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Terumo Precision-Drive Articulating Instrument To Facilitate Gynecologic Laparoscopy
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S109–S127
S125
tricks to optimise its use compared to the classical rectal probe and rectal catheter.
robotic capability to meet consumer demands. The robotic camera holder provides a steady surgeon controlled image.
433
436
Video Session 13dNew Instrumentation and Techniques (9:05 AM d 9:12 AM)
Laparoscopic Vaginal Cuff Closure with Uni- and Bi-Directional Barbed Suture Siedhoff MT, Yunker AC, Steege JF. Division of Advanced Laparoscopy and Pelvic Pain, University of North Carolina, Chapel Hill, North Carolina Several reports have suggested that vaginal cuff dehiscence occurs more frequently after laparoscopic, as opposed to other types of hysterectomy. To address the problem in our practice, we began using barbed suture for closure and have not experienced this complication in over 200 cases. We also have noticed reduced rates of bleeding and cuff cellulitis. This video demonstrates laparoscopic cuff closure with both the V-Loc 180 Absorbable Wound Closure Device (Covidien) and Quill SRS (Angiotech). The former has one needle, barbs in a single direction, and a loop at the end of the suture. Quill is doublearmed with barbs that change direction in the middle of the suture. By holding in the tissue, barbed suture obviates the need to tie knots laparoscopically and represents an inexpensive alternative to single-use suturing devices. The technique is easy to learn and takes less than ten minutes to complete.
434
Video Session 13dNew Instrumentation and Techniques (9:13 AM d 9:20 AM)
Terumo Precision-Drive Articulating Instrument To Facilitate Gynecologic Laparoscopy Milad M, Pavone ME. Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois The Terumo Precision-Drive Articulating Instrument is designed to provide motorized rotation and articulation for endoscopic suture placement, knot tying, dissection and mono and bi-polar electrosurgery. Over the past two years, we applied the Terumo Precision-Drive Articulating Instrument to 6 female pigs of medium weight followed by 4 cadaveric dissections. The new device optimizes dissection, desiccation, suturing and knot tying during common gynecologic procedures. A reduction number of ports and time involved for the more difficult maneuvers was also noted. Accurate suture placement even with posterior myomectomy repair was seen. The Terumo Precision-Drive Articulating Instrument is a simple and effective alternative to both conventional and robotically assisted gynecologic procedures providing both articulation and rotation via a hand activated device. It is available within the operating room setting, on short notice and optimizes needle placement and knot tying.
435
Video Session 13dNew Instrumentation and Techniques (9:21 AM d 9:29 AM)
Solo Laparoscopic Supracervical Hysterectomy with VIKY Robotic Assistance Rosenfield RB. Gynecology, Pearl Women’s Center, Portland, Oregon This video demonstrates a Solo technique of Laparoscopic Supracervical Hysterectomy. A robotic camera holder and uterine positioning system are used to eliminate the need for a surgical assistant and skilled scrub tech. The patient is morbidly obese with a large fibroid uterus. The surgery is performed by one surgeon, completely solo (i.e. the primary surgeon performed this case with no assistance). The scrub tech set up the instruments but did not touch the patient during the operation. With a uterine positioning system, uterine manipulation was performed by the surgeon, eliminating need for a skilled assistant. In a world of increasing health care cost and technology, eliminating the need for a surgical assistant can possibly lead to cost effective solutions. Many hospitals cannot afford more expensive robotic systems, but desire
Video Session 13dNew Instrumentation and Techniques (9:30 AM d 9:35 AM)
Laparoscopic Salpingo-Oopherectomy Assisted with Cul-de-Sac Trocar Shapiro A, DiSciullo A. OB/Gyn, Mount Auburn Hospital, Cambridge, Massachusetts This video demonstrates a laparoscopic salpingo-oophorectomy utilizing only 5 mm abdominal ports and a cul-de-sac trocar to assist with specimen extraction. The patient in this case is perimenopausal, and was found to have a 6 cm complex adnexal mass on ultrasound. After removing the right adnexa, a long 15mm cul-de-sac trocar is introduced under direct visualization. Using an endoscopic bag, the specimen is retrieved. Due to distendability of the vaginal wall, the specimen is extracted intact and with ease. The vaginal entry is then closed laparoscopically. We believe that foregoing the 10mm abdominal port reduces post-operative pain and the chance of internal herniation.
437
Video Session 13dNew Instrumentation and Techniques (9:36 AM d 9:44 AM)
Laparoscopic Neovagina Procedure with Graft Rardin CR, Washington BB, Wohlrab KJ. Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island Iatrogenic obliteration of the vagina can be a challenging situation. The Davydov-Adamyan type procedure is one that has been described, where the peritoneum is anastomosed to the vaginal remnant, and a high peritoneal pursestring suture creates a neovagina composed of peritoneum. Howeverm some practitioners are concerned that the peritoneal pursestring suture is not string enough to reliably prevent evisceration. This modification involves using a biologic graft to extend the length of the vagina; peritoneal pursestring sutures are then used to provide apical support as well as peritoneal vascular support. Thus, security and safety are enhanced while the neovagina undergoes epithelialization.
438
Video Session 13dNew Instrumentation and Techniques (9:45 AM d 9:53 AM)
Minimally Invasive Management an Advanced Abdominal Pregnancy Raff GJ, Rothenberg JM, Golichowski AM. Ob/Gyn, Indiana University School of Medicine, Indianapolis, Indiana Abdominal pregnancy is an extremely rare but serious obstetric condition. It is associated with increased maternal mortality. The standard treatment is surgical interruption of the pregnancy. In this video we demonstrate the laparoscopic management of a 17-week gestation secondary abdominal pregnancy. We review the incidence, maternal and infant mortality rates, and differentiate between primary and secondary abdominal pregnancies as described by Studdiford. Our target audiences are advanced laparoscopists at tertiary referral centers who are likely to have these patients referred to them for further management. We demonstrate a safe minimally invasive alternative to the traditional exploratory laparotomy approach. 439
Video Session 13dNew Instrumentation and Techniques (9:54 AM d 10:00 AM)
Laparoscopic Wedge Resection of Adenomyosis Istre O, Suzuki Y. Ob/Gyn, BWH Harvard Medical School, Boston, Massachusetts Introduction: adenomyosis is a smooth muscle cells and endometriosic tissue, typically originating within the uterus. Methods: These patients usually
S125
tricks to optimise its use compared to the classical rectal probe and rectal catheter.
robotic capability to meet consumer demands. The robotic camera holder provides a steady surgeon controlled image.
433
436
Video Session 13dNew Instrumentation and Techniques (9:05 AM d 9:12 AM)
Laparoscopic Vaginal Cuff Closure with Uni- and Bi-Directional Barbed Suture Siedhoff MT, Yunker AC, Steege JF. Division of Advanced Laparoscopy and Pelvic Pain, University of North Carolina, Chapel Hill, North Carolina Several reports have suggested that vaginal cuff dehiscence occurs more frequently after laparoscopic, as opposed to other types of hysterectomy. To address the problem in our practice, we began using barbed suture for closure and have not experienced this complication in over 200 cases. We also have noticed reduced rates of bleeding and cuff cellulitis. This video demonstrates laparoscopic cuff closure with both the V-Loc 180 Absorbable Wound Closure Device (Covidien) and Quill SRS (Angiotech). The former has one needle, barbs in a single direction, and a loop at the end of the suture. Quill is doublearmed with barbs that change direction in the middle of the suture. By holding in the tissue, barbed suture obviates the need to tie knots laparoscopically and represents an inexpensive alternative to single-use suturing devices. The technique is easy to learn and takes less than ten minutes to complete.
434
Video Session 13dNew Instrumentation and Techniques (9:13 AM d 9:20 AM)
Terumo Precision-Drive Articulating Instrument To Facilitate Gynecologic Laparoscopy Milad M, Pavone ME. Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois The Terumo Precision-Drive Articulating Instrument is designed to provide motorized rotation and articulation for endoscopic suture placement, knot tying, dissection and mono and bi-polar electrosurgery. Over the past two years, we applied the Terumo Precision-Drive Articulating Instrument to 6 female pigs of medium weight followed by 4 cadaveric dissections. The new device optimizes dissection, desiccation, suturing and knot tying during common gynecologic procedures. A reduction number of ports and time involved for the more difficult maneuvers was also noted. Accurate suture placement even with posterior myomectomy repair was seen. The Terumo Precision-Drive Articulating Instrument is a simple and effective alternative to both conventional and robotically assisted gynecologic procedures providing both articulation and rotation via a hand activated device. It is available within the operating room setting, on short notice and optimizes needle placement and knot tying.
435
Video Session 13dNew Instrumentation and Techniques (9:21 AM d 9:29 AM)
Solo Laparoscopic Supracervical Hysterectomy with VIKY Robotic Assistance Rosenfield RB. Gynecology, Pearl Women’s Center, Portland, Oregon This video demonstrates a Solo technique of Laparoscopic Supracervical Hysterectomy. A robotic camera holder and uterine positioning system are used to eliminate the need for a surgical assistant and skilled scrub tech. The patient is morbidly obese with a large fibroid uterus. The surgery is performed by one surgeon, completely solo (i.e. the primary surgeon performed this case with no assistance). The scrub tech set up the instruments but did not touch the patient during the operation. With a uterine positioning system, uterine manipulation was performed by the surgeon, eliminating need for a skilled assistant. In a world of increasing health care cost and technology, eliminating the need for a surgical assistant can possibly lead to cost effective solutions. Many hospitals cannot afford more expensive robotic systems, but desire
Video Session 13dNew Instrumentation and Techniques (9:30 AM d 9:35 AM)
Laparoscopic Salpingo-Oopherectomy Assisted with Cul-de-Sac Trocar Shapiro A, DiSciullo A. OB/Gyn, Mount Auburn Hospital, Cambridge, Massachusetts This video demonstrates a laparoscopic salpingo-oophorectomy utilizing only 5 mm abdominal ports and a cul-de-sac trocar to assist with specimen extraction. The patient in this case is perimenopausal, and was found to have a 6 cm complex adnexal mass on ultrasound. After removing the right adnexa, a long 15mm cul-de-sac trocar is introduced under direct visualization. Using an endoscopic bag, the specimen is retrieved. Due to distendability of the vaginal wall, the specimen is extracted intact and with ease. The vaginal entry is then closed laparoscopically. We believe that foregoing the 10mm abdominal port reduces post-operative pain and the chance of internal herniation.
437
Video Session 13dNew Instrumentation and Techniques (9:36 AM d 9:44 AM)
Laparoscopic Neovagina Procedure with Graft Rardin CR, Washington BB, Wohlrab KJ. Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island Iatrogenic obliteration of the vagina can be a challenging situation. The Davydov-Adamyan type procedure is one that has been described, where the peritoneum is anastomosed to the vaginal remnant, and a high peritoneal pursestring suture creates a neovagina composed of peritoneum. Howeverm some practitioners are concerned that the peritoneal pursestring suture is not string enough to reliably prevent evisceration. This modification involves using a biologic graft to extend the length of the vagina; peritoneal pursestring sutures are then used to provide apical support as well as peritoneal vascular support. Thus, security and safety are enhanced while the neovagina undergoes epithelialization.
438
Video Session 13dNew Instrumentation and Techniques (9:45 AM d 9:53 AM)
Minimally Invasive Management an Advanced Abdominal Pregnancy Raff GJ, Rothenberg JM, Golichowski AM. Ob/Gyn, Indiana University School of Medicine, Indianapolis, Indiana Abdominal pregnancy is an extremely rare but serious obstetric condition. It is associated with increased maternal mortality. The standard treatment is surgical interruption of the pregnancy. In this video we demonstrate the laparoscopic management of a 17-week gestation secondary abdominal pregnancy. We review the incidence, maternal and infant mortality rates, and differentiate between primary and secondary abdominal pregnancies as described by Studdiford. Our target audiences are advanced laparoscopists at tertiary referral centers who are likely to have these patients referred to them for further management. We demonstrate a safe minimally invasive alternative to the traditional exploratory laparotomy approach. 439
Video Session 13dNew Instrumentation and Techniques (9:54 AM d 10:00 AM)
Laparoscopic Wedge Resection of Adenomyosis Istre O, Suzuki Y. Ob/Gyn, BWH Harvard Medical School, Boston, Massachusetts Introduction: adenomyosis is a smooth muscle cells and endometriosic tissue, typically originating within the uterus. Methods: These patients usually