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The Laparoscopic Appearances and Diagnosis of Endometriosis
Abstracts / Journal of Minimally Invasive Gynecology 20 (2013) S133–S181 There was no significant difference in the operative time and blood loss between the two groups. There was also no significant difference in pre and post-operative WBC count, but CRP 3 days after surgery was significantly higher in the LESS-M group with 2.011.3mg/dl, compared to the SLIM group with 1.431.2mg/dl (P=0.038). The epidural administration count for postoperative pain was higher in the LESS-M group with 2.02.5 times, than 1.01.5 times in the SLIM group (P=0.048). The enlarged wound in the umbilicus for collection of the myoma in LESS-M group was invasive and caused post-operative pain.
S181
Endometriosis can be a cruel and devastating disease, causing chronic pain, menstrual disorders and infertility in millions of women. For this reason, it is essential a correct diagnosis is made early so that appropriate treatment can be instituted. Most gynecologists easily recognize black powder burn lesions as endometriosis, yet nonpigmented or ‘‘subtle’’ implants that are vesicular, red, white, or peritoneal defects may also be endometriosis. Near-touch laparoscopy and a complete survey of the pelvic and abdominal cavity are crucial techniques in diagnosis of endometriosis. This video reviews three considerations when conducting a laparoscopy for the diagnosis of endometriosis: the peritoneal fluid, the appearance of typical and non-typical endometriosis on the peritoneum and the location of endometriosis.
VIDEO POSTER: EDUCATION 595 Myomectomies: Three Different Techniques Acosta J, Garzon H, Macias F, Acosta D. Ob/Gyn, Hospital Metropolitano, Quito, Pichincha, Ecuador This video shows three different techniques to perform myomectomies in symptomatic women that would want to conserve their uterus and preserve fertility. Some of the women are no longer interested in preserving fertility, however they might be young and they still want to preserve their uterus and having regular menstrual periods. The first technique shows a hysteroscopic myomectomy using a loop resectoscope. The second technique shows a laparoscopic myomectomy in which the uterine leiomyoma is extracted by first by excicing the myoma and secondly morcelating it and suturing the myometrium. The last technique also uses a laparoscopic myomectomy; however, the uterine leiomyoma is extracted using a surgical glove bag when an endopouch is not available.
596 Retroperitoneal Anatomy and Retrorectal Dissection of a Tail Gut Cyst Akl A, Yi J, Billow M, Magtibay P. Gynecologic Surgery, Mayo Clinic, Phoenix, Arizona To demonstrate a step by step approach of a difficult dissection in the deep retrorectal space of a tail gut cyst and emphasize the boundaries of the pararectal and retrorectal pelvic spaces. In this video we demonstrate a deep dissection in the retrorectal space. The patient is a 26 year old Hispanic female who has been seeking medical care for 8 years secondary to pelvic pain. She has had multiple procedures involving incision and drainage of what was thought to be perirectal abscesses. Her MRI showed multiple multicystic structures highly suspicious for a tail gut cysts. Entering the pararectal, presacral and retrorectal spaces is especially useful for identifying the ureters, major vessels and nerves and ensures a safe dissection. With fundamental knowledge of the pelvic retroperitoneal structures and spaces, Pelvic surgeons are able to perform safe, efficient, and effective operations without compromise.
597 The Laparoscopic Appearances and Diagnosis of Endometriosis Guan X, Ng V, Ryan NA. MIGS-Obstetrics & Gynecology, Baylor College of Medicine, Houston, Texas
598 A Step-by-Step Appoach to Laparoscopic Sacralcolpopexy Lang TG, Pasic RP. Obstetrics, Gynecology and Women’s Health, University of Louisville, Louisville, Kentucky In this video we present a detailed step by step approach to laparoscopic sacralcolpopexy that can be used as a teaching tool for residents, novice or advanced laparoscopic surgeons.
599 The ABC Approach to Laparoscopic Hysterectomy Lang TG,1 Biscette S,1 Shepherd J,3 Hudgens J,2 Pasic RP.1 1Ob/Gyn and Women’s Health, University of Louisville School of Medicine, Louisville, Kentucky; 2Owensboro Health Women’s Center, Owensboro, Kentucky; 3 Ob/Gyn - Minimally Invasive Gynecology, Universiy of Illinois, College of Medicine at Chicago, Chicago, Illinois In this video we present a systematic approach to Laparscopic Hysterecomy. In the ABC approach segment A represents the identiication and restoration of the anatomy and the detachment of the adnexae. Segment B corresponds to the creation of the bladder flap, skeletonization of the posterior leaf of the broad ligament and the coagulation and transection of the blood vessels (uterine arery and vein). Segment C corresponds to the lateralizaion of the cardinal ligaments, the colpotomy incision and cuff closure. The ABC approach can be ulitlized as a teaching tool for residents, the novice laparoscopic surgeon and experienced surgeons as the steps are easy to follow and are reproducible.
600 Laparoscopic Ovarian Cystectomy with the Stripping Technique Mahmoud MS. OBGyn, Michigan State University, lansing, Michigan Laparoscopy is considered the gold standard for the surgical treatment of benign ovarian cysts. The stripping technique is the most commonly used for benign ovarian cystectomy. It encompasses the use of two atraumatic grasping forceps to pull the cyst wall and the normal ovarian parenchyma in opposite directions, thus developing the cleavage plane. The stripping technique has demonstrated to to be a tissue-sparing procedure. We present in this video a 22 year old G0P0 with left pelvic pain complaint and the finding of a persistent 6 cm left ovarian cyst with benign features on ultrasound. She underwent a laparoscopic ovarian cystectomy using the stripping technique. The final pathology result was consistent with a serous cystadenoma.
S181
Endometriosis can be a cruel and devastating disease, causing chronic pain, menstrual disorders and infertility in millions of women. For this reason, it is essential a correct diagnosis is made early so that appropriate treatment can be instituted. Most gynecologists easily recognize black powder burn lesions as endometriosis, yet nonpigmented or ‘‘subtle’’ implants that are vesicular, red, white, or peritoneal defects may also be endometriosis. Near-touch laparoscopy and a complete survey of the pelvic and abdominal cavity are crucial techniques in diagnosis of endometriosis. This video reviews three considerations when conducting a laparoscopy for the diagnosis of endometriosis: the peritoneal fluid, the appearance of typical and non-typical endometriosis on the peritoneum and the location of endometriosis.
VIDEO POSTER: EDUCATION 595 Myomectomies: Three Different Techniques Acosta J, Garzon H, Macias F, Acosta D. Ob/Gyn, Hospital Metropolitano, Quito, Pichincha, Ecuador This video shows three different techniques to perform myomectomies in symptomatic women that would want to conserve their uterus and preserve fertility. Some of the women are no longer interested in preserving fertility, however they might be young and they still want to preserve their uterus and having regular menstrual periods. The first technique shows a hysteroscopic myomectomy using a loop resectoscope. The second technique shows a laparoscopic myomectomy in which the uterine leiomyoma is extracted by first by excicing the myoma and secondly morcelating it and suturing the myometrium. The last technique also uses a laparoscopic myomectomy; however, the uterine leiomyoma is extracted using a surgical glove bag when an endopouch is not available.
596 Retroperitoneal Anatomy and Retrorectal Dissection of a Tail Gut Cyst Akl A, Yi J, Billow M, Magtibay P. Gynecologic Surgery, Mayo Clinic, Phoenix, Arizona To demonstrate a step by step approach of a difficult dissection in the deep retrorectal space of a tail gut cyst and emphasize the boundaries of the pararectal and retrorectal pelvic spaces. In this video we demonstrate a deep dissection in the retrorectal space. The patient is a 26 year old Hispanic female who has been seeking medical care for 8 years secondary to pelvic pain. She has had multiple procedures involving incision and drainage of what was thought to be perirectal abscesses. Her MRI showed multiple multicystic structures highly suspicious for a tail gut cysts. Entering the pararectal, presacral and retrorectal spaces is especially useful for identifying the ureters, major vessels and nerves and ensures a safe dissection. With fundamental knowledge of the pelvic retroperitoneal structures and spaces, Pelvic surgeons are able to perform safe, efficient, and effective operations without compromise.
597 The Laparoscopic Appearances and Diagnosis of Endometriosis Guan X, Ng V, Ryan NA. MIGS-Obstetrics & Gynecology, Baylor College of Medicine, Houston, Texas
598 A Step-by-Step Appoach to Laparoscopic Sacralcolpopexy Lang TG, Pasic RP. Obstetrics, Gynecology and Women’s Health, University of Louisville, Louisville, Kentucky In this video we present a detailed step by step approach to laparoscopic sacralcolpopexy that can be used as a teaching tool for residents, novice or advanced laparoscopic surgeons.
599 The ABC Approach to Laparoscopic Hysterectomy Lang TG,1 Biscette S,1 Shepherd J,3 Hudgens J,2 Pasic RP.1 1Ob/Gyn and Women’s Health, University of Louisville School of Medicine, Louisville, Kentucky; 2Owensboro Health Women’s Center, Owensboro, Kentucky; 3 Ob/Gyn - Minimally Invasive Gynecology, Universiy of Illinois, College of Medicine at Chicago, Chicago, Illinois In this video we present a systematic approach to Laparscopic Hysterecomy. In the ABC approach segment A represents the identiication and restoration of the anatomy and the detachment of the adnexae. Segment B corresponds to the creation of the bladder flap, skeletonization of the posterior leaf of the broad ligament and the coagulation and transection of the blood vessels (uterine arery and vein). Segment C corresponds to the lateralizaion of the cardinal ligaments, the colpotomy incision and cuff closure. The ABC approach can be ulitlized as a teaching tool for residents, the novice laparoscopic surgeon and experienced surgeons as the steps are easy to follow and are reproducible.
600 Laparoscopic Ovarian Cystectomy with the Stripping Technique Mahmoud MS. OBGyn, Michigan State University, lansing, Michigan Laparoscopy is considered the gold standard for the surgical treatment of benign ovarian cysts. The stripping technique is the most commonly used for benign ovarian cystectomy. It encompasses the use of two atraumatic grasping forceps to pull the cyst wall and the normal ovarian parenchyma in opposite directions, thus developing the cleavage plane. The stripping technique has demonstrated to to be a tissue-sparing procedure. We present in this video a 22 year old G0P0 with left pelvic pain complaint and the finding of a persistent 6 cm left ovarian cyst with benign features on ultrasound. She underwent a laparoscopic ovarian cystectomy using the stripping technique. The final pathology result was consistent with a serous cystadenoma.