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Retrospective Analysis of 152 Cases between Ligation of Cervical Stump and Suturing of Uterine Arteries in Laparoscopic Supracervical Hysterectomy (LSH)
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S136–S190 hemostasis we retrieve the specimen through the ‘‘Lap-Protector’’ using ‘‘the roll paper technique’’ with surgical scalpels. Measurements and Main Results: The maximum nodule diameter was 8cm and the maximum number of the nodules was 4.The operative time ranged 140min to 260 min .The blood loss ranged 100ml to 350ml. All cases were performed by the beginners with no complications and no up conversion. Conclusion: We found that this procedure is for the beginners because it needed no special skill such as the pure intra corporeal knot-tying. In addition we were relieved from the skilled maneuver required in the pneumoperitoneum laparoscopic surgery by using the open surgery instrument through the elastic port. 547 Retrospective Analysis of 152 Cases between Ligation of Cervical Stump and Suturing of Uterine Arteries in Laparoscopic Supracervical Hysterectomy (LSH) Mun ST. Dept. of Ob/Gyn, SoonChunHyang University Hospital, CheonAn-si, ChungNam, Korea Study Objective: To compare the efficacy and safety between two methods such as ligation of cervical stump and suturing of uterine vessels in LSH. Design: Retrospective analysis of 152 consecutive cases of LSH. Setting: University Hospital. Patients: 152 women (ages 33-52 yrs) undergoing Laparoscopic supracervical hysterectomy. 99 women was cervical stump ligation group, 53 women was uterine vessel suturing group. Intervention: Charts were reviewed to determine post-operative complications and surgical values. A comparison was made between two methods groups in post-operative hemoglobin, and hematocrits changes, operation time, blood loss during operation, post-operative drainage volume.(n=152)
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the average time of the procedure between the two groups, 89.5min vs. 62.2min (p\.0001). There were significant differences in blood loss, 143.1ml vs 103.0ml (p\0.05), change in hemoglobin, 1.61 vs 1.12 (p\0.05) and hematocrit, 5.43 vs 3.12 (p\0.05). Conclusion: Suturing of Uterine vessels is more safe and effective methods than ligation of cervical stump in LSH. 548 Successful Treatment of Rectus Muscle Endometriosis by Laparoscopy Na YJ, Song YJ, Kim HG, Yang JS, Yeom JI. Obstetrics & Gynecology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Republic of Korea Study Objective: Endometriosis is the existence of endometrial tissue out of the intrauterine cavity. Most frequently endometriosis occurs within the pelvis. However, the extrapelvic implantation of endometrial tissue has been described in virtually every organ. Design: Endometriosis of rectus abdominis muscle is extremely rare. It should be considered in the differential diagnosis of abdominal wall masses in women with cyclic pain. Patients: We experienced a case of endometriosis of the rectus abdominis muscle in a 45 years old woman who had a tender nodular lesion on right mid portion abdominal wall, fluctuating with her menstrual cycles for 1 year. She had received Cesarean section 7 years ago. Intervention: The physical examination revealed an ill defined, about 3cm sized mass on her right mid portion abdominal wall above 2cm of surgical scar. CT scan showed an 2.7cm ill-defined mass with contrast enhanced. Measurements and Main Results: We performed a resection of rectus abdominis muscle mass by laparoscopic approach without using mesh. The histological examination of rectus abdominis muscle mass was consistent with endometriosis. There was no postoperative complication. Conclusion: To the best of our knowledge, this is the first case of successful treatment of rectus muscle endometriosis by laparoscopy. 549 Effect of BMI on the Safety at the Time of Laparoscopic Entry Nagashima M,1 Noguchi Y,1 Ishikawa T,2 Mimura T,2 Sekizawa A.2 1 Yamato Tokushuukai Hospital, Yamato, Kanagawa, Japan; 2Showa University School of Medicine, Shinagawa, Tokyo, Japan
cervical stump ligation method.
uterine vessel suturing method.
Measurements and Main Results: There was no statistically significant difference between the groups in terms of age, indication for surgery, uterine size, body mass index, parity. There was a significant decrease in
Study Objective: The purpose of this study is to assess the association between the body mass index (BMI) and safe depth of entry into the abdominal cavity at the time of insertion of a Veress needle into the umbilical area after lifting the anterior abdominal wall. Design: Retrospective study. Setting: We prospectively conducted the study in 61 cases of laparoscopic gynecologic surgery between September 2011 and February 2012. Patients: We enrolled the patients who were primipara and never had previous history of abdominal surgery nor adhesion. Intervention: We measured the thickness of the abdominal wall, the distance from inside of the anterior abdominal wall to the spine (abdominal cavity distance) when lifting the abdominal wall, and the thickness of the intestinal tract during operation. We therefore compared these parameters to the BMI. Measurements and Main Results: The mean thickness of the abdominal wall was 1.30.4cm (0.6-3.1cm). There was a significant positive correlation between this thickness and BMI. The mean abdominal cavity distance was 11.00.4cm (8.1-13.9cm). We could not observe significant correlation between this distance and BMI. In every case, thickness of the intestinal tract was less than 3cm. We supposed that the depth of the safe entry is deeper than the thickness of the abdominal wall and is shallower than this thickness plus abdominal cavity distance minus the thickness of the intestinal tract. And the value was between 3.1 and 6.3cm in every case. Conclusion: It is revealed that the depth of the safe entry of Veress needle seems to be 3.1-6.3cm, when we execute blind insertion in the first trocar, although actual depth should be decided taking account of BMI.
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the average time of the procedure between the two groups, 89.5min vs. 62.2min (p\.0001). There were significant differences in blood loss, 143.1ml vs 103.0ml (p\0.05), change in hemoglobin, 1.61 vs 1.12 (p\0.05) and hematocrit, 5.43 vs 3.12 (p\0.05). Conclusion: Suturing of Uterine vessels is more safe and effective methods than ligation of cervical stump in LSH. 548 Successful Treatment of Rectus Muscle Endometriosis by Laparoscopy Na YJ, Song YJ, Kim HG, Yang JS, Yeom JI. Obstetrics & Gynecology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Republic of Korea Study Objective: Endometriosis is the existence of endometrial tissue out of the intrauterine cavity. Most frequently endometriosis occurs within the pelvis. However, the extrapelvic implantation of endometrial tissue has been described in virtually every organ. Design: Endometriosis of rectus abdominis muscle is extremely rare. It should be considered in the differential diagnosis of abdominal wall masses in women with cyclic pain. Patients: We experienced a case of endometriosis of the rectus abdominis muscle in a 45 years old woman who had a tender nodular lesion on right mid portion abdominal wall, fluctuating with her menstrual cycles for 1 year. She had received Cesarean section 7 years ago. Intervention: The physical examination revealed an ill defined, about 3cm sized mass on her right mid portion abdominal wall above 2cm of surgical scar. CT scan showed an 2.7cm ill-defined mass with contrast enhanced. Measurements and Main Results: We performed a resection of rectus abdominis muscle mass by laparoscopic approach without using mesh. The histological examination of rectus abdominis muscle mass was consistent with endometriosis. There was no postoperative complication. Conclusion: To the best of our knowledge, this is the first case of successful treatment of rectus muscle endometriosis by laparoscopy. 549 Effect of BMI on the Safety at the Time of Laparoscopic Entry Nagashima M,1 Noguchi Y,1 Ishikawa T,2 Mimura T,2 Sekizawa A.2 1 Yamato Tokushuukai Hospital, Yamato, Kanagawa, Japan; 2Showa University School of Medicine, Shinagawa, Tokyo, Japan
cervical stump ligation method.
uterine vessel suturing method.
Measurements and Main Results: There was no statistically significant difference between the groups in terms of age, indication for surgery, uterine size, body mass index, parity. There was a significant decrease in
Study Objective: The purpose of this study is to assess the association between the body mass index (BMI) and safe depth of entry into the abdominal cavity at the time of insertion of a Veress needle into the umbilical area after lifting the anterior abdominal wall. Design: Retrospective study. Setting: We prospectively conducted the study in 61 cases of laparoscopic gynecologic surgery between September 2011 and February 2012. Patients: We enrolled the patients who were primipara and never had previous history of abdominal surgery nor adhesion. Intervention: We measured the thickness of the abdominal wall, the distance from inside of the anterior abdominal wall to the spine (abdominal cavity distance) when lifting the abdominal wall, and the thickness of the intestinal tract during operation. We therefore compared these parameters to the BMI. Measurements and Main Results: The mean thickness of the abdominal wall was 1.30.4cm (0.6-3.1cm). There was a significant positive correlation between this thickness and BMI. The mean abdominal cavity distance was 11.00.4cm (8.1-13.9cm). We could not observe significant correlation between this distance and BMI. In every case, thickness of the intestinal tract was less than 3cm. We supposed that the depth of the safe entry is deeper than the thickness of the abdominal wall and is shallower than this thickness plus abdominal cavity distance minus the thickness of the intestinal tract. And the value was between 3.1 and 6.3cm in every case. Conclusion: It is revealed that the depth of the safe entry of Veress needle seems to be 3.1-6.3cm, when we execute blind insertion in the first trocar, although actual depth should be decided taking account of BMI.