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Total Laparoscopic Hysterectomy for Uteri Over 1Kg
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253 503
506
Total Laparoscopic Hysterectomy for Uteri Over 1Kg Fukuda M, Andou M. Kurashiki Medical Center, Kurashiki, Okayama, Japan
Uterine Suspension: A New Laparoscopic Technique Di Donato N, Costantino C, Montanari G, Facchini C, Zanello M, Seracchioli R. Minimally Invasive Gynaecological Surgery Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
Laparoscopic surgery is a frequently performed surgical technique in a gynecological field. Total Laparoscopic Hysterectomy (TLH) for large uteri is a difficult procedure technically. In this study, We report our experience with large uteri and present a case of TLH performed on a uterus weighting 3550g. From 2012 to 2013, We performed TLH procedures for 962 cases, TLH in case of uteri weighing over one kilogram was 60 cases. The median uteri weight was 1050g (1000-4545g) The median operative time and blood loss were 119 minutes(62-315 minutes) and 334ml (10-1380ml). The convention to abdominal hysterectomy was only one case (1.7%). The experience and specialized techniques are necessary to performe TLH for large uteri safely and fast.
504 Laparoscopic Repair of Uterine Scar Dehiscence After Cesarean Section Ding J, Hua K, Zhang X. The Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China This 32-year-old female was admitted for ‘‘Postmenstrual abnormal uterine bleeding after cesarean section for 3 years.’’ She had a prolonged period for more than 14 days every month. MRI showed the presence of a reservoirlike pouch on the anterior wall of the uterine isthmus at the site of a previous cesarean delivery scar. And she underwent laparoscopic repair of uterine scar dehiscence. Firstly the bladder is mobilized inferiorly over the cervix. Then hysteroscopy was done, and an antetior pseudocavity was found at the scar. The scar is excised laparoscopically. A mattress suture following running suture using delay absorbable material closed the scar. After surgery, the period of the patient shortened to 7 days, and MRI showed that the pouch on the anterior wall of the uterine isthmus was disappeared. Conclusion: Laparoscopic surgical repair of the defect is feasible and effective.
505 Laparoscopic Hysterectomy (LH): An Easy Technique to Decrease Bleeding With Titanium Clips on the Uterine Arteries Leal C,1 Rubio V,1 Unda ME.2 1Obstetrics and Gynecology; Division Gynecology Oncology, Hospital Christus Muguerza Del Parque, Chihuahua, Mexico; 2Obstetrics and Gynecology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, DF, Mexico Hysterectomy is one of the most commonly performed surgical procedures in the U.S., with almost 600,000 cases each year. Laparoscopic hysterectomy (LH), defined as the laparoscopic ligation of the major vessels supplying the uterus by electrosurgical dissection, suture ligature, or staples was first performed in 1988. Today, LH is a safe and feasible technique to manage benign uterine pathology as it offers minimal postoperative discomfort, shorter hospital stay, rapid recovery, and early return to the activities of the daily living. On concern are the complications which can be divided into minor complications and major. The main major complication is bleeding, which can be presented in 0.07% of the cases with no hematologic problems. The intention on this video is to present an easy technique to decrease the chances for bleeding in a special situation like a patient with a history of thrombosis since the age of 15 years; since then she is on anticoagulation therapy. The technique occlude the blood supply to the uterus.
S147
A new technique to reduce pelvic pain in patients with uterine retroversion. 507 Laparoscopic Management of a Ruptured Interstitial Pregnancy Associated With Massive Haemoperitoneum and History of Ipsilateral Salpingectomy Minas V, Ashraf K. Obstetrics & Gynaecology, Wirral University Teaching Hospital, Upton, Wirral, United Kingdom The present video describes the laparoscopic management of a ruptured interstitial pregnancy in a patient with history of ipsilateral salpingectomy in a community hospital. Our patient presented with low abdominal pain at 6 weeks gestation. She had a previous right laparoscopic salpingectomy for a tubal pregnancy. Her beta-hCG was 6334 mIU/ml and haemoglobin 9.6 g/dL. At laparoscopy massive haemoperitoneum and a ruptured right interstitial pregnancy were seen. The pregnancy tissue was removed and the uterine wound repaired with intracorporeal suturing. Post-operative recovery was uneventful. Interstitial pregnancy accounts for 2-4 % of all tubal gestations. Mortality rates are reported between 2–2.5%. The commonest risk factor is history of ipsilateral salpingectomy. Traditional treatment, particularly in cases of haemodynamically unstable patients, has been by laparotomy. The current case and our literature review suggest that such cases can be managed successfully by laparoscopy and either cornual resection and suturing or suturing alone. 508 Profuse Vaginal Discharge May Equally Suggest Adenoma Malignum and Lobular Endocervical Glandular Hyperplasia (LEGH), But Same Cover, Different Story Moon H, Kim S, Park G, Koo J. Center for Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Good Moonhwa Hospital, Busan, Korea Adenoma malignum is an extremely well-differentiated mucinous adenocarcinoma. LEGH is a benign lesion characterized by non-invasive proliferation of endocervical glandular cells. Both adenoma malignum and LEGH present profuse watery vaginal discharge. TVUS and MRI findings show multicystic lesion which are identical in the two diseases. Pap smear is usually normal and conization is the diagnostic method of choice, however it is not an appropriate method in case of deep and highly located lesion. Treatment of adenoma malignum is radical hysterectomy with pelvic lymph node dissection, but in case of LEGH simple hysterectomy is adequate. Due to such apparent difference, an accurate preoperative differential diagnosis is necessary. We present a case of a 42-year-old woman who complained of profuse watery vaginal discharge for 3 years. We performed excisional biopsy with frozen section for differential diagnosis during laparoscopic operation, and after confirming LEGH on frozen section we proceeded with simple hysterectomy. 509 Laparoscopic Approach for Myomas in Complex and Unusual Sites John BM, Mathew S. Minimally Invasive Gynecology, Credence Hospital, Trivandrum, Kerala, India Myomas at unusual and precarious sites increase the risk of surgical complications due their proximity to organs such as the bladder, ureter, rectum, etc and cause greater surgical technical difficulties due to poor access to the operative field, difficulty in suturing, increased blood loss, and
506
Total Laparoscopic Hysterectomy for Uteri Over 1Kg Fukuda M, Andou M. Kurashiki Medical Center, Kurashiki, Okayama, Japan
Uterine Suspension: A New Laparoscopic Technique Di Donato N, Costantino C, Montanari G, Facchini C, Zanello M, Seracchioli R. Minimally Invasive Gynaecological Surgery Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
Laparoscopic surgery is a frequently performed surgical technique in a gynecological field. Total Laparoscopic Hysterectomy (TLH) for large uteri is a difficult procedure technically. In this study, We report our experience with large uteri and present a case of TLH performed on a uterus weighting 3550g. From 2012 to 2013, We performed TLH procedures for 962 cases, TLH in case of uteri weighing over one kilogram was 60 cases. The median uteri weight was 1050g (1000-4545g) The median operative time and blood loss were 119 minutes(62-315 minutes) and 334ml (10-1380ml). The convention to abdominal hysterectomy was only one case (1.7%). The experience and specialized techniques are necessary to performe TLH for large uteri safely and fast.
504 Laparoscopic Repair of Uterine Scar Dehiscence After Cesarean Section Ding J, Hua K, Zhang X. The Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China This 32-year-old female was admitted for ‘‘Postmenstrual abnormal uterine bleeding after cesarean section for 3 years.’’ She had a prolonged period for more than 14 days every month. MRI showed the presence of a reservoirlike pouch on the anterior wall of the uterine isthmus at the site of a previous cesarean delivery scar. And she underwent laparoscopic repair of uterine scar dehiscence. Firstly the bladder is mobilized inferiorly over the cervix. Then hysteroscopy was done, and an antetior pseudocavity was found at the scar. The scar is excised laparoscopically. A mattress suture following running suture using delay absorbable material closed the scar. After surgery, the period of the patient shortened to 7 days, and MRI showed that the pouch on the anterior wall of the uterine isthmus was disappeared. Conclusion: Laparoscopic surgical repair of the defect is feasible and effective.
505 Laparoscopic Hysterectomy (LH): An Easy Technique to Decrease Bleeding With Titanium Clips on the Uterine Arteries Leal C,1 Rubio V,1 Unda ME.2 1Obstetrics and Gynecology; Division Gynecology Oncology, Hospital Christus Muguerza Del Parque, Chihuahua, Mexico; 2Obstetrics and Gynecology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, DF, Mexico Hysterectomy is one of the most commonly performed surgical procedures in the U.S., with almost 600,000 cases each year. Laparoscopic hysterectomy (LH), defined as the laparoscopic ligation of the major vessels supplying the uterus by electrosurgical dissection, suture ligature, or staples was first performed in 1988. Today, LH is a safe and feasible technique to manage benign uterine pathology as it offers minimal postoperative discomfort, shorter hospital stay, rapid recovery, and early return to the activities of the daily living. On concern are the complications which can be divided into minor complications and major. The main major complication is bleeding, which can be presented in 0.07% of the cases with no hematologic problems. The intention on this video is to present an easy technique to decrease the chances for bleeding in a special situation like a patient with a history of thrombosis since the age of 15 years; since then she is on anticoagulation therapy. The technique occlude the blood supply to the uterus.
S147
A new technique to reduce pelvic pain in patients with uterine retroversion. 507 Laparoscopic Management of a Ruptured Interstitial Pregnancy Associated With Massive Haemoperitoneum and History of Ipsilateral Salpingectomy Minas V, Ashraf K. Obstetrics & Gynaecology, Wirral University Teaching Hospital, Upton, Wirral, United Kingdom The present video describes the laparoscopic management of a ruptured interstitial pregnancy in a patient with history of ipsilateral salpingectomy in a community hospital. Our patient presented with low abdominal pain at 6 weeks gestation. She had a previous right laparoscopic salpingectomy for a tubal pregnancy. Her beta-hCG was 6334 mIU/ml and haemoglobin 9.6 g/dL. At laparoscopy massive haemoperitoneum and a ruptured right interstitial pregnancy were seen. The pregnancy tissue was removed and the uterine wound repaired with intracorporeal suturing. Post-operative recovery was uneventful. Interstitial pregnancy accounts for 2-4 % of all tubal gestations. Mortality rates are reported between 2–2.5%. The commonest risk factor is history of ipsilateral salpingectomy. Traditional treatment, particularly in cases of haemodynamically unstable patients, has been by laparotomy. The current case and our literature review suggest that such cases can be managed successfully by laparoscopy and either cornual resection and suturing or suturing alone. 508 Profuse Vaginal Discharge May Equally Suggest Adenoma Malignum and Lobular Endocervical Glandular Hyperplasia (LEGH), But Same Cover, Different Story Moon H, Kim S, Park G, Koo J. Center for Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Good Moonhwa Hospital, Busan, Korea Adenoma malignum is an extremely well-differentiated mucinous adenocarcinoma. LEGH is a benign lesion characterized by non-invasive proliferation of endocervical glandular cells. Both adenoma malignum and LEGH present profuse watery vaginal discharge. TVUS and MRI findings show multicystic lesion which are identical in the two diseases. Pap smear is usually normal and conization is the diagnostic method of choice, however it is not an appropriate method in case of deep and highly located lesion. Treatment of adenoma malignum is radical hysterectomy with pelvic lymph node dissection, but in case of LEGH simple hysterectomy is adequate. Due to such apparent difference, an accurate preoperative differential diagnosis is necessary. We present a case of a 42-year-old woman who complained of profuse watery vaginal discharge for 3 years. We performed excisional biopsy with frozen section for differential diagnosis during laparoscopic operation, and after confirming LEGH on frozen section we proceeded with simple hysterectomy. 509 Laparoscopic Approach for Myomas in Complex and Unusual Sites John BM, Mathew S. Minimally Invasive Gynecology, Credence Hospital, Trivandrum, Kerala, India Myomas at unusual and precarious sites increase the risk of surgical complications due their proximity to organs such as the bladder, ureter, rectum, etc and cause greater surgical technical difficulties due to poor access to the operative field, difficulty in suturing, increased blood loss, and