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Single-Port Access Total Laparoscopic Hysterectomy (SPA-TLH) with Standard Instrumentations
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Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S169–S178
these types of Mullerian anomalies with accompanying animations. In addition, multiple variations of cervical agenesis are illustrated and associated malformation such as ureteral and renal anomalies are discussed. Second, typical signs and symptoms as well as physical exam findings of cervical agenesis are presented. Suggestions are made for appropriate pre-operative imaging. Finally, a surgical video of the patient’s surgery highlights useful tips and techniques for managing cervical agenesis laparoscopically. Treatment options are summarized and controversies and complications are addressed.
sutures for faster, easier closure of the large single-port, 3) modified homemade port including better smoke drainage and less trocar heads’ fighting, 4) easier removal of Allexis inner ring with vein retractor, 5) percutaneous sling suture saving additional port in total laparoscopic hysterectomy, myomectomy, ovarian cystectomy, 6) laparoscopic morcellation with morcellating knife, and, 7) better laparoscopic vault closure technique using vaginal tube.
592 589 TLH for Large Uterus Jain N. OB/GYN, Vardhman Trauma and Laparoscopy Centre Pvt. Ltd., Muzaffarnagar, UP, India To assess the safety and feasibility of TLH for large uterus. Design: Retrospective study. Setting: Tertiary referral centre. Patients: 42 Cases having uterus wt. above 1000gm. Intervention: We are presenting our standard method of tackling these patients.10 mm telescope is introduced at the epigastriums. On the left side the lower port is at the level of umbilicus and upper port is at the highest point on left side. A suprapubic port is introduced, which has the sole function to push the uterus on the contra lateral side and present the adenexa and uterine artery for transaction. Measurements and Main Results: All patients discharged with in 48 hours. One ureteric transaction diagnosed intraoperatively had laparoscopic end to end re-anastomosis. Conclusion: In our experience, with good team work, TLH for large uteri is safe and feasible.
590 Vaginal Vault Closure with Intracorporeal Continuous Suture in Single Port Access Transumbilical Total Laparoscopic Hysterectomy Lee M, Yun BH, Kim SW. Yonsei University College of Medicine, Seoul, Korea Laparoscopic hysterectomy is currently considered the standard procedure in patients who need hysterectomy. To reduce incisional morbidity and improve cosmetic outcome, we performed single port access (SPA) transumbilical laparoscopic surgery from August 2008 using a specially designed single 3 channel port and standard laparoscopic instruments. Until now we performed SPA laparoscopic surgery in more than 500 patients and SPA total laparoscopic hysterectomy (TLH) in more than 300 patients. In single port laparoscopic hysterectomy, vault closure is the most challenging procedure during hysterectomy. Now we report an intracorporeal continuous vaginal vault suture method which can be performed by using two conventional needle holders and 35-40 cm 1-0 Monosyn with premade slipknots at the end.
591 Single-Port Access Total Laparoscopic Hysterectomy (SPA-TLH) with Standard Instrumentations Park Y. Gynecology, CHA University, Gangnam CHA Hospital, Seoul, Korea Current techniques of single-port access hysterectomy have many advantages, but also disadvantages. These disadvantages act as barriers disturbing its popularization. To overcome these, many instruments have been developed. However, these are not satisfactory, furthermore very expensive. All my SPA surgeries have been performed only with straight instrumentations. And also I’ve tried to improve current techniques: such as 1) modified direct trocar insertion under periumbilical incision, which is more convenient and gives faster decision making whether to convert to multi-port surgery or laparotomy than Haesson technique, 2) anchoring
Hysterectomy by Single-Port Laparoscopy in Enlarged Uterus Roman H. Obstetrics and Gynecology, Rouen University Hospital, Rouen, Normandy, France The aim of this movie is to describe the supracervical single-port laparoscopic hysterectomy technique in enlarged benign uterus using primary uterine devascularization, performed in a woman whose uterus weighted 500 g. The keys to a successful procedure are: the complete devascularization before any other surgical procedure is performed on the uterus, supracervical section of the isthmus using an monopolar endoloop and morcellation using a morcellator introduced through the cervix. To these could be added the previous free-residue diet that further guarantees safety and peroperative convenience and the strong mobilization of the uterus by use of a uterine manipulator. This procedure avoids unexpected peroperative hemorrhage requiring conversion to the abdominal ou classical laparoscopic route, provides optimal protection for the ureters, and apperas to decrease postoperative pain when compared to classical laparoscopy.
593 Single Incision Laparoscopic Vaginal Cuff Closure with Barbed Suture Scheib SA, Curlin H. Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee Demonstration of single incision laparoscopic vaginal cuff closure technique with barbed suture.
594 Total Laparoscopic Removal of Huge Uterus Using the LigasureÔ Device, Classical Bipolar and Barbed V-LocÔ Suture Wattiez A, Vazquez A, Rovira R, Maia S. IRCAD, Strasbourg, France We present the case of a 54-year-old woman with pelvic pain. Ultrasound shows a huge uterus with multiple fibroids. Abdominal exploration manifests an uterus size equivalent to 24 weeks gestation. In this video, we demonstrate that with different technology like LigaSureÔ, barbed suture and Clermont-Ferrand uterine manipulator, and with an adequate knowledge of the anatomy and surgical technique a total laparoscopic hysterectomy can be performed without too much difficulty despite the uterine size.
VIDEO FESTIVAL SESSION: NEW INSTRUMENTATION 595 Orifice Assisted Small Incision Surgery (OASIS) Einarsson JI, Cohen SL. Division of Minimally Invasive Gynecologic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts Orifice-assisted small-incision surgery (OASIS) is a novel technique that attempts to incorporate the benefits of single-incision and natural-orifice surgery while minimizing issues such as instrument crowding at the umbilicus. In this method, optical access is gained via the posterior culde-sac by placing a flexible sigmoidoscope through a vaginally placed
Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S169–S178
these types of Mullerian anomalies with accompanying animations. In addition, multiple variations of cervical agenesis are illustrated and associated malformation such as ureteral and renal anomalies are discussed. Second, typical signs and symptoms as well as physical exam findings of cervical agenesis are presented. Suggestions are made for appropriate pre-operative imaging. Finally, a surgical video of the patient’s surgery highlights useful tips and techniques for managing cervical agenesis laparoscopically. Treatment options are summarized and controversies and complications are addressed.
sutures for faster, easier closure of the large single-port, 3) modified homemade port including better smoke drainage and less trocar heads’ fighting, 4) easier removal of Allexis inner ring with vein retractor, 5) percutaneous sling suture saving additional port in total laparoscopic hysterectomy, myomectomy, ovarian cystectomy, 6) laparoscopic morcellation with morcellating knife, and, 7) better laparoscopic vault closure technique using vaginal tube.
592 589 TLH for Large Uterus Jain N. OB/GYN, Vardhman Trauma and Laparoscopy Centre Pvt. Ltd., Muzaffarnagar, UP, India To assess the safety and feasibility of TLH for large uterus. Design: Retrospective study. Setting: Tertiary referral centre. Patients: 42 Cases having uterus wt. above 1000gm. Intervention: We are presenting our standard method of tackling these patients.10 mm telescope is introduced at the epigastriums. On the left side the lower port is at the level of umbilicus and upper port is at the highest point on left side. A suprapubic port is introduced, which has the sole function to push the uterus on the contra lateral side and present the adenexa and uterine artery for transaction. Measurements and Main Results: All patients discharged with in 48 hours. One ureteric transaction diagnosed intraoperatively had laparoscopic end to end re-anastomosis. Conclusion: In our experience, with good team work, TLH for large uteri is safe and feasible.
590 Vaginal Vault Closure with Intracorporeal Continuous Suture in Single Port Access Transumbilical Total Laparoscopic Hysterectomy Lee M, Yun BH, Kim SW. Yonsei University College of Medicine, Seoul, Korea Laparoscopic hysterectomy is currently considered the standard procedure in patients who need hysterectomy. To reduce incisional morbidity and improve cosmetic outcome, we performed single port access (SPA) transumbilical laparoscopic surgery from August 2008 using a specially designed single 3 channel port and standard laparoscopic instruments. Until now we performed SPA laparoscopic surgery in more than 500 patients and SPA total laparoscopic hysterectomy (TLH) in more than 300 patients. In single port laparoscopic hysterectomy, vault closure is the most challenging procedure during hysterectomy. Now we report an intracorporeal continuous vaginal vault suture method which can be performed by using two conventional needle holders and 35-40 cm 1-0 Monosyn with premade slipknots at the end.
591 Single-Port Access Total Laparoscopic Hysterectomy (SPA-TLH) with Standard Instrumentations Park Y. Gynecology, CHA University, Gangnam CHA Hospital, Seoul, Korea Current techniques of single-port access hysterectomy have many advantages, but also disadvantages. These disadvantages act as barriers disturbing its popularization. To overcome these, many instruments have been developed. However, these are not satisfactory, furthermore very expensive. All my SPA surgeries have been performed only with straight instrumentations. And also I’ve tried to improve current techniques: such as 1) modified direct trocar insertion under periumbilical incision, which is more convenient and gives faster decision making whether to convert to multi-port surgery or laparotomy than Haesson technique, 2) anchoring
Hysterectomy by Single-Port Laparoscopy in Enlarged Uterus Roman H. Obstetrics and Gynecology, Rouen University Hospital, Rouen, Normandy, France The aim of this movie is to describe the supracervical single-port laparoscopic hysterectomy technique in enlarged benign uterus using primary uterine devascularization, performed in a woman whose uterus weighted 500 g. The keys to a successful procedure are: the complete devascularization before any other surgical procedure is performed on the uterus, supracervical section of the isthmus using an monopolar endoloop and morcellation using a morcellator introduced through the cervix. To these could be added the previous free-residue diet that further guarantees safety and peroperative convenience and the strong mobilization of the uterus by use of a uterine manipulator. This procedure avoids unexpected peroperative hemorrhage requiring conversion to the abdominal ou classical laparoscopic route, provides optimal protection for the ureters, and apperas to decrease postoperative pain when compared to classical laparoscopy.
593 Single Incision Laparoscopic Vaginal Cuff Closure with Barbed Suture Scheib SA, Curlin H. Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee Demonstration of single incision laparoscopic vaginal cuff closure technique with barbed suture.
594 Total Laparoscopic Removal of Huge Uterus Using the LigasureÔ Device, Classical Bipolar and Barbed V-LocÔ Suture Wattiez A, Vazquez A, Rovira R, Maia S. IRCAD, Strasbourg, France We present the case of a 54-year-old woman with pelvic pain. Ultrasound shows a huge uterus with multiple fibroids. Abdominal exploration manifests an uterus size equivalent to 24 weeks gestation. In this video, we demonstrate that with different technology like LigaSureÔ, barbed suture and Clermont-Ferrand uterine manipulator, and with an adequate knowledge of the anatomy and surgical technique a total laparoscopic hysterectomy can be performed without too much difficulty despite the uterine size.
VIDEO FESTIVAL SESSION: NEW INSTRUMENTATION 595 Orifice Assisted Small Incision Surgery (OASIS) Einarsson JI, Cohen SL. Division of Minimally Invasive Gynecologic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts Orifice-assisted small-incision surgery (OASIS) is a novel technique that attempts to incorporate the benefits of single-incision and natural-orifice surgery while minimizing issues such as instrument crowding at the umbilicus. In this method, optical access is gained via the posterior culde-sac by placing a flexible sigmoidoscope through a vaginally placed