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Rectosigmoid Bowel Resection and Nodule Excision from Bladder Located Close to Ureter Orifice for Radical Treatment of Deep Infiltrative Endometriosis
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Abstracts / Journal of Minimally Invasive Gynecology 20 (2013) S182–S195
617 Rectosigmoid Bowel Resection and Nodule Excision from Bladder Located Close to Ureter Orifice for Radical Treatment of Deep Infiltrative Endometriosis Taskiran C,1 Oktem O,1 Celik S,2 Turkgeldi E,2 Bugra D,1 Urman B.1 1 Ob/Gyn, Koc University, Istanbul, Sisli, Turkey; 2VKV American Hospital, Istanbul, Sisli, Turkey Deep infiltrative endometriosis (DIE) is unique disorder invading more than 5 mm of any pelvic organs. It may invade bowel, bladder, ureter, and any other pelvic organ. The treatment for (DIE) involves the resection of all fibrotic endometriotic foci sometimes with resection of corresponding organ. The patient presented at this video was 27 years old and she had underwent 3 surgeries for endometriosis before. At this operation very severe adhesions and endometriotic involvement of pelvis, rectosigmoid colon and bladder were detected. After extensive dissection of pelvic organs rectosigmoid colon resection-anastomosis and nodule excision from bladder which is very close to ureter orrifice were performed. No intraoperative or postoperative complication was seen and the patient discharged at day eight. Since several very informative dissections, resections and anastomoses were performed we wanted to present this unique case within the video session.
At the end of the surgey, women can recover a triangular cavity, much more efficient for subsequent pregnancy. 621 Essure Expulsion of Outer Coils: A Report of Two Cases Nimaroff ML, Fenster T, Sanidad S, Seidman S. Obstetrics and Gynecology, North Shore University Hospital, Manhasset, New York Hysteroscopic tubal sterilzation using the Essure microinserts has been shown to be highly effective and carries a low rate of complications. Early expulsions of the device prior to the three month recommended hysterosalpingogram, have been reported to be approximately 3%.(1) However, expulsion of the microinsert after confirming occluded tubes is believed to be an unusual event. Dr. Garcia recently reported in JMIG the first known case report of expulsion remote from insertion.(2) This video presents the treatment of two additional cases of symptomatic Essure expulsion years after successful insertion documented by occluded fallopian tubes on HSG. 1. Cooper JM, Carigan CS, Cher D, Kerin JF. Microinsert Nonincisional Hysteroscopic Sterilization. Obstet Gynecol 2003;102:59-67. 2. Garcia AL, Lewis RM, Sloan AL. Essure insert expulsion after 3month hysterosalpingogram confirmation of bilateral tubal occlusion and bilateral correct placement: case report. J Minim Invasive Gynecol 2013 Jan-Feb;20(1):107-111.
618 Robot Assisted Laparoscopic Partial Bladder Resection of Advanced Endometriosis Tran B-VT, Advincula AP. Florida Hospital-Celebration Health, Celebration, Florida Advanced endometriosis can be surgically challenging due to significant fibrosis and involvement of surrounding organs such as the rectum, colon and bladder. A multi-disciplinary approach to surgical treatment is often necessary for optimal surgical outcomes. We demonstrate a case of endometriosis invading through the full thickness of the bladder, that is successfully resected with minimally invasive surgery with robot assisted technology in collaboration with urology.
VIDEO POSTER: HYSTEROSCOPY, ENDOMETRIAL ABLATION 619 Hysteroscopic Myomectomy for Submucous and Intramural Myomas Albornoz J, Fernandez E, Fernandez C. Obstetrics and Gynecology, Clinica Las Condes, Santiago, Region Metropolitana, Chile Myomas or fibroids affect approximately 30 to 40% of women in the thirties. The incidence of submucous myomas is between 5-10% of all myomas. Common symptoms include menorrhagia, anemia and infertility, which vary in relation to location, number and size of myomas. The diagnostic approach includes Transvaginal ultrasound, Sonohysterography, 3-D Ultrasound and Magnetic Resonance Imaging. Surgical approach by hysteroscopy is the treatment of choice, but the surgeon should pay especial attention to operating time and fluid balance to minimize the risk of fluid overload. In this video we show how to perform hysteroscopic myomectomy for submucous and intramural myomas by resectoscopy, a minimally invasive surgery that in experienced hands is a safe and effective procedure. 620 Hysteroscopic Treatment of a Rudimentaory Horn Fernandez H, Capmas P. Gynecology, H^opital Bic^etre, Le Kremlin Bic^etre, France Rudimentary horns sometimes communicate with uterine cavity as a septate uterus with a total and closed partition. A preoperatory precise cartography is needed before performing the surgery. An ultrasound guidance can also be interesting to control the section of the septum.
622 Hysteroscopically Guided Intramyometrial Local Anaesthesia – The Focal Local – for Resection of Endometrial Polyps by Vaginoscopic Microhysteroscopy in Postmenopausal Women; a Novel Technique for Office Treatment Skensved H. Gynaecology, Private Practice, Hillerod, Denmark Several studies have demonstrated the feasibility of hysteroscopic polypectomy using a 3,5 mm microhysteroscope and applying the vaginoscopic approach. However, pain is the leading cause of failure has hampered a more widespread use of the technique outside the research settings. Indeed, very recent reports from Holland as well as the UK have revealed that 75% of polyps are still removed in theatre, the majority under general or regional anaesthesia. During the primary microhysteroscopy, local anaesthesia through a 5 Fr cystoscopic needle can be placed in the myometrium, at the base of the polyp, rendering the removal pain free and at the same time facilitating the resection. 623 Combined Laparoscopic and Hysteroscopic Approach to a Cervical Ectopic Pregnancy von Walter Gonzalez A, Robinson JK. Obstetrics & Gynecology, The George Washington University, Washington, District of Columbia This case demonstrates a combined hystersocopic and laparoscopic approach to a cervical ectopic pregnancy. A 36yo G6P1041 was found to have a cervical ectopic pregnancy at her initial prenatal visit dating consistent with her LMP of 8 wks and 3 days. She described painless vaginal spotting for two days. Her surgical history was significant for one prior c-section and four uterine curettages. The patient was taken to the operating room and a diagnostic laparoscopy was done followed by bladder mobilization, skeletonization of bilateral uterine arteries, and identification of b/l ureters in the event hemorrhage was encountered. Hysteroscopy revealed the fetus in its gestational sac located in the anterior aspect of the endocervical. The fetus was delivered using polyp forceps and the rest of the products were removed using the 21French bipolar resectoscope. The EBL was 50cc and patient went home the next day without complications.
Abstracts / Journal of Minimally Invasive Gynecology 20 (2013) S182–S195
617 Rectosigmoid Bowel Resection and Nodule Excision from Bladder Located Close to Ureter Orifice for Radical Treatment of Deep Infiltrative Endometriosis Taskiran C,1 Oktem O,1 Celik S,2 Turkgeldi E,2 Bugra D,1 Urman B.1 1 Ob/Gyn, Koc University, Istanbul, Sisli, Turkey; 2VKV American Hospital, Istanbul, Sisli, Turkey Deep infiltrative endometriosis (DIE) is unique disorder invading more than 5 mm of any pelvic organs. It may invade bowel, bladder, ureter, and any other pelvic organ. The treatment for (DIE) involves the resection of all fibrotic endometriotic foci sometimes with resection of corresponding organ. The patient presented at this video was 27 years old and she had underwent 3 surgeries for endometriosis before. At this operation very severe adhesions and endometriotic involvement of pelvis, rectosigmoid colon and bladder were detected. After extensive dissection of pelvic organs rectosigmoid colon resection-anastomosis and nodule excision from bladder which is very close to ureter orrifice were performed. No intraoperative or postoperative complication was seen and the patient discharged at day eight. Since several very informative dissections, resections and anastomoses were performed we wanted to present this unique case within the video session.
At the end of the surgey, women can recover a triangular cavity, much more efficient for subsequent pregnancy. 621 Essure Expulsion of Outer Coils: A Report of Two Cases Nimaroff ML, Fenster T, Sanidad S, Seidman S. Obstetrics and Gynecology, North Shore University Hospital, Manhasset, New York Hysteroscopic tubal sterilzation using the Essure microinserts has been shown to be highly effective and carries a low rate of complications. Early expulsions of the device prior to the three month recommended hysterosalpingogram, have been reported to be approximately 3%.(1) However, expulsion of the microinsert after confirming occluded tubes is believed to be an unusual event. Dr. Garcia recently reported in JMIG the first known case report of expulsion remote from insertion.(2) This video presents the treatment of two additional cases of symptomatic Essure expulsion years after successful insertion documented by occluded fallopian tubes on HSG. 1. Cooper JM, Carigan CS, Cher D, Kerin JF. Microinsert Nonincisional Hysteroscopic Sterilization. Obstet Gynecol 2003;102:59-67. 2. Garcia AL, Lewis RM, Sloan AL. Essure insert expulsion after 3month hysterosalpingogram confirmation of bilateral tubal occlusion and bilateral correct placement: case report. J Minim Invasive Gynecol 2013 Jan-Feb;20(1):107-111.
618 Robot Assisted Laparoscopic Partial Bladder Resection of Advanced Endometriosis Tran B-VT, Advincula AP. Florida Hospital-Celebration Health, Celebration, Florida Advanced endometriosis can be surgically challenging due to significant fibrosis and involvement of surrounding organs such as the rectum, colon and bladder. A multi-disciplinary approach to surgical treatment is often necessary for optimal surgical outcomes. We demonstrate a case of endometriosis invading through the full thickness of the bladder, that is successfully resected with minimally invasive surgery with robot assisted technology in collaboration with urology.
VIDEO POSTER: HYSTEROSCOPY, ENDOMETRIAL ABLATION 619 Hysteroscopic Myomectomy for Submucous and Intramural Myomas Albornoz J, Fernandez E, Fernandez C. Obstetrics and Gynecology, Clinica Las Condes, Santiago, Region Metropolitana, Chile Myomas or fibroids affect approximately 30 to 40% of women in the thirties. The incidence of submucous myomas is between 5-10% of all myomas. Common symptoms include menorrhagia, anemia and infertility, which vary in relation to location, number and size of myomas. The diagnostic approach includes Transvaginal ultrasound, Sonohysterography, 3-D Ultrasound and Magnetic Resonance Imaging. Surgical approach by hysteroscopy is the treatment of choice, but the surgeon should pay especial attention to operating time and fluid balance to minimize the risk of fluid overload. In this video we show how to perform hysteroscopic myomectomy for submucous and intramural myomas by resectoscopy, a minimally invasive surgery that in experienced hands is a safe and effective procedure. 620 Hysteroscopic Treatment of a Rudimentaory Horn Fernandez H, Capmas P. Gynecology, H^opital Bic^etre, Le Kremlin Bic^etre, France Rudimentary horns sometimes communicate with uterine cavity as a septate uterus with a total and closed partition. A preoperatory precise cartography is needed before performing the surgery. An ultrasound guidance can also be interesting to control the section of the septum.
622 Hysteroscopically Guided Intramyometrial Local Anaesthesia – The Focal Local – for Resection of Endometrial Polyps by Vaginoscopic Microhysteroscopy in Postmenopausal Women; a Novel Technique for Office Treatment Skensved H. Gynaecology, Private Practice, Hillerod, Denmark Several studies have demonstrated the feasibility of hysteroscopic polypectomy using a 3,5 mm microhysteroscope and applying the vaginoscopic approach. However, pain is the leading cause of failure has hampered a more widespread use of the technique outside the research settings. Indeed, very recent reports from Holland as well as the UK have revealed that 75% of polyps are still removed in theatre, the majority under general or regional anaesthesia. During the primary microhysteroscopy, local anaesthesia through a 5 Fr cystoscopic needle can be placed in the myometrium, at the base of the polyp, rendering the removal pain free and at the same time facilitating the resection. 623 Combined Laparoscopic and Hysteroscopic Approach to a Cervical Ectopic Pregnancy von Walter Gonzalez A, Robinson JK. Obstetrics & Gynecology, The George Washington University, Washington, District of Columbia This case demonstrates a combined hystersocopic and laparoscopic approach to a cervical ectopic pregnancy. A 36yo G6P1041 was found to have a cervical ectopic pregnancy at her initial prenatal visit dating consistent with her LMP of 8 wks and 3 days. She described painless vaginal spotting for two days. Her surgical history was significant for one prior c-section and four uterine curettages. The patient was taken to the operating room and a diagnostic laparoscopy was done followed by bladder mobilization, skeletonization of bilateral uterine arteries, and identification of b/l ureters in the event hemorrhage was encountered. Hysteroscopy revealed the fetus in its gestational sac located in the anterior aspect of the endocervical. The fetus was delivered using polyp forceps and the rest of the products were removed using the 21French bipolar resectoscope. The EBL was 50cc and patient went home the next day without complications.