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Total Laparoscopic Cerclage Sacrohysteropexy
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97 distant from the surgical field. In this pilot, a probe and monopolar needle were used to resect simulated endometrial polyps. Surgical principles of adequate exposure and traction and counter-traction are demonstrated. Conclusion: The robotic endoscope platform may offer advantages over conventional hysteroscopy that could be useful for some applications. These advantages include: improved exposure, finer dissection capability, and use of two handed technique to allow traction and counter-traction. Further study regarding the safe, efficient, and cost-effective use of the robotic endoscope in gynecology is needed. Plenary 4: Hysteroscopy (4:10 PM − 5:10 PM)
S9 towards the treatment of pelvic organ prolapse. This surgical procedure simplifies the laparoscopic sacrohysteropexy procedure by significantly reducing endoscopic suturing and knot tying, without the need for a combined laparoscopic and vaginal surgical approach. Setting: A 69 -year-old G2P2 Caucasian female suffering from stage II pelvic organ prolapse. Her POP-Q was notable for anterior and apical prolapse to the level of the hymen. The laparoscopic cerclage sacrohysteropexy was initiated following a bilateral salpingo-oophorectomy and completed entirely from the laparoscopic approach. Interventions: Laparoscopic cerclage sacrohysteropexy. Conclusion: This case demonstrates that a laparoscopic cerclage sacrohysteropexy is an efficient, simple, and time saving surgical option for women with pelvic organ prolapse.
5:00 PM Post-Ablation Cavity Evaluation: A Prospective, Multicenter, Observational Study to Assess Hysteroscopic Evaluation of the Uterine Cavity in Subjects who have Undergone Water Vapor Endometrial Ablation for the Treatment of Heavy Menstrual Bleeding Basinski CM,1,* Harris M2. 1OB/GYN, Indiana University School of Medicine, Evansville, IN; 2Clinical Research, MomDoc Women’s Health Research, Scottsdale, AZ *Corresponding author.
Plenary 5: Urogynecology (11:00 AM − 12:45 PM) 11:10 AM Rectus Abdominis Pedicled Flap: An Innovative Robotic Approach Haverland R,1,* Yi J,2 Rebecca AM3. 1Mayo Clinic Arizona, Phoenix, AZ; 2 Mayo Clinic, Phoenix; 3Division of Plastic and Reconstructive Surgery, Mayo Clinic Arizona, Phoenix, AZ *Corresponding author.
Study Objective: Determine the ability to perform a diagnostic hysteroscopic exam more than 3 years after a water vapor endometrial ablation procedure. Design: Prospective, observational, multicenter, pooled analysis of the Post-Ablation Cavity Evaluation (PACE) Trial Series. Setting: Office and outpatient centers in the U.S. (7) and Mexico (1). Patients or Participants: 70 women who had undergone water vapor endometrial ablation a mean of 3.9 years earlier as part of the AEGEA Pivotal Clinical Trial (NCT01979861). The mean age of subjects at time of diagnostic hysteroscopy was 44 years. None of the subjects had undergone any gynecologic intervention involving the uterine cavity since their participation in the AEGEA Pivotal Clinical Trial. Interventions: Diagnostic hysteroscopy. Measurements and Main Results: Hysteroscopic examinations were recorded and all analyses were made by an Independent Reviewer blinded to subject history and ablation procedure results.Hysteroscopic access to the uterine cavity was achieved in 90% (63/70) of subjects. One or both cornua and ostia were visualized in 79% (50/63) of subjects with cavity access. Intracavity adhesions were absent in 75% (47/63) with only two findings of severe adhesions (3%, 2/63) of subjects with cavity access. Biopsy was projected to be feasible in 89% (62/70) and IUD placement in 60% (42/70) of all subjects. A selection bias analysis demonstrated comparability of the subjects enrolled in this study to the remaining eligible subjects who completed three-year follow-up in the Pivotal Trial. Conclusion: Water vapor endometrial ablation preserved an accessible and evaluable uterine cavity and visualization of the ostia in the majority of the subjects studied with minimal findings of severe adhesions.
Video Objective: To provide education on the utility of rectus muscle flap during pelvic floor reconstruction and describe in detail a minimally invasive technique to avoid laparotomy. Setting: Patients requiring pelvic floor reconstruction at an academic medical center. Interventions: The rectus abdominis muscle flap can be used as a workhorse flap for pelvic reconstruction, providing a large volume of well vascularized soft tissue that can be used in treatment of complex pelvic floor reconstruction, including genital fistulas, post-radiation pelvic exenteration and abdominoperineal resection defects. Intraperitoneal harvest of the rectus muscle using a robotic approach allows avoidance of laparotomy and subsequent disruption of the anterior rectus sheath, thus preserving the integrity of the abdominal wall. This educational video demonstrates robotic docking as well as surgical techniques in detail to show the feasibility for robotic-assisted rectus flap harvest and pelvic floor reconstruction. Conclusion: Robotic-assisted rectus abdominis flap harvest for pelvic floor reconstruction is a reliable means of defect closure. This novel approach is surgically feasible for the reconstructive surgeon and maintenance of minimally invasive technique allows for significant advantages over the traditional laparotomy approach.
TUESDAY, NOVEMBER 12, 2019 Plenary 5: Urogynecology (11:00 AM − 12:45 PM)
Urethral Diverticulum Excision and Placement of Autologous Fascia Lata Sling Acosta DA,1,* Carrubba AR,2 Pettit PD,2 Chen AH2. 1Minimally Invasive Gynecology Surgery Department, Maimonides Medical Center, Brooklyn, NY; 2Gynecologic Surgery, Mayo Clinic Florida, Jacksonville, FL *Corresponding author.
11:00 AM Total Laparoscopic Cerclage Sacrohysteropexy Rosenblatt PL,1,* Movilla PR,2 Armstrong KL1. 1Mount Auburn Hospital, Cambridge, MA; 2Minimally Invasive Gynecologic Surgery, Newton Wellesley Hospital, Newton, MA *Corresponding author. Video Objective: There has been a growing interest among both patients and surgeons in preserving the uterus during the treatment of pelvic organ prolapse. In this video we are demonstrating a novel surgical approach
Plenary 5: Urogynecology (11:00 AM − 12:45 PM) 11:20 AM
Video Objective: To show the repair of an uncommon urogynecological pathology, and to illustrate a case where an autologous fascial graft is placed for management of stress urinary incontinence. Setting: The patient is a 59-year-old with abdominal pain, urinary incontinence, incomplete bladder emptying, and hematuria. She has a complex past medical and surgical history. Pre-operative urodynamic testing showed genuine stress urinary incontinence, and office cystoscopy was unremarkable. Imaging demonstrated a urethral diverticulum containing
S9 towards the treatment of pelvic organ prolapse. This surgical procedure simplifies the laparoscopic sacrohysteropexy procedure by significantly reducing endoscopic suturing and knot tying, without the need for a combined laparoscopic and vaginal surgical approach. Setting: A 69 -year-old G2P2 Caucasian female suffering from stage II pelvic organ prolapse. Her POP-Q was notable for anterior and apical prolapse to the level of the hymen. The laparoscopic cerclage sacrohysteropexy was initiated following a bilateral salpingo-oophorectomy and completed entirely from the laparoscopic approach. Interventions: Laparoscopic cerclage sacrohysteropexy. Conclusion: This case demonstrates that a laparoscopic cerclage sacrohysteropexy is an efficient, simple, and time saving surgical option for women with pelvic organ prolapse.
5:00 PM Post-Ablation Cavity Evaluation: A Prospective, Multicenter, Observational Study to Assess Hysteroscopic Evaluation of the Uterine Cavity in Subjects who have Undergone Water Vapor Endometrial Ablation for the Treatment of Heavy Menstrual Bleeding Basinski CM,1,* Harris M2. 1OB/GYN, Indiana University School of Medicine, Evansville, IN; 2Clinical Research, MomDoc Women’s Health Research, Scottsdale, AZ *Corresponding author.
Plenary 5: Urogynecology (11:00 AM − 12:45 PM) 11:10 AM Rectus Abdominis Pedicled Flap: An Innovative Robotic Approach Haverland R,1,* Yi J,2 Rebecca AM3. 1Mayo Clinic Arizona, Phoenix, AZ; 2 Mayo Clinic, Phoenix; 3Division of Plastic and Reconstructive Surgery, Mayo Clinic Arizona, Phoenix, AZ *Corresponding author.
Study Objective: Determine the ability to perform a diagnostic hysteroscopic exam more than 3 years after a water vapor endometrial ablation procedure. Design: Prospective, observational, multicenter, pooled analysis of the Post-Ablation Cavity Evaluation (PACE) Trial Series. Setting: Office and outpatient centers in the U.S. (7) and Mexico (1). Patients or Participants: 70 women who had undergone water vapor endometrial ablation a mean of 3.9 years earlier as part of the AEGEA Pivotal Clinical Trial (NCT01979861). The mean age of subjects at time of diagnostic hysteroscopy was 44 years. None of the subjects had undergone any gynecologic intervention involving the uterine cavity since their participation in the AEGEA Pivotal Clinical Trial. Interventions: Diagnostic hysteroscopy. Measurements and Main Results: Hysteroscopic examinations were recorded and all analyses were made by an Independent Reviewer blinded to subject history and ablation procedure results.Hysteroscopic access to the uterine cavity was achieved in 90% (63/70) of subjects. One or both cornua and ostia were visualized in 79% (50/63) of subjects with cavity access. Intracavity adhesions were absent in 75% (47/63) with only two findings of severe adhesions (3%, 2/63) of subjects with cavity access. Biopsy was projected to be feasible in 89% (62/70) and IUD placement in 60% (42/70) of all subjects. A selection bias analysis demonstrated comparability of the subjects enrolled in this study to the remaining eligible subjects who completed three-year follow-up in the Pivotal Trial. Conclusion: Water vapor endometrial ablation preserved an accessible and evaluable uterine cavity and visualization of the ostia in the majority of the subjects studied with minimal findings of severe adhesions.
Video Objective: To provide education on the utility of rectus muscle flap during pelvic floor reconstruction and describe in detail a minimally invasive technique to avoid laparotomy. Setting: Patients requiring pelvic floor reconstruction at an academic medical center. Interventions: The rectus abdominis muscle flap can be used as a workhorse flap for pelvic reconstruction, providing a large volume of well vascularized soft tissue that can be used in treatment of complex pelvic floor reconstruction, including genital fistulas, post-radiation pelvic exenteration and abdominoperineal resection defects. Intraperitoneal harvest of the rectus muscle using a robotic approach allows avoidance of laparotomy and subsequent disruption of the anterior rectus sheath, thus preserving the integrity of the abdominal wall. This educational video demonstrates robotic docking as well as surgical techniques in detail to show the feasibility for robotic-assisted rectus flap harvest and pelvic floor reconstruction. Conclusion: Robotic-assisted rectus abdominis flap harvest for pelvic floor reconstruction is a reliable means of defect closure. This novel approach is surgically feasible for the reconstructive surgeon and maintenance of minimally invasive technique allows for significant advantages over the traditional laparotomy approach.
TUESDAY, NOVEMBER 12, 2019 Plenary 5: Urogynecology (11:00 AM − 12:45 PM)
Urethral Diverticulum Excision and Placement of Autologous Fascia Lata Sling Acosta DA,1,* Carrubba AR,2 Pettit PD,2 Chen AH2. 1Minimally Invasive Gynecology Surgery Department, Maimonides Medical Center, Brooklyn, NY; 2Gynecologic Surgery, Mayo Clinic Florida, Jacksonville, FL *Corresponding author.
11:00 AM Total Laparoscopic Cerclage Sacrohysteropexy Rosenblatt PL,1,* Movilla PR,2 Armstrong KL1. 1Mount Auburn Hospital, Cambridge, MA; 2Minimally Invasive Gynecologic Surgery, Newton Wellesley Hospital, Newton, MA *Corresponding author. Video Objective: There has been a growing interest among both patients and surgeons in preserving the uterus during the treatment of pelvic organ prolapse. In this video we are demonstrating a novel surgical approach
Plenary 5: Urogynecology (11:00 AM − 12:45 PM) 11:20 AM
Video Objective: To show the repair of an uncommon urogynecological pathology, and to illustrate a case where an autologous fascial graft is placed for management of stress urinary incontinence. Setting: The patient is a 59-year-old with abdominal pain, urinary incontinence, incomplete bladder emptying, and hematuria. She has a complex past medical and surgical history. Pre-operative urodynamic testing showed genuine stress urinary incontinence, and office cystoscopy was unremarkable. Imaging demonstrated a urethral diverticulum containing