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Proximal Uterine Artery Ligation in a Large Fibroid Uterus
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97 Open Communications 13: Basic Science/Research/Education (4:10 PM − 5:10 PM)
S53 distorted anatomy elsewhere. Thus, by isolating key structures in the retroperitoneal space, we can simplify an otherwise challenging dissection.
4:17 PM X Marks the Knot: Simplified Laparoscopic IntraCorporeal Knot Tying Carrubba AR,* Jijon AJ, Chen AH. Gynecologic Surgery, Mayo Clinic Florida, Jacksonville, FL *Corresponding author. Video Objective: The objectives of this video are to present a novel technique for simplified laparoscopic intra-corporeal knot tying and to demonstrate the importance of laparoscopic simulation in learning new techniques. Setting: Traditional intra-corporeal knot tying can be difficult, depending on the angle of the suture, port placement, or other technical difficulty. Many surgeons have turned to alternatives to circumvent this procedure, including the use of barbed suture, knotless suture re-load devices, Lapraty’s, and extra-corporeal knot tying. However, this remains an important skill to for the gynecologic surgeon. This video presents a step-by-step technique of a novel intra-corporeal knot tying method. The setting includes both a simulation trainer for laparoscopy and a live surgery. The patient in the surgery is a 48-year-old female with abnormal uterine bleeding undergoing total laparoscopic hysterectomy; we use our laparoscopic knot to reinforce the vaginal cuff closure. Interventions: The simplified extra-corporeal knot starts with placement of an interrupted suture. The primary surgeon crosses the suture to create an X, which is stabilized by the assistant surgeon. The primary surgeon passes the tail of the suture through the loop created by the X twice to create a surgeon’s knot. The ends are then pulled downward to create a flat knot. This process is repeated. In order to create square knots, the tail should be passed in front of or behind the loop with each alternating throw. Conclusion: The simplified intra-corporal knot is a useful resource for surgeons who experience difficulty with traditional laparoscopic knot tying. The maneuvers are intuitive and are similar to open two-handed knot tying. There is a learning curve associated with this procedure, and it is important to practice in a simulated setting. We hope this video will provide an alternative method for surgeons planning to tie intra-corporeal knots. Open Communications 13: Basic Science/Research/Education (4:10 PM − 5:10 PM) 4:24 PM Proximal Uterine Artery Ligation in a Large Fibroid Uterus Gupta N*. Minimally Invasive Gynecologic Surgery, Jackson Madison County General Hospital, Jackson, TN *Corresponding author. Video Objective: Basic techniques of retroperitoneal dissection to isolate the proximal uterine artery Setting: Large fibroid uterus and complicated pelvic surgeries like extensive adhesions or deeply infiltrative endometriosis Interventions: Hysterectomy or myomectomy of a large multi fibroid uterus Conclusion: Proximal uterine artery ligation at its origin can be a valuable tool while performing difficult hysterectomy or myomectomy. This should be routinely practiced by a MIGS fellow under supervision to learn the vital retroperitoneal anatomy and dissection techniques. With adequate practice, it can be safely and efficiently performed at the start of a complicated pelvic surgery and thus decrease the overall blood loss as well as identify the key anatomical structures, thus avoiding the risk of inadvertent injuries. This video demonstrates the proximal uterine artery ligation technique in a patient with large multifibroid uterus as well as stage 4 endometriosis. The retroperitoneum is relatively well preserved despite a frozen pelvis and
Open Communications 13: Basic Science/Research/Education (4:10 PM − 5:10 PM) 4:31 PM Basic Laparoscopic Skills Training is Equally Effective Using Either 2d or 3d Visualization: A Randomized Controlled Trial Montanari E, Kuessel L, Schwameis R, Veit-Rubin N, Husslein H*. Department of Obstetrics and Gynecology, Medical University Vienna, Vienna, Austria *Corresponding author. Study Objective: To assess whether basic laparoscopic skills (BLS) training on a standard laparoscopic box trainer using 2D visualization is at least equally effective compared to 3D. Design: Randomized controlled trial. Setting: Tertiary care center, Vienna, Austria. Patients or Participants: A total of 32 medical students of the Medical University of Vienna were recruited. Interventions: Participants were randomized to BLS training using either 2D or 3D visualization and trained four Fundamentals of Laparoscopic Surgery (FLS) tasks for one hour twice a week for four weeks. Baseline and post training tests were performed. Improvement in total test scores and the scores for the four individual FLS tasks within the assigned visualization modality was assessed. The non-inferiority margin was set as 10% of the mean improvement in the 3D group. Measurements and Main Results: Data of 31 participants were analysed (n=16 in the 2D, n=15 in the 3D group, n=1 drop out). Baseline test scores did not differ significantly between groups except for the peg transfer task and total scores, where participants in the 3D group scored better than those in the 2D group. Total scores as well as the scores for all four tasks separately improved significantly in both groups. Post training test total and single task scores did not differ significantly between the groups. Noninferiority of 2D compared to 3D training modality could be demonstrated for the improvement in total scores and in all individual FLS tasks, except for the suturing with extracorporeal knot tying task. Only the peg transfer task showed superiority in score improvement in the 2D compared to the 3D group. Conclusion: Learning BLS using standard 2D visualization is at least equally effective as with 3D visualization. 3D visualization seems to offer a slight advantage at baseline testing, but does not translate to better test scores at post training testing. Open Communications 13: Basic Science/Research/Education (4:10 PM − 5:10 PM) 4:38 PM Trends of Hysterectomies Performed by Graduating Residents Using American College of Graduate Medical Education Case Log Whitmore G,1,* Arruda J,2 Bastow BD2. 1Obstetric and Gynecology, University of Colorado, Denver, CO; 2Obstetrics and Gynecology, University of Colorado, Denver, CO *Corresponding author. Study Objective: We sought to evaluate the overall trend in hysterectomies for obstetrics and gynecology (OBGYN) resident surgeons from 2002 through 2017 using the data from the Accreditation Counsel for Graduate Medical Education (ACGME). The data stratifies hysterectomy type by abdominal (TAH), vaginal (TVH), and laparoscopic (TLH). We hypothesize that the rates of TVH and TAH will decrease during this time period with a concurrent increase in TLH.
S53 distorted anatomy elsewhere. Thus, by isolating key structures in the retroperitoneal space, we can simplify an otherwise challenging dissection.
4:17 PM X Marks the Knot: Simplified Laparoscopic IntraCorporeal Knot Tying Carrubba AR,* Jijon AJ, Chen AH. Gynecologic Surgery, Mayo Clinic Florida, Jacksonville, FL *Corresponding author. Video Objective: The objectives of this video are to present a novel technique for simplified laparoscopic intra-corporeal knot tying and to demonstrate the importance of laparoscopic simulation in learning new techniques. Setting: Traditional intra-corporeal knot tying can be difficult, depending on the angle of the suture, port placement, or other technical difficulty. Many surgeons have turned to alternatives to circumvent this procedure, including the use of barbed suture, knotless suture re-load devices, Lapraty’s, and extra-corporeal knot tying. However, this remains an important skill to for the gynecologic surgeon. This video presents a step-by-step technique of a novel intra-corporeal knot tying method. The setting includes both a simulation trainer for laparoscopy and a live surgery. The patient in the surgery is a 48-year-old female with abnormal uterine bleeding undergoing total laparoscopic hysterectomy; we use our laparoscopic knot to reinforce the vaginal cuff closure. Interventions: The simplified extra-corporeal knot starts with placement of an interrupted suture. The primary surgeon crosses the suture to create an X, which is stabilized by the assistant surgeon. The primary surgeon passes the tail of the suture through the loop created by the X twice to create a surgeon’s knot. The ends are then pulled downward to create a flat knot. This process is repeated. In order to create square knots, the tail should be passed in front of or behind the loop with each alternating throw. Conclusion: The simplified intra-corporal knot is a useful resource for surgeons who experience difficulty with traditional laparoscopic knot tying. The maneuvers are intuitive and are similar to open two-handed knot tying. There is a learning curve associated with this procedure, and it is important to practice in a simulated setting. We hope this video will provide an alternative method for surgeons planning to tie intra-corporeal knots. Open Communications 13: Basic Science/Research/Education (4:10 PM − 5:10 PM) 4:24 PM Proximal Uterine Artery Ligation in a Large Fibroid Uterus Gupta N*. Minimally Invasive Gynecologic Surgery, Jackson Madison County General Hospital, Jackson, TN *Corresponding author. Video Objective: Basic techniques of retroperitoneal dissection to isolate the proximal uterine artery Setting: Large fibroid uterus and complicated pelvic surgeries like extensive adhesions or deeply infiltrative endometriosis Interventions: Hysterectomy or myomectomy of a large multi fibroid uterus Conclusion: Proximal uterine artery ligation at its origin can be a valuable tool while performing difficult hysterectomy or myomectomy. This should be routinely practiced by a MIGS fellow under supervision to learn the vital retroperitoneal anatomy and dissection techniques. With adequate practice, it can be safely and efficiently performed at the start of a complicated pelvic surgery and thus decrease the overall blood loss as well as identify the key anatomical structures, thus avoiding the risk of inadvertent injuries. This video demonstrates the proximal uterine artery ligation technique in a patient with large multifibroid uterus as well as stage 4 endometriosis. The retroperitoneum is relatively well preserved despite a frozen pelvis and
Open Communications 13: Basic Science/Research/Education (4:10 PM − 5:10 PM) 4:31 PM Basic Laparoscopic Skills Training is Equally Effective Using Either 2d or 3d Visualization: A Randomized Controlled Trial Montanari E, Kuessel L, Schwameis R, Veit-Rubin N, Husslein H*. Department of Obstetrics and Gynecology, Medical University Vienna, Vienna, Austria *Corresponding author. Study Objective: To assess whether basic laparoscopic skills (BLS) training on a standard laparoscopic box trainer using 2D visualization is at least equally effective compared to 3D. Design: Randomized controlled trial. Setting: Tertiary care center, Vienna, Austria. Patients or Participants: A total of 32 medical students of the Medical University of Vienna were recruited. Interventions: Participants were randomized to BLS training using either 2D or 3D visualization and trained four Fundamentals of Laparoscopic Surgery (FLS) tasks for one hour twice a week for four weeks. Baseline and post training tests were performed. Improvement in total test scores and the scores for the four individual FLS tasks within the assigned visualization modality was assessed. The non-inferiority margin was set as 10% of the mean improvement in the 3D group. Measurements and Main Results: Data of 31 participants were analysed (n=16 in the 2D, n=15 in the 3D group, n=1 drop out). Baseline test scores did not differ significantly between groups except for the peg transfer task and total scores, where participants in the 3D group scored better than those in the 2D group. Total scores as well as the scores for all four tasks separately improved significantly in both groups. Post training test total and single task scores did not differ significantly between the groups. Noninferiority of 2D compared to 3D training modality could be demonstrated for the improvement in total scores and in all individual FLS tasks, except for the suturing with extracorporeal knot tying task. Only the peg transfer task showed superiority in score improvement in the 2D compared to the 3D group. Conclusion: Learning BLS using standard 2D visualization is at least equally effective as with 3D visualization. 3D visualization seems to offer a slight advantage at baseline testing, but does not translate to better test scores at post training testing. Open Communications 13: Basic Science/Research/Education (4:10 PM − 5:10 PM) 4:38 PM Trends of Hysterectomies Performed by Graduating Residents Using American College of Graduate Medical Education Case Log Whitmore G,1,* Arruda J,2 Bastow BD2. 1Obstetric and Gynecology, University of Colorado, Denver, CO; 2Obstetrics and Gynecology, University of Colorado, Denver, CO *Corresponding author. Study Objective: We sought to evaluate the overall trend in hysterectomies for obstetrics and gynecology (OBGYN) resident surgeons from 2002 through 2017 using the data from the Accreditation Counsel for Graduate Medical Education (ACGME). The data stratifies hysterectomy type by abdominal (TAH), vaginal (TVH), and laparoscopic (TLH). We hypothesize that the rates of TVH and TAH will decrease during this time period with a concurrent increase in TLH.