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Resection of Deep Endometriosis
Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159
S45
In many case of large myoma, there is not enough surgical fields for us to handle the instruments and to separate the myoma completely from the uterus by the conventional techniques of laparoscopic myomectomy. However, our technique ‘Enucleation of the myoma by direct morcellation’ offers some advantages to resolve these problems. Besides, it seems to minimize the bleeding and shorten the incision length to myoma. Our video shows that as the myoma is progressively morcellated, the junction between the myoma and the uterine wall can be separated easily, and as the uterine size is reduced, additional space is created for the optimal movements of instruments. Thus, we think our technique may help to reduce the operating time and the technical difficulties of laparoscopic myomectomy.
without aid of vaginal assisted procedures. We believe that laparoscopic view of radical hysterectomy has clearer dissection line and more precise surgical procedure is possible. Laparoscopy is excellent instrument to share the information of techniques or anatomy or consensus of surgical techniques.
166
The video is intended to provide the viewer with the means by which large uterii may be safely removed laparoscopically.
Video Session 6dHysterectomy and Fibroids (11:53 AM d 12:01 PM)
Uterine Manipulator, the Dionisi Elevator Dionisi HJ. Ginecologia, Instituto Oulton, Cordoba, Argentina In recent years, we have developed a technique for endoscopic hysterectomy. The key instrument for our procedure is the Uterine Elevator made from stainless steel, Reusable is a Pre requisite for Minimally Invasive Intrafacial Laparoscopic Hysterectomy. This device which allows us to move the uterus forward, backward and sideways, as well as, by means of an intrauterine device, preventing the uterus from rotating around its axis. The uterus can be elevated using the same device, imitating the function that the clips of the angles have in an AH.The device makes an easy grasping of the uterine pedicles, creating a distance between the ureters and the uterine pedicles and allows lateral parametrium dissection with no hemorrhage or ureter injury. The device allows an optimal exposure of the vaginal fornices and a wide range of uterine movements. The instrument is reusable, easy to assemble and the pneumoperitoneum is quite well maintained.
167
Video Session 6dHysterectomy and Fibroids (12:02 PM d 12:05 PM)
Hysterectomy on Large (900cc) Uteri Kamergorodsky G, Junior C Severino, Lemos N, Kondo L, Pereira D, Ribeiro PA, Aoki T. Gynecology, Faculdade de Ciencias Me´dicas da Santa Casa de Sa˜o Paulo, Sa˜o Paulo, Brazil The objective this video is describe a technique for laparoscopy histerectomy on large uteri. Case report: 42 year-old woman with hypermenorragia and pelvic pain, reporting no desire of further pregnancies. MRI showed uterine myomatosis and total uterine volume of 900 cc. The key features are: higher camera trocar placement, uterine arteries ligation prior to myomectomy, extirpation of larger fibroids, use of endoscopic Pozzi clamp to enhance traction and partial morcelation to allow vaginal uterine extraction.
168
Video Session 6dHysterectomy and Fibroids (12:06 PM d 12:14 PM)
Recent Conceptions of Nerve Sparing Radical Hysterectomy under the Magnified View of Laparoscopy Lee YS. Obstetrics and Gynecology, School of Medicine, Kyung Pook National University, Daegu, Republic of Korea The laparoscopy is excellent instrument to identify and preserve nerves. It has magnifications the surgeon so that fine vessels and nerves can be identified. Any injuries to the inf. Hypogastric plexus (IHP) may result in voiding, defecation or sexual dysfunction. Inf. Hypogastric plexus (IHP) had afferent branches from sacral root (S2,S3,S4) and sympathetic ganglion and hypogasric nerve. It’s efferent branches to vesical (med., lat.) and uterovaginal and inf. Rectal. Laparoscopic views of nerve sparing radical hysterectomy will be described here esp. in IHP and shown in video. The whole procedures can be completely by laparoscopy
169
Video Session 6dHysterectomy and Fibroids (12:15 PM d 12:22 PM)
Laparoscopic Hysterectomy of the Very Large Uterus Zisow DL. Gynecology & Minimally Invasive Surgery, Northwest Hospital Center, Randallstown, Maryland
170
Video Session 7dEndometriosis II (11:35 AM d 11:43 AM)
Systematic Surgical Approach for DIE of the Posterior Compartment Raymundo TS,1,2 Panisset KS,2 de Oliveira MA Pinho,1 Crispi CP,2 Oliveira FM.2 1University of the State of Rio de Janeiro, Rio de Janeiro, Brazil; 2Fernandes Figueira Institute, Rio de Janeiro, Brazil We start the procedure elevating both ovaries to improve the surgical field. Then, the bilateral ureterolysis is performed in order to take them away from the retrocervical area. After this step, we enucleate the nodule, keeping it attached to the rectum, until we identify the tissue free from disease at the rectovaginal septum. The dissection of the pararetal space is made to mobilize the rectum from the pelvis. The local of the application of the linear stapler is defined and cleaned to improve the result of the anastomosis The linear stapler is introduced into the right iliac trocar for the section of the distal segment, followed by vaginal exteriorization of the proximal segment. Once it is cut, the ogiva is inserted into the proximal segment of the bowel. The segment is returned to the abdominal cavity and the anastomosis is concluded with the circular stapler.
171
Video Session 7dEndometriosis II (11:44 AM d 11:52 AM)
Resection of Deep Endometriosis Cholkeri-Singh A, Miller CE. OB/Gyn at Lutheran General Hospital, The Advanced Gynecologic Surgery Institute, Park Ridge, Illinois The patient in our video was offered resection of bowel with reanastomosis due to the proximity of bowel and endometriosis. By employing basic surgical techniques, the surgeons were able to resect the endometriotic nodule without trauma to vital structures. This video is intended to educate practitioners the value of basic surgical principles even with difficult resections.
172
Video Session 7dEndometriosis II (11:53 AM d 12:01 PM)
Laparoscopic Removal of Pelvic Uterus-Like Masses e Smooth Muscle Metaplasia or Remnant of a Mu¨llerian System Defect? Kaufman Y,1,2 Alturki H,1 Lam A.1 1CARE, Centre for Advanced Reproductive Endosurgery, St Leonards, New South Wales, Australia; 2 Department of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center Affiliated to the Technion Institute of Technology Medical School, Haifa, Israel The pelvic uterus-like mass is a rare phenomenon in which an extrauterine mass, comprised of smooth muscle and a central cavity lined by endometrium, is found within the pelvis. The mass is associated with endometriosis and in some of the cases the with congenital Mu¨llerian malformations. The multipotent cells of the peritoneal mesothelium in
S45
In many case of large myoma, there is not enough surgical fields for us to handle the instruments and to separate the myoma completely from the uterus by the conventional techniques of laparoscopic myomectomy. However, our technique ‘Enucleation of the myoma by direct morcellation’ offers some advantages to resolve these problems. Besides, it seems to minimize the bleeding and shorten the incision length to myoma. Our video shows that as the myoma is progressively morcellated, the junction between the myoma and the uterine wall can be separated easily, and as the uterine size is reduced, additional space is created for the optimal movements of instruments. Thus, we think our technique may help to reduce the operating time and the technical difficulties of laparoscopic myomectomy.
without aid of vaginal assisted procedures. We believe that laparoscopic view of radical hysterectomy has clearer dissection line and more precise surgical procedure is possible. Laparoscopy is excellent instrument to share the information of techniques or anatomy or consensus of surgical techniques.
166
The video is intended to provide the viewer with the means by which large uterii may be safely removed laparoscopically.
Video Session 6dHysterectomy and Fibroids (11:53 AM d 12:01 PM)
Uterine Manipulator, the Dionisi Elevator Dionisi HJ. Ginecologia, Instituto Oulton, Cordoba, Argentina In recent years, we have developed a technique for endoscopic hysterectomy. The key instrument for our procedure is the Uterine Elevator made from stainless steel, Reusable is a Pre requisite for Minimally Invasive Intrafacial Laparoscopic Hysterectomy. This device which allows us to move the uterus forward, backward and sideways, as well as, by means of an intrauterine device, preventing the uterus from rotating around its axis. The uterus can be elevated using the same device, imitating the function that the clips of the angles have in an AH.The device makes an easy grasping of the uterine pedicles, creating a distance between the ureters and the uterine pedicles and allows lateral parametrium dissection with no hemorrhage or ureter injury. The device allows an optimal exposure of the vaginal fornices and a wide range of uterine movements. The instrument is reusable, easy to assemble and the pneumoperitoneum is quite well maintained.
167
Video Session 6dHysterectomy and Fibroids (12:02 PM d 12:05 PM)
Hysterectomy on Large (900cc) Uteri Kamergorodsky G, Junior C Severino, Lemos N, Kondo L, Pereira D, Ribeiro PA, Aoki T. Gynecology, Faculdade de Ciencias Me´dicas da Santa Casa de Sa˜o Paulo, Sa˜o Paulo, Brazil The objective this video is describe a technique for laparoscopy histerectomy on large uteri. Case report: 42 year-old woman with hypermenorragia and pelvic pain, reporting no desire of further pregnancies. MRI showed uterine myomatosis and total uterine volume of 900 cc. The key features are: higher camera trocar placement, uterine arteries ligation prior to myomectomy, extirpation of larger fibroids, use of endoscopic Pozzi clamp to enhance traction and partial morcelation to allow vaginal uterine extraction.
168
Video Session 6dHysterectomy and Fibroids (12:06 PM d 12:14 PM)
Recent Conceptions of Nerve Sparing Radical Hysterectomy under the Magnified View of Laparoscopy Lee YS. Obstetrics and Gynecology, School of Medicine, Kyung Pook National University, Daegu, Republic of Korea The laparoscopy is excellent instrument to identify and preserve nerves. It has magnifications the surgeon so that fine vessels and nerves can be identified. Any injuries to the inf. Hypogastric plexus (IHP) may result in voiding, defecation or sexual dysfunction. Inf. Hypogastric plexus (IHP) had afferent branches from sacral root (S2,S3,S4) and sympathetic ganglion and hypogasric nerve. It’s efferent branches to vesical (med., lat.) and uterovaginal and inf. Rectal. Laparoscopic views of nerve sparing radical hysterectomy will be described here esp. in IHP and shown in video. The whole procedures can be completely by laparoscopy
169
Video Session 6dHysterectomy and Fibroids (12:15 PM d 12:22 PM)
Laparoscopic Hysterectomy of the Very Large Uterus Zisow DL. Gynecology & Minimally Invasive Surgery, Northwest Hospital Center, Randallstown, Maryland
170
Video Session 7dEndometriosis II (11:35 AM d 11:43 AM)
Systematic Surgical Approach for DIE of the Posterior Compartment Raymundo TS,1,2 Panisset KS,2 de Oliveira MA Pinho,1 Crispi CP,2 Oliveira FM.2 1University of the State of Rio de Janeiro, Rio de Janeiro, Brazil; 2Fernandes Figueira Institute, Rio de Janeiro, Brazil We start the procedure elevating both ovaries to improve the surgical field. Then, the bilateral ureterolysis is performed in order to take them away from the retrocervical area. After this step, we enucleate the nodule, keeping it attached to the rectum, until we identify the tissue free from disease at the rectovaginal septum. The dissection of the pararetal space is made to mobilize the rectum from the pelvis. The local of the application of the linear stapler is defined and cleaned to improve the result of the anastomosis The linear stapler is introduced into the right iliac trocar for the section of the distal segment, followed by vaginal exteriorization of the proximal segment. Once it is cut, the ogiva is inserted into the proximal segment of the bowel. The segment is returned to the abdominal cavity and the anastomosis is concluded with the circular stapler.
171
Video Session 7dEndometriosis II (11:44 AM d 11:52 AM)
Resection of Deep Endometriosis Cholkeri-Singh A, Miller CE. OB/Gyn at Lutheran General Hospital, The Advanced Gynecologic Surgery Institute, Park Ridge, Illinois The patient in our video was offered resection of bowel with reanastomosis due to the proximity of bowel and endometriosis. By employing basic surgical techniques, the surgeons were able to resect the endometriotic nodule without trauma to vital structures. This video is intended to educate practitioners the value of basic surgical principles even with difficult resections.
172
Video Session 7dEndometriosis II (11:53 AM d 12:01 PM)
Laparoscopic Removal of Pelvic Uterus-Like Masses e Smooth Muscle Metaplasia or Remnant of a Mu¨llerian System Defect? Kaufman Y,1,2 Alturki H,1 Lam A.1 1CARE, Centre for Advanced Reproductive Endosurgery, St Leonards, New South Wales, Australia; 2 Department of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center Affiliated to the Technion Institute of Technology Medical School, Haifa, Israel The pelvic uterus-like mass is a rare phenomenon in which an extrauterine mass, comprised of smooth muscle and a central cavity lined by endometrium, is found within the pelvis. The mass is associated with endometriosis and in some of the cases the with congenital Mu¨llerian malformations. The multipotent cells of the peritoneal mesothelium in