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Repeat Laparoscopic Paraaortic Lymphadenectomy for Woman with an Isolated Lymph Node Recurrence
Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S169–S178 LUC can assist with ureteral identification during performance of complex laparoscopic hysterectomies.
566 Repeat Laparoscopic Paraaortic Lymphadenectomy for Woman with an Isolated Lymph Node Recurrence Choi JS, Lee JH, Hong JH, Eom JM. Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Kangbuk Samsung Hospital, Seoul, Republic of Korea The patient was referred to our institution due to watery vaginal discharge and left flank pain on postoperative day 19 after total laparoscopic hysterectomy. During cystography and intravenous pyelography, left distal ureteral trasection was detected. We performed the laparoscopic ureteroureteral anastomosis. The ends of transected ureter were debrided and spatulated, respectively. To minimize handling of the ureter, holding suture was placed on 6 o’clock portion of both free ends. Laparoscopic ureteroureteral anastomosis was performed using 4-0 Vicryl interrupted sutures with intracorporeal suture techniques over a double-J catheter without tension. The anastomosis site was wrapped with omentum to facilitate good healing. The Foley catheter was removed after 2 weeks, and the stents were removed after 8 weeks. During follow-up of 4 months, there were no urologic sequelae associated with ureteral transection or laparoscopic surgery for it.
567 Simple Stategies for Single Port Laparoscopic Bilateral SalpingoOphorectomies Deimling T, Harkins G, Davies M. Minimally Invasive Gyn Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania Single Port Laparoscopic surgical techniques have become popular across multiple surgical disciplines, including General Surgery, Urology and Gynecology. We feel there are some surgical procedures unique to Gynecology that present an ideal case for adaptation of Single Port Surgical Laparoscopy. We present our statagey for Single PortLaparoscopic Surgery for Bilateral Salpingo-ophorectomy.
S171
570 Can We Get Satisfied Results after Laparoscopic Resection and Myolysis with RF for Severe Adenomyosis? Eun D-S, Shin K-S, Choi J, Choi Y-S, Jeong B-S, Park J-N. Obstetrics & Gynecology, Eun’s Hospital, Gwang-ju, Jeonlanam-do, Korea To evaluate relief of symptoms and disappearance of adenomyomas after laparoscopic resection and myolysis with RF in severe adenomyosis Design: Prospective study Patients: 355 patients from 1st. Jan. 2006 to 31st. Dec.2010. Interventions: The 1.5 cm thickened, seromuscular layer covered adenomyoma is remained after wide resection of deep adenomyosis in posterior and fundus. Adhesion of the endometrium and myometium to remained seromuscular layer was made with 1-0 monocryl after removal of the elevator. Myolysis was made on the anterior surface. Suture was done on the healthy tissue and sometimes penetrated into the widely lytic hole. Results: Dysmenorrhea was improved relatively in 85%and menorrhagia was 95%. Conclusions: Symptoms in severe adenomyosis could be controlled well by laparoscopic resection and myolysis with RF.
571 Laparoscopic Removal of a 15cm Ovarian Cyst Gould CH, Johnson S. Minimally Invasive Surgery, Legacy Emanuel Medical Center, Portland, Oregon A 57 year old postmenopaual female was referred by her naturopath due to acute pain in the pelvis. The patient had a known right ovarian cyst for which she had previously refused treatment. Imaging studies showed growth of the mass with the right ovary measuring 5.4 cm in largest diameter and a complex mass measuring 10.3 x 10.7 x 8.2 cm arising from the ovary. Significant inflammatory changes were encountered at the time of surgery, and extensive lysis of adhesions was performed. The entire ovary and torsed fallopian tube were removed laparoscopically after decompression. Care was taken to avoid spilling of the contents of the cyst by placement of a purse-string suture prior to drainage. The final pathology results were consistent with a benign cystadenofibroma.
572 568 Parasitic Myomectomy Eigg MH. OB/GYN, Rochester General Hospital, Rochester, New York This is an educational video that demonstrates what can be missed at open surgery and treated well by MIS. This patient had an open S-TAH and thought to have a distended bladder at that time. After surgery pain and a mass was identified and found, ultimately, to be a large cervical myoma hidden into the bladder and left retroperitoneum. Extensive adhesion lysis, bladder mobilization, ureteral stenting and trachelectomy are all demonstrated in this short video.
Laparoscopic Excision of Intraligamental Fibroid Guan X, Zurawin RK. Gynecology, Baylor College of Medicine, Houston, Texas This video demonstrates how to perform an anatomically-based laparoscopic excision of a very large broad ligament fibroid using harmonic energy. The patient is a 45 year old G2P2 complaining of pain and menorrhagia. MRI showed an 11 x 9.1 x 7.1 cm mass isodense with adjacent myometrium on the right side of the pelvis. It could not be determined radiologically if the mass arose from the ovary or the uterus. Fibroids in the broad ligament not contiguous with the uterus are very rare and are well known for achieving enormous size. In this case, the large fibroid was transected from right pelvic side wall without compromise of the other vital pelvic structures. The patient was discharged home same day without complication.
569 Single Port Approach to Complex Dissection of Residual Ovary Eisenstein DI, Nawfal AK. Women’s Health, Henry Ford Health System, West Bloomfield, Michigan Single port access for laparoscopic surgery is currently used for such indications as prophylactic oophorectomy, hysterectomy, and appendectomy. We present a case of pelvic pain with residual ovarian disease that demonstrates how single port access can be successfully used to approach this clinical problem. The video demonstrates instrumentation and techniques of tissue handling and pelvic sidewall dissection.
573 Abdominal Mass in Pregnancy Hawa NN,1 Obias V,2 Robinson JK.1 1Minimally Invasive Gynecology, The George Washington University Hospital, Washington, District of Columbia; 2Colon and Rectal Surgery, The George Washington University Hospital, Washington, District of Columbia We present a case of a 30 year old Gravida 3 Para 1101 who presented at 8 week gestation with an intra uterine pregnancy and a fundal hight of 22 cm.
566 Repeat Laparoscopic Paraaortic Lymphadenectomy for Woman with an Isolated Lymph Node Recurrence Choi JS, Lee JH, Hong JH, Eom JM. Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Kangbuk Samsung Hospital, Seoul, Republic of Korea The patient was referred to our institution due to watery vaginal discharge and left flank pain on postoperative day 19 after total laparoscopic hysterectomy. During cystography and intravenous pyelography, left distal ureteral trasection was detected. We performed the laparoscopic ureteroureteral anastomosis. The ends of transected ureter were debrided and spatulated, respectively. To minimize handling of the ureter, holding suture was placed on 6 o’clock portion of both free ends. Laparoscopic ureteroureteral anastomosis was performed using 4-0 Vicryl interrupted sutures with intracorporeal suture techniques over a double-J catheter without tension. The anastomosis site was wrapped with omentum to facilitate good healing. The Foley catheter was removed after 2 weeks, and the stents were removed after 8 weeks. During follow-up of 4 months, there were no urologic sequelae associated with ureteral transection or laparoscopic surgery for it.
567 Simple Stategies for Single Port Laparoscopic Bilateral SalpingoOphorectomies Deimling T, Harkins G, Davies M. Minimally Invasive Gyn Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania Single Port Laparoscopic surgical techniques have become popular across multiple surgical disciplines, including General Surgery, Urology and Gynecology. We feel there are some surgical procedures unique to Gynecology that present an ideal case for adaptation of Single Port Surgical Laparoscopy. We present our statagey for Single PortLaparoscopic Surgery for Bilateral Salpingo-ophorectomy.
S171
570 Can We Get Satisfied Results after Laparoscopic Resection and Myolysis with RF for Severe Adenomyosis? Eun D-S, Shin K-S, Choi J, Choi Y-S, Jeong B-S, Park J-N. Obstetrics & Gynecology, Eun’s Hospital, Gwang-ju, Jeonlanam-do, Korea To evaluate relief of symptoms and disappearance of adenomyomas after laparoscopic resection and myolysis with RF in severe adenomyosis Design: Prospective study Patients: 355 patients from 1st. Jan. 2006 to 31st. Dec.2010. Interventions: The 1.5 cm thickened, seromuscular layer covered adenomyoma is remained after wide resection of deep adenomyosis in posterior and fundus. Adhesion of the endometrium and myometium to remained seromuscular layer was made with 1-0 monocryl after removal of the elevator. Myolysis was made on the anterior surface. Suture was done on the healthy tissue and sometimes penetrated into the widely lytic hole. Results: Dysmenorrhea was improved relatively in 85%and menorrhagia was 95%. Conclusions: Symptoms in severe adenomyosis could be controlled well by laparoscopic resection and myolysis with RF.
571 Laparoscopic Removal of a 15cm Ovarian Cyst Gould CH, Johnson S. Minimally Invasive Surgery, Legacy Emanuel Medical Center, Portland, Oregon A 57 year old postmenopaual female was referred by her naturopath due to acute pain in the pelvis. The patient had a known right ovarian cyst for which she had previously refused treatment. Imaging studies showed growth of the mass with the right ovary measuring 5.4 cm in largest diameter and a complex mass measuring 10.3 x 10.7 x 8.2 cm arising from the ovary. Significant inflammatory changes were encountered at the time of surgery, and extensive lysis of adhesions was performed. The entire ovary and torsed fallopian tube were removed laparoscopically after decompression. Care was taken to avoid spilling of the contents of the cyst by placement of a purse-string suture prior to drainage. The final pathology results were consistent with a benign cystadenofibroma.
572 568 Parasitic Myomectomy Eigg MH. OB/GYN, Rochester General Hospital, Rochester, New York This is an educational video that demonstrates what can be missed at open surgery and treated well by MIS. This patient had an open S-TAH and thought to have a distended bladder at that time. After surgery pain and a mass was identified and found, ultimately, to be a large cervical myoma hidden into the bladder and left retroperitoneum. Extensive adhesion lysis, bladder mobilization, ureteral stenting and trachelectomy are all demonstrated in this short video.
Laparoscopic Excision of Intraligamental Fibroid Guan X, Zurawin RK. Gynecology, Baylor College of Medicine, Houston, Texas This video demonstrates how to perform an anatomically-based laparoscopic excision of a very large broad ligament fibroid using harmonic energy. The patient is a 45 year old G2P2 complaining of pain and menorrhagia. MRI showed an 11 x 9.1 x 7.1 cm mass isodense with adjacent myometrium on the right side of the pelvis. It could not be determined radiologically if the mass arose from the ovary or the uterus. Fibroids in the broad ligament not contiguous with the uterus are very rare and are well known for achieving enormous size. In this case, the large fibroid was transected from right pelvic side wall without compromise of the other vital pelvic structures. The patient was discharged home same day without complication.
569 Single Port Approach to Complex Dissection of Residual Ovary Eisenstein DI, Nawfal AK. Women’s Health, Henry Ford Health System, West Bloomfield, Michigan Single port access for laparoscopic surgery is currently used for such indications as prophylactic oophorectomy, hysterectomy, and appendectomy. We present a case of pelvic pain with residual ovarian disease that demonstrates how single port access can be successfully used to approach this clinical problem. The video demonstrates instrumentation and techniques of tissue handling and pelvic sidewall dissection.
573 Abdominal Mass in Pregnancy Hawa NN,1 Obias V,2 Robinson JK.1 1Minimally Invasive Gynecology, The George Washington University Hospital, Washington, District of Columbia; 2Colon and Rectal Surgery, The George Washington University Hospital, Washington, District of Columbia We present a case of a 30 year old Gravida 3 Para 1101 who presented at 8 week gestation with an intra uterine pregnancy and a fundal hight of 22 cm.