the preferred method for hysterectomy and in patients with endometriosis as it not infrequently will result in persistent pelvic pain requiring subsequent trachelectomy. 51
Open Communications 1dEndometriosis (2:15 PM d 2:20 PM)
Use of Proteomic Technology To Identify Urine Biomarkers in Patients with and without Endometriosis: A Preliminary Study Liu H, Wang L, Liao M, Lang J. Obstet Gynecol, Peking Unino Medical College Hospital, Beijing, China Study Objective: To investigate the possibility of using the ClinProt technique to find diagnostic markers that are able to discriminate endometriosis patients(EMs) from controls. Design: Prospective case-control study. Setting: University based medical center. Patients: A total of 61 patients suffering from dysmenorrhea and infertility suspected of endometriosis were enrolled into the study. Intervention: Urine sample and patients medical history were collected before laparoscopy. Measurements and Main Results: Urine samples were analyzed by the ClinProt and MALDI-ToF technique to generate protein profiling and coupled LC-MS/MS was used to identify the different protein peeks in protein profiling. At laparoscopy 30 patients were diagnosed as endometriosis and 31 patients were disease free. 76 differently expressed potential biomarkers (P\0.01) were identified. Using ClinproTool software, we established GA algorithm. The combination of five markers lead to an improvement in diagnostic efficacy with specificity and