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Robot-Assisted Laparoscopic Adenomyomectomy for Conserving Uterus in Patient Who Have Huge Adenomyoma
Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201 Post op course was uncomplicated and patient was discharged home on POD #6. Foley removed and urology follow up was unremarkable in 2 weeks. Patient successfully started on chemotherapy.
564
Virtual Posters – Session 4 (12:45 PM–1:45 PM)
blood loss. Develop the vesico-uterine space over the colpotomy cup of your uterine manipulator. Back fill the bladder to help identify its boundaries and assist in dissection. Finally, carefully take town the uterine adhesions while avoiding removing the abdominal wall fascia. This will allow for safe dissection of the tethered uterus after multiple cesarean deliveries. 566
1:03 PM – STATION B Robot-Assisted Laparoscopic Adenomyomectomy for Conserving Uterus in Patient Who Have Huge Adenomyoma Hwang H-J, Lee M-K, Kim H-K, Chung Y-J, Cho H-H, Kim J-H, Kim M-R. Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea Study Objective: To report the surgical method for adenomyomectomy as robot-assisted laparoscopic adenomyomectomy. Design: Case report. Setting: Fibroid Center of tertiary university hospital. Patients: Patient who underwent robot-assisted laparoscopic adenomyomectomy. Intervention: 45 year old woman with severe secondary dysmenorrhea and urinary retention visited Seoul St. Mary’s hospital. She was unmarried, nulliparous, and had no other past medical history. Adenomyosis was diagnosed by pelvic ultrasonography. Pelvic MRI was performed for detecting exact location and sized of the lesion. 6.5x9.4 size focal adenomyosis was noted on posterior uterine wall, and enlarged uterus compressed bladder. Serum level of CA-125 before surgery was 434.00/mL. The robot-assisted laparoscopic adenomyomectomy was performed under general anesthesia. We made a vertical incision on uterine posterior wall, and the adenomyoma was removed by monopolar scissor without electrocauterization. For suturing remained myometrium without dead space, we divide the space in left and right. At first left half myometrium was sutured with barbed suture material, and then the right side was done in same manner. Suture of both side myometrium approximate the remained uterine wall sufficiently. We sutured serosa layer with baseball suture for inhibiting post operation adhesion. Measurements and Main Results: Dysmenorrhea and pelvic pain nearly disappeared after surgery. Three months after surgery, patient had pelvic ultrasonography for evaluating status of uterus. There was no remaining adenomyosis in pelvic ultrasonography, and the serum level of CA-125 was 2.24/mL. Conclusion: Adenomyosis is one of common gynecologic disease. Patients usually suffer from dysmenorrhea, menorrhagia, chronic pelvic pain, and infertility. Unclear margin from normal myometrium and easily breaking tissue challenge the surgical removal of adenomyoma. Robot-assisted laparoscopic adenomyomectomy can be one of choice for adenomyosis patients who want to fertility preservation.
565
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 1:03 PM – STATION C
Robotic Approach to the Tethered Uterus after Multiple Cesarean Deliveries Keltz J, Lopez J, Shin JH. Obstetrics and Gynecology and Women’s Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York In our patient population, multiple prior cesarean deliveries are common. With each repeat surgery, the risk of developing significant adhesions increases. Patients with uterine adhesions following cesarean delivery may present with chronic pelvic pain, dysmenorrhea, dyspareunia, or abnormal uterine bleeding requiring surgical intervention. This video aims to illustrate a stepwise minimally invasive approach to safely dissect dense adhesions of the uterus to the anterior abdominal wall and bladder at time of hysterectomy. First identify the anatomy, then open the round ligament and dissect out the uterine vessels to minimize
S185
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 1:03 PM – STATION D
Robotic Repair of Incidental Vaginal Laceration during da Vinci-Assisted TLH Gupta N, Depasquale S. University of Tennessee College of Medicine, Chattanooga, Tennessee This video presentation describes da Vinci assisted repair of vaginal lacerations, noted after completion of a robotic hysterectomy. The laceration is repaired prior to closure of the vaginal cuff. These lacerations are usually caused by removal of large uterus, instrumentation or manipulation of a narrow, atrophic vagina for specimen retrieval. Such repairs can be cumbersome, if vaginal approach is used. This is due to their high location in the upper one-third of vagina, close to the cuff. By performing a robotic repair, surgeons can decrease their operative time, blood loss from the laceration and spare the struggle of a vaginal repair. 567
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 1:03 PM – STATION E
Robotic Single-Incision Laparoscopic Burch Colposuspension for Stress Urinary Incontinence Zhang Y,1 Liu J,2 Kliethermes C,1 Guan X1. 1Ob/Gyn, Baylor College of Medicine, Houston, Texas; 2Ob/Gyn, Guangzhou Medical University, Guangzhou, Guangdong, China Background: Burch colposuspension is a reliable alternative to sling procedures for treating women presenting with stress urinary incontinence (SUI), which affects approximately 15% of women in the United States. The proposed mechanisms of achieving continence are bladder neck elevation and stabilization, which allows normal pressure transmission during periods of increased intra-abdominal pressure restoring continence in a previously incontinent, hypermobile UVJ. Single-incision laparoscopic(SILS) Burch colposuspension is a minimally invasive fashion with less bleeding, infection, pain, and better cosmetic outcome. However it is challenging for difficult intracorporeal suturing and precise placement of sutures in the pelvis. Robot-assisted SILS circumvents such difficulty. Objective: To describe the robotic SILS Burch colposuspension for SUI. Clinical information: A 67 year-old G4P3 female presenting with SUI and stage III pelvic organ prolapse. Interventions: Robotic SILS Burch colposuspension after sacrocolpopexy. Conclusion: Robotic SILS Burch colposuspension is feasible alternative for management of stress urinary incontinence.
568
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 1:03 PM – STATION F
Role of Robotic Surgery in Patients with Huge Uteri Wang P-Y. Obstetrics and Gynaecology, Taipei Medical University Hospital, Taipei City, Taiwan The objective of this video is to present a case of robotic total hysterectomy on a patient with a huge myomatous and adenomatous uterus, and to demonstrate the capability of robotic instruments and certain techniques used
564
Virtual Posters – Session 4 (12:45 PM–1:45 PM)
blood loss. Develop the vesico-uterine space over the colpotomy cup of your uterine manipulator. Back fill the bladder to help identify its boundaries and assist in dissection. Finally, carefully take town the uterine adhesions while avoiding removing the abdominal wall fascia. This will allow for safe dissection of the tethered uterus after multiple cesarean deliveries. 566
1:03 PM – STATION B Robot-Assisted Laparoscopic Adenomyomectomy for Conserving Uterus in Patient Who Have Huge Adenomyoma Hwang H-J, Lee M-K, Kim H-K, Chung Y-J, Cho H-H, Kim J-H, Kim M-R. Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea Study Objective: To report the surgical method for adenomyomectomy as robot-assisted laparoscopic adenomyomectomy. Design: Case report. Setting: Fibroid Center of tertiary university hospital. Patients: Patient who underwent robot-assisted laparoscopic adenomyomectomy. Intervention: 45 year old woman with severe secondary dysmenorrhea and urinary retention visited Seoul St. Mary’s hospital. She was unmarried, nulliparous, and had no other past medical history. Adenomyosis was diagnosed by pelvic ultrasonography. Pelvic MRI was performed for detecting exact location and sized of the lesion. 6.5x9.4 size focal adenomyosis was noted on posterior uterine wall, and enlarged uterus compressed bladder. Serum level of CA-125 before surgery was 434.00/mL. The robot-assisted laparoscopic adenomyomectomy was performed under general anesthesia. We made a vertical incision on uterine posterior wall, and the adenomyoma was removed by monopolar scissor without electrocauterization. For suturing remained myometrium without dead space, we divide the space in left and right. At first left half myometrium was sutured with barbed suture material, and then the right side was done in same manner. Suture of both side myometrium approximate the remained uterine wall sufficiently. We sutured serosa layer with baseball suture for inhibiting post operation adhesion. Measurements and Main Results: Dysmenorrhea and pelvic pain nearly disappeared after surgery. Three months after surgery, patient had pelvic ultrasonography for evaluating status of uterus. There was no remaining adenomyosis in pelvic ultrasonography, and the serum level of CA-125 was 2.24/mL. Conclusion: Adenomyosis is one of common gynecologic disease. Patients usually suffer from dysmenorrhea, menorrhagia, chronic pelvic pain, and infertility. Unclear margin from normal myometrium and easily breaking tissue challenge the surgical removal of adenomyoma. Robot-assisted laparoscopic adenomyomectomy can be one of choice for adenomyosis patients who want to fertility preservation.
565
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 1:03 PM – STATION C
Robotic Approach to the Tethered Uterus after Multiple Cesarean Deliveries Keltz J, Lopez J, Shin JH. Obstetrics and Gynecology and Women’s Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York In our patient population, multiple prior cesarean deliveries are common. With each repeat surgery, the risk of developing significant adhesions increases. Patients with uterine adhesions following cesarean delivery may present with chronic pelvic pain, dysmenorrhea, dyspareunia, or abnormal uterine bleeding requiring surgical intervention. This video aims to illustrate a stepwise minimally invasive approach to safely dissect dense adhesions of the uterus to the anterior abdominal wall and bladder at time of hysterectomy. First identify the anatomy, then open the round ligament and dissect out the uterine vessels to minimize
S185
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 1:03 PM – STATION D
Robotic Repair of Incidental Vaginal Laceration during da Vinci-Assisted TLH Gupta N, Depasquale S. University of Tennessee College of Medicine, Chattanooga, Tennessee This video presentation describes da Vinci assisted repair of vaginal lacerations, noted after completion of a robotic hysterectomy. The laceration is repaired prior to closure of the vaginal cuff. These lacerations are usually caused by removal of large uterus, instrumentation or manipulation of a narrow, atrophic vagina for specimen retrieval. Such repairs can be cumbersome, if vaginal approach is used. This is due to their high location in the upper one-third of vagina, close to the cuff. By performing a robotic repair, surgeons can decrease their operative time, blood loss from the laceration and spare the struggle of a vaginal repair. 567
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 1:03 PM – STATION E
Robotic Single-Incision Laparoscopic Burch Colposuspension for Stress Urinary Incontinence Zhang Y,1 Liu J,2 Kliethermes C,1 Guan X1. 1Ob/Gyn, Baylor College of Medicine, Houston, Texas; 2Ob/Gyn, Guangzhou Medical University, Guangzhou, Guangdong, China Background: Burch colposuspension is a reliable alternative to sling procedures for treating women presenting with stress urinary incontinence (SUI), which affects approximately 15% of women in the United States. The proposed mechanisms of achieving continence are bladder neck elevation and stabilization, which allows normal pressure transmission during periods of increased intra-abdominal pressure restoring continence in a previously incontinent, hypermobile UVJ. Single-incision laparoscopic(SILS) Burch colposuspension is a minimally invasive fashion with less bleeding, infection, pain, and better cosmetic outcome. However it is challenging for difficult intracorporeal suturing and precise placement of sutures in the pelvis. Robot-assisted SILS circumvents such difficulty. Objective: To describe the robotic SILS Burch colposuspension for SUI. Clinical information: A 67 year-old G4P3 female presenting with SUI and stage III pelvic organ prolapse. Interventions: Robotic SILS Burch colposuspension after sacrocolpopexy. Conclusion: Robotic SILS Burch colposuspension is feasible alternative for management of stress urinary incontinence.
568
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 1:03 PM – STATION F
Role of Robotic Surgery in Patients with Huge Uteri Wang P-Y. Obstetrics and Gynaecology, Taipei Medical University Hospital, Taipei City, Taiwan The objective of this video is to present a case of robotic total hysterectomy on a patient with a huge myomatous and adenomatous uterus, and to demonstrate the capability of robotic instruments and certain techniques used