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The Use of Mini Laparoscopy in Gynecology: Myomectomy and Hysterectomy
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Abstracts / Journal of Minimally Invasive Gynecology 20 (2013) S95–S132
adheres to the uterus for reliable manipulation. The disposable device is guided over the sound. The device comprises a cervical cup availabe in 30, 35, and 40mm diameters and a vaginal occluder to maintain pneumoperitoneum. The illumination seal is on one side of the cup and the light cord is inserted at the distal end. Benefits: Transillumination aids in tissue dissection during difficult cases involving deep pelvic tissue disease such as endometriosis and adhesive disease. The cervical cup allows minimal vaginal tissue resection to maintain vaginal length, provides tactile feedback during robotic-assisted TLH, displaces ureters away from cervix for safer dissection. The vaginal occluder allows maintenance of pneumoperitoneum.
pregnancy and a right ovarian cyst. Interventions: the operation process including: (1)creation of gastric access; (2)establishment of pneumoperitoneum; (3)detecting uterus and bilateral adnexa: find an endometriosis lesion on right ovarian wall. (4)cystotomy was performed for the ovarian cyst; (5)electrical cautery of the endometriosis; (6) salpingostomy and dissection of ectopic pregnancy lesion from tubal wall; (7)removal of embryonic tissue; (8)closure of the gastric incision. Results: All embryonic tissue was removed with size of 4.0cm!2.5cm. The patient did well postoperatively without any complications. The histological examination conformed the presence of chorionic villus in the specimen.
412
415
Video Session 12dNew Instrumentation (8:30 AM d 8:38 AM)
Video Session 12dNew Instrumentation (8:56 AM d 9:04 AM)
Use of Thulium Laser in Hysteroscopy Gomez F, Gomez S, Diaz I, Casta~neda J, Sotolongo R. Reproductive Medicine Department, Sanitas University, Marly Clinic, Bogota, Colombia
The Use of Mini Laparoscopy in Gynecology: Myomectomy and Hysterectomy Shepherd JA. Department of Ob/Gyn, University of Illinois at Chicago, Chicago, Illinois
The purpose of our video is show some procedures that we can do by hysteroscopy with the implementation of thulium laser technology with a fiber of 600 microns that can pass through the operative channel of the diagnostic hysteroscope. Due to its low tissue penetration 0.2 mm, thulium laser provides the surgeon a more precise cut avoiding injury to surrounding tissue and a favorable observable surgical effect due to its wavelength of 2010 nm. We wanted to test in different pathologies, including submucous myomas, uterine septum, abnormal uterine bleeding and endocervical polyp; with good results in all. The average time of surgery was 15 minutes, with surgeries that lasted only 1 minute and another that lasted 40 minutes; the average power used was 20 watts. We analyze that the use of laser technology could be a surgical option in the management of benign endometrial pathology giving us haemostasis and precision.
With the increasing importance of cosmesis in surgery, the use of smaller trocars and instruments play a significant role in the choice of operative techniques. Minilaparoscopy offers patients that option as it has gained renewed importance in the last few years. Its use can be seen in benign GYN procedures and the small changes in surgical technique allows patients a significantly improved cosmetic result. The 3 mm Instrument Set for Minilaparoscopy from KARL STORZ has a diameter of 3 mm and a length of 36 cm. The instrumentation and procedures are shown in this video to display the ease of use and the different techniques that can be implemented during the surgeries.
413
Video Session 12dNew Instrumentation (8:39 AM d 8:46 AM)
Laparoscopic Ultrasound-Guided Radiofrequency Volumetric Thermal Ablation (RFVTA) of Deep Intramural Fibroids Galen DI. Halt Medical, Inc., Brentwood, California Current uterine-sparing fibroid treatment options commonly leave many untreated fibroids in the uterus and are associated with a high risk of fibroid recurrence and high re-intervention rates. Laparoscopic ultrasound-guided RFVTA is a uterine-sparing method for ablation of virtually all uterine fibroids, including deep intramurals which account for >50% of fibroids; the method is presented in this procedural video and is targeted at gynecologic surgeons. No uterine incisions or uterine suturing are required. Demonstration of both the use and advantages of laparoscopic ultrasounddas well as of the RFVTA techniquedare shown. 414
Video Session 12dNew Instrumentation (8:47 AM d 8:55 AM)
Pure Tansgastric Natural Orifice Translumenal Endoscopic Surgery (NOTES) in Adnexal Procedures: The First Human Case Report Kong X,1 Liu B,2 Cui G.2 1Department of Gynaecology and Obstetrics, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China; 2Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China Objective: to offer a new method of treatments in adnexal diseases with transgastric NOTES. Patient: A 36-year-old woman presented with the symptoms of vaginal bleeding 20 days and left lower abdominal pain 3 days. Her b-hCG was 547.23mIU/ml(normal less than 5mIU/ ml).Transvaginal ultrasonography confirmed left fallopian tubal ectopic
416
Video Session 12dNew Instrumentation (9:05 AM d 9:13 AM)
J-Plasma: A New Helium Based Energy Device for Advanced Gyn Laparoscopy Gutierrez M, Volker KW, Vennart RM, Odhav R. Las Vegas Institute of Minimally Invasive Surgery and Women’s Pelvic Health Center, Las Vegas, Nevada Purpose: To introduce a new energy device, J-Plasma by Bovie, illustrate its surgical applications, describe the technology. Description: The J-Plasma beam is created when Helium gas is passed over an electrically energized blade. There is a blade for precision cutting when advanced, or for broader coagulation effects when retracted. There is no net flow of energy through the patient, so no grounding pad is needed.The maxiumum beam depth 2mm, thus there is less underlying tissue damage. There are two energy control settings; electrical power (% of 40W) and flow rate. Higher settings, (ie 50-100%, 5L/min flow) are used for cutting. Lower settings, 10-40%, 3L/min flow are used for coagulation. J-Plasma has multiple surgical applications, including tissue transection (i.e. round ligament, bladder flap, ovarian cystotomy/cystectomy), tissue cautery for hemostasis, adhesiolysis, laparoscopic myomectomy, fulguration of endometriosis, ablation of vulvar condylomas. Conclusion: J-plasma is a new and safe helium based energy device that can be utilized for numerous gynecologic procedures. 417
Video Session 12dNew Instrumentation (9:14 AM d 9:20 AM)
The Use of Articulating Instruments in Gynecologic Laparoscopy Nimaroff ML,1 Fenster T,1 Bharadwa K.2 1Obstetrics and Gynecology, North Shore University Hospital, Manhasset, New York; 2Obstetrics and Gynecology, Long Island Jewish Medical Center, New Hyde Park, New York The number of robotic assisted gynecologic procedures has increased dramatically over the past decade. Surgeon preference for using this
Abstracts / Journal of Minimally Invasive Gynecology 20 (2013) S95–S132
adheres to the uterus for reliable manipulation. The disposable device is guided over the sound. The device comprises a cervical cup availabe in 30, 35, and 40mm diameters and a vaginal occluder to maintain pneumoperitoneum. The illumination seal is on one side of the cup and the light cord is inserted at the distal end. Benefits: Transillumination aids in tissue dissection during difficult cases involving deep pelvic tissue disease such as endometriosis and adhesive disease. The cervical cup allows minimal vaginal tissue resection to maintain vaginal length, provides tactile feedback during robotic-assisted TLH, displaces ureters away from cervix for safer dissection. The vaginal occluder allows maintenance of pneumoperitoneum.
pregnancy and a right ovarian cyst. Interventions: the operation process including: (1)creation of gastric access; (2)establishment of pneumoperitoneum; (3)detecting uterus and bilateral adnexa: find an endometriosis lesion on right ovarian wall. (4)cystotomy was performed for the ovarian cyst; (5)electrical cautery of the endometriosis; (6) salpingostomy and dissection of ectopic pregnancy lesion from tubal wall; (7)removal of embryonic tissue; (8)closure of the gastric incision. Results: All embryonic tissue was removed with size of 4.0cm!2.5cm. The patient did well postoperatively without any complications. The histological examination conformed the presence of chorionic villus in the specimen.
412
415
Video Session 12dNew Instrumentation (8:30 AM d 8:38 AM)
Video Session 12dNew Instrumentation (8:56 AM d 9:04 AM)
Use of Thulium Laser in Hysteroscopy Gomez F, Gomez S, Diaz I, Casta~neda J, Sotolongo R. Reproductive Medicine Department, Sanitas University, Marly Clinic, Bogota, Colombia
The Use of Mini Laparoscopy in Gynecology: Myomectomy and Hysterectomy Shepherd JA. Department of Ob/Gyn, University of Illinois at Chicago, Chicago, Illinois
The purpose of our video is show some procedures that we can do by hysteroscopy with the implementation of thulium laser technology with a fiber of 600 microns that can pass through the operative channel of the diagnostic hysteroscope. Due to its low tissue penetration 0.2 mm, thulium laser provides the surgeon a more precise cut avoiding injury to surrounding tissue and a favorable observable surgical effect due to its wavelength of 2010 nm. We wanted to test in different pathologies, including submucous myomas, uterine septum, abnormal uterine bleeding and endocervical polyp; with good results in all. The average time of surgery was 15 minutes, with surgeries that lasted only 1 minute and another that lasted 40 minutes; the average power used was 20 watts. We analyze that the use of laser technology could be a surgical option in the management of benign endometrial pathology giving us haemostasis and precision.
With the increasing importance of cosmesis in surgery, the use of smaller trocars and instruments play a significant role in the choice of operative techniques. Minilaparoscopy offers patients that option as it has gained renewed importance in the last few years. Its use can be seen in benign GYN procedures and the small changes in surgical technique allows patients a significantly improved cosmetic result. The 3 mm Instrument Set for Minilaparoscopy from KARL STORZ has a diameter of 3 mm and a length of 36 cm. The instrumentation and procedures are shown in this video to display the ease of use and the different techniques that can be implemented during the surgeries.
413
Video Session 12dNew Instrumentation (8:39 AM d 8:46 AM)
Laparoscopic Ultrasound-Guided Radiofrequency Volumetric Thermal Ablation (RFVTA) of Deep Intramural Fibroids Galen DI. Halt Medical, Inc., Brentwood, California Current uterine-sparing fibroid treatment options commonly leave many untreated fibroids in the uterus and are associated with a high risk of fibroid recurrence and high re-intervention rates. Laparoscopic ultrasound-guided RFVTA is a uterine-sparing method for ablation of virtually all uterine fibroids, including deep intramurals which account for >50% of fibroids; the method is presented in this procedural video and is targeted at gynecologic surgeons. No uterine incisions or uterine suturing are required. Demonstration of both the use and advantages of laparoscopic ultrasounddas well as of the RFVTA techniquedare shown. 414
Video Session 12dNew Instrumentation (8:47 AM d 8:55 AM)
Pure Tansgastric Natural Orifice Translumenal Endoscopic Surgery (NOTES) in Adnexal Procedures: The First Human Case Report Kong X,1 Liu B,2 Cui G.2 1Department of Gynaecology and Obstetrics, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China; 2Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China Objective: to offer a new method of treatments in adnexal diseases with transgastric NOTES. Patient: A 36-year-old woman presented with the symptoms of vaginal bleeding 20 days and left lower abdominal pain 3 days. Her b-hCG was 547.23mIU/ml(normal less than 5mIU/ ml).Transvaginal ultrasonography confirmed left fallopian tubal ectopic
416
Video Session 12dNew Instrumentation (9:05 AM d 9:13 AM)
J-Plasma: A New Helium Based Energy Device for Advanced Gyn Laparoscopy Gutierrez M, Volker KW, Vennart RM, Odhav R. Las Vegas Institute of Minimally Invasive Surgery and Women’s Pelvic Health Center, Las Vegas, Nevada Purpose: To introduce a new energy device, J-Plasma by Bovie, illustrate its surgical applications, describe the technology. Description: The J-Plasma beam is created when Helium gas is passed over an electrically energized blade. There is a blade for precision cutting when advanced, or for broader coagulation effects when retracted. There is no net flow of energy through the patient, so no grounding pad is needed.The maxiumum beam depth 2mm, thus there is less underlying tissue damage. There are two energy control settings; electrical power (% of 40W) and flow rate. Higher settings, (ie 50-100%, 5L/min flow) are used for cutting. Lower settings, 10-40%, 3L/min flow are used for coagulation. J-Plasma has multiple surgical applications, including tissue transection (i.e. round ligament, bladder flap, ovarian cystotomy/cystectomy), tissue cautery for hemostasis, adhesiolysis, laparoscopic myomectomy, fulguration of endometriosis, ablation of vulvar condylomas. Conclusion: J-plasma is a new and safe helium based energy device that can be utilized for numerous gynecologic procedures. 417
Video Session 12dNew Instrumentation (9:14 AM d 9:20 AM)
The Use of Articulating Instruments in Gynecologic Laparoscopy Nimaroff ML,1 Fenster T,1 Bharadwa K.2 1Obstetrics and Gynecology, North Shore University Hospital, Manhasset, New York; 2Obstetrics and Gynecology, Long Island Jewish Medical Center, New Hyde Park, New York The number of robotic assisted gynecologic procedures has increased dramatically over the past decade. Surgeon preference for using this