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Prevention of Tumor Spillage in 24-cm Ovarian Cyst
Abstracts / Journal of Minimally Invasive Gynecology 19 (2012) S151–S178 menstruations were obseved over 1yr.The endometirum and myometrium of the upper half of the uterus may be considered as the critical region for abnormal ingrowth and invagination of the basal endometrium into the subendometrial myometrial junction causing dysmenorrhea and menorrhagia.
588 Laparoscopic Bilateral Salpingo-Oophorectomy Huang D, Mintah A. Obstetrics and Gynecology, Beth Israel Medical Center, New York, New York This is a 57 year old post-menopausal woman with known history of bilateral ovarian cysts. On ultrasound two ovarian cysts of 6 and 8cms were noted. Pre-operative evaluation including tumor markers which were all suggestive of benign disease. This patient desired definitive surgical management and was consented for a laparoscopic bilateral salpingooophorectomy. The purpose of this video is to demonstrate the removal of large bilateral ovarian cysts through the laparoscope with Ligasure for the RSO and Gyrus for the LSO. Exposure was important during this case and welldemonstrated by the assistant. The cysts were manipulated to allow for maximum exposure without rupture. The specimen were removed via endocatch bags after deflation without difficulty. Final pathology: benign serous cystadenomas.
S177
invasive surgery and proves to be benefit in prevention of tumor spillage in ovarian surgery. 591 Laparoscopic Removal of a Chronically Retained Gauze Kim H-J, Lee J-W, Lee Y-Y, Kim B-G, Bae D-S. Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea A 44-year-old woman presented with irritability, abdominal discomfort. A forgotten surgical gauze in the left side of the pelvis was seen on abdomen-pelvis x-ray. She had a past history of acute appendicitis operated on 20 years earlier and had vague abdominal discomfort and anorexia after the operation. Computed tomography scan revealed a foreign body measured 6.2 cm with heterogeneous internal structure in the right iliac fossa that had been surrounded by the small intestine and the colon. Laparoscopy was done with a 12-mm suprapubic port and three 5-mm ports in the left, right lower quadrants and infra-umbilical areas. The small bowel loops adhered to the gauze, which together made up a mass. Using sharp dissection, bowel loops were carefully separated. The gauze had decomposed into a semi-liquid material consisting of hundreds of small particles and could not be removed in one piece; a basket was used.
592 589 Low-Grade Endometrial Stromal Sarcoma Diagnosed after Myoma Morcellations in Laparoscopic Myomectomy Jofre MF,1 Rosacher M,1 Dionisi J.2 1Department of Gynecology and Obstetricis, Sanatorio Allende, Nueva Cordoba, Cordoba, Argentina; 2 Ginecology, Centro Dionisi de Ginecologia, Centro, Cordoba, Argentina A 37-year-old woman consulted for increased size of tumor last year. A laparoscopic myomectomy was performed. On sectioning the uterus to perform the myomectomy, a friable and softened tissue was intraoperatively found. A frozen section of the piece was done. The pathologist did not report malignant cells. A morcellation of the piece was correctly done. The pathlogy report revealed a low-grade ESS. The case was presented in a Oncology Group, and a full exploration of the cavity with biopsy and total histerectomy plus salpingo-oforecctomy with pelvic lymphadenectomy by laparoscopic and hormonal receptors were suggested. Another laparoscopic surgery was smoothly and successfully perfomed 22 days after the first one. The final pathology reports confirmed that the tumor was only limited to the removed pieces; the rest of the analyzed organs had no tumors. After 2 years of follow-up the patients were free of disease.
590 Prevention of Tumor Spillage in 24-cm Ovarian Cyst Khemarangsan V. Obstetrics and Gynecology, Charoenkrungpracharak Hospital, Bangkok, Samutsakorn, Thailand A serious concern in applying laparoscopic surgery to ovarian tumor is the possibility of tumor spillage and seeding. Recent advances in conventional laparoscopy has favorably impacted in gynecological surgery. With the goal of improving morbidity and cosmetic results, continued efforts have lead to minimization of size and number of ports required for these procedures. However, these have become the major drawback of laparoscopic ovarian surgery in preventing tumor spillage. Therefore, the major concern is how laparoscopic surgery can minimize tumor spillage and seeding intraoperatively. Through single-port surgery, with a single, small-skin incision concealed within the umbilicus, 15-cm ovarian cyst can be removed intactly with large plastic bag. In 24-cm ovarian cyst, novel technique has developed to remove it intactly without risk of tumor spillage. On the conclusion, SILS is the latest innovation in minimally
Cross Bag Technique: Excision of Dermoid Cyst without Spillage Kondrup JD, Sylvester B. OB/GYN, Lourdes Hospital, Binghamton, New York Many times during laparoscopic ovarian cystectomy the surgeon desires to prevent spillage whether or not the ovary is to be removed or salvaged. This is especially true in cases of Dermoid cysts, Mucinous Cystadenomas and any cyst that has complex characteristics indicating possible borderline or frank carcinoma. This video demonstrates an easy solution to prevent cyst spillage. In this technique the ovary/ cyst is placed inside a water tested endopouch and the cyst is removed and the ovary spared utilizing the two other ports. If spillage occurs then the cyst contents are caught in the bag.
593 Palmer’s Point - Go for It! The Technique of LUQ and Direct View Entry Kondrup JD, Sylvester B. OB/GYN, Lourdes Hospital, Binghamton, New York Palmer’s point is described as the area in the left upper quadrant 3 cm below the costal margin and in the midclavicular line. Raoul Palmer MD was a French gynecologist many feel developed modern laparoscopy. 1n 1974 he described Palmer’s Point. This entry is utilized when midline adhesions are suspected. This video clearly demonstrates the technique of left upper quadrant entry as well as entry using the Direct View or Optiview entry instead of Veress or blind direct view entry.
594 Oophoropexy: The ‘‘Hotdog in a Bun’’ Technique Kondrup JD, Measick J. OB/GYN, Lourdes Hospital, Binghamton, New York Adnexal torsion is an acute emergency. Failure to recognize the signs and symptoms can result in loss of the ovary. Surgeons are approaching torsion in a conservative fashion by untwisting and observing for tissue viability.
588 Laparoscopic Bilateral Salpingo-Oophorectomy Huang D, Mintah A. Obstetrics and Gynecology, Beth Israel Medical Center, New York, New York This is a 57 year old post-menopausal woman with known history of bilateral ovarian cysts. On ultrasound two ovarian cysts of 6 and 8cms were noted. Pre-operative evaluation including tumor markers which were all suggestive of benign disease. This patient desired definitive surgical management and was consented for a laparoscopic bilateral salpingooophorectomy. The purpose of this video is to demonstrate the removal of large bilateral ovarian cysts through the laparoscope with Ligasure for the RSO and Gyrus for the LSO. Exposure was important during this case and welldemonstrated by the assistant. The cysts were manipulated to allow for maximum exposure without rupture. The specimen were removed via endocatch bags after deflation without difficulty. Final pathology: benign serous cystadenomas.
S177
invasive surgery and proves to be benefit in prevention of tumor spillage in ovarian surgery. 591 Laparoscopic Removal of a Chronically Retained Gauze Kim H-J, Lee J-W, Lee Y-Y, Kim B-G, Bae D-S. Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea A 44-year-old woman presented with irritability, abdominal discomfort. A forgotten surgical gauze in the left side of the pelvis was seen on abdomen-pelvis x-ray. She had a past history of acute appendicitis operated on 20 years earlier and had vague abdominal discomfort and anorexia after the operation. Computed tomography scan revealed a foreign body measured 6.2 cm with heterogeneous internal structure in the right iliac fossa that had been surrounded by the small intestine and the colon. Laparoscopy was done with a 12-mm suprapubic port and three 5-mm ports in the left, right lower quadrants and infra-umbilical areas. The small bowel loops adhered to the gauze, which together made up a mass. Using sharp dissection, bowel loops were carefully separated. The gauze had decomposed into a semi-liquid material consisting of hundreds of small particles and could not be removed in one piece; a basket was used.
592 589 Low-Grade Endometrial Stromal Sarcoma Diagnosed after Myoma Morcellations in Laparoscopic Myomectomy Jofre MF,1 Rosacher M,1 Dionisi J.2 1Department of Gynecology and Obstetricis, Sanatorio Allende, Nueva Cordoba, Cordoba, Argentina; 2 Ginecology, Centro Dionisi de Ginecologia, Centro, Cordoba, Argentina A 37-year-old woman consulted for increased size of tumor last year. A laparoscopic myomectomy was performed. On sectioning the uterus to perform the myomectomy, a friable and softened tissue was intraoperatively found. A frozen section of the piece was done. The pathologist did not report malignant cells. A morcellation of the piece was correctly done. The pathlogy report revealed a low-grade ESS. The case was presented in a Oncology Group, and a full exploration of the cavity with biopsy and total histerectomy plus salpingo-oforecctomy with pelvic lymphadenectomy by laparoscopic and hormonal receptors were suggested. Another laparoscopic surgery was smoothly and successfully perfomed 22 days after the first one. The final pathology reports confirmed that the tumor was only limited to the removed pieces; the rest of the analyzed organs had no tumors. After 2 years of follow-up the patients were free of disease.
590 Prevention of Tumor Spillage in 24-cm Ovarian Cyst Khemarangsan V. Obstetrics and Gynecology, Charoenkrungpracharak Hospital, Bangkok, Samutsakorn, Thailand A serious concern in applying laparoscopic surgery to ovarian tumor is the possibility of tumor spillage and seeding. Recent advances in conventional laparoscopy has favorably impacted in gynecological surgery. With the goal of improving morbidity and cosmetic results, continued efforts have lead to minimization of size and number of ports required for these procedures. However, these have become the major drawback of laparoscopic ovarian surgery in preventing tumor spillage. Therefore, the major concern is how laparoscopic surgery can minimize tumor spillage and seeding intraoperatively. Through single-port surgery, with a single, small-skin incision concealed within the umbilicus, 15-cm ovarian cyst can be removed intactly with large plastic bag. In 24-cm ovarian cyst, novel technique has developed to remove it intactly without risk of tumor spillage. On the conclusion, SILS is the latest innovation in minimally
Cross Bag Technique: Excision of Dermoid Cyst without Spillage Kondrup JD, Sylvester B. OB/GYN, Lourdes Hospital, Binghamton, New York Many times during laparoscopic ovarian cystectomy the surgeon desires to prevent spillage whether or not the ovary is to be removed or salvaged. This is especially true in cases of Dermoid cysts, Mucinous Cystadenomas and any cyst that has complex characteristics indicating possible borderline or frank carcinoma. This video demonstrates an easy solution to prevent cyst spillage. In this technique the ovary/ cyst is placed inside a water tested endopouch and the cyst is removed and the ovary spared utilizing the two other ports. If spillage occurs then the cyst contents are caught in the bag.
593 Palmer’s Point - Go for It! The Technique of LUQ and Direct View Entry Kondrup JD, Sylvester B. OB/GYN, Lourdes Hospital, Binghamton, New York Palmer’s point is described as the area in the left upper quadrant 3 cm below the costal margin and in the midclavicular line. Raoul Palmer MD was a French gynecologist many feel developed modern laparoscopy. 1n 1974 he described Palmer’s Point. This entry is utilized when midline adhesions are suspected. This video clearly demonstrates the technique of left upper quadrant entry as well as entry using the Direct View or Optiview entry instead of Veress or blind direct view entry.
594 Oophoropexy: The ‘‘Hotdog in a Bun’’ Technique Kondrup JD, Measick J. OB/GYN, Lourdes Hospital, Binghamton, New York Adnexal torsion is an acute emergency. Failure to recognize the signs and symptoms can result in loss of the ovary. Surgeons are approaching torsion in a conservative fashion by untwisting and observing for tissue viability.