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Total laparoscopic hysterectomy in a rural Ontario hospital
August 2002, Vol. 9, No. 3 Supplement TheJournal of the American Association of Gynecologic Laparoscopists
153. Total Laparoscopic Hysterectomy in a Rural Ontario Hospital ~DM Rosenthal, ~RJSimms, 2j Hawkins. ~Department of Obstetrics and Gynecology, North York General Hospital, Toronto, Canada; 2Stevenson Memorial
vaginal wall prolapse, although SIS results in the restoration of functional tissue sooner than porcine dermis.
155. A Retroperitoneal Approach to Deep Infiltrating Endometriosis
Hospital, Alliston, Canada.
A Rossetti, O Sizzi. Department of Obstetrics and Gynecology, Columbus Hospital of Rome, Rome, Italy.
Objective. To report experience with TLH in a rural Ontario hospital. Measurements and Main Results. A retrospective chart review was carried out of all 41 TLHs performed at our institution by a team headed by a visiting endoscopic surgeon. Additional procedures included unilateral or bilateral salpingo-oophorectomy (13) and Burch urethropexy (2). Mean operating time was 118 minutes (range 70-145 min) and mean hospital stay was 2.3 days (range 1 4 days). There were no intraoperative complications; no patient required laparotomy or blood transfusion. One postoperative complication; vaginal vault cellulitis, was treated with intravenous antibiotics. Conclusion. With proper instruments, surgical training, and patient selection, TLH is a safe, effective procedure, and applicable to a rural hospital.
Objective. To describe a retroperitoneal approach to managing deep infiltrating endometriosis. Measurements and Main Results. Thirty-eight women with endometriotic lesions of the pouch of Douglas or broad ligament and no evidence of other potential cause of pain on physical examination, laparoscopy, or tra_nsvaginal ultrasonography underwent total excision of the lesions by retroperitoneal approach. Complete ureterolysis was often required. Lateral pelvic peritoneum was incised starting from a healthy area; the more extensive retroperitoneal lesions are, the closer the incision must be to the pelvic brim. The ureter was progressively freed under visual control. Endometriotic lesions, including those with important lateral extension, were completely excised, leaving the ureter in total safety. In cases with deep endometriosis infiltrating the rectovaginal septum with partiaJly or totally obliterated pouch of Douglas in midline and the rectum adhering to the internal surface of uterosacral ligaments, the laparoscopic part of surgery started with dissection of the two pararectal spaces. Peritoneum was opened from the internal edge of the uterosacral ligament to the external lateral edge of the rectum. Lateral dissection made it easier to identify the median plane between the rectum and the nodule. Average operating time was 135 minutes and intraoperative blood loss was minimal. Average postoperative hospital stay was 2.9 days. No major intraoperative complications occurred. One woman was readmitted with symptoms of subocclusion but did not require reintervention. Thirty-two patients (84.2%) were free of symptoms at follow-up (range 6-24 too). Five patients had only partial relief but did not require additional surgery. One woman had relapse of dyspareunia and dysmenorrhea after 12 months and was scheduled for second-look laparoscopy. Conclusion. Laparoscopic surgery for deep infiltrating endometriosis is effective treatment and offers significant symptom relief. A retroperitoneal approach starting in a region free of pathology makes it easier
154. Replacement of Endopelvic Fascia with Different Xenogeneic Grafts in Posterior Vaginal Wall Prolapse 1j Ross, 2MR Preston. 1Salinas, California; 2St. Lukes Roosevelt Hospital, New York, New York.
Objective. To evaluate the efficacy of two xenogeneic grafts for endopelvic fascia (EPF) replacement in posterior vaginal wall prolapse. Measurements and Main Results. Porcine dermis and small intestine submucosa (SIS) were used in 18 and 13 patients, respectively, to replace posterior vaginal EPF in stage I or greater (POP-Q) defects. Multiple intraoperative and postoperative parameters were monitored including ease of use and tissue attachment, wall support, restoration of organ function, and tissue biocompatibility. There were no operative or postoperative complications in either group. On a Likert scale grading system, both dermis and SIS were easy to use and to attach to tissue, and formed strong wall support. SIS had slightly higher quality of life scores. At 3 to 6 months, SIS had statistically significant better biocompatibility scores than dermis, with softer and more pliable tissue at the implant site. Conclusion. Porcine dermis and SIS are effective short-term EPF replacement materials in posterior
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153. Total Laparoscopic Hysterectomy in a Rural Ontario Hospital ~DM Rosenthal, ~RJSimms, 2j Hawkins. ~Department of Obstetrics and Gynecology, North York General Hospital, Toronto, Canada; 2Stevenson Memorial
vaginal wall prolapse, although SIS results in the restoration of functional tissue sooner than porcine dermis.
155. A Retroperitoneal Approach to Deep Infiltrating Endometriosis
Hospital, Alliston, Canada.
A Rossetti, O Sizzi. Department of Obstetrics and Gynecology, Columbus Hospital of Rome, Rome, Italy.
Objective. To report experience with TLH in a rural Ontario hospital. Measurements and Main Results. A retrospective chart review was carried out of all 41 TLHs performed at our institution by a team headed by a visiting endoscopic surgeon. Additional procedures included unilateral or bilateral salpingo-oophorectomy (13) and Burch urethropexy (2). Mean operating time was 118 minutes (range 70-145 min) and mean hospital stay was 2.3 days (range 1 4 days). There were no intraoperative complications; no patient required laparotomy or blood transfusion. One postoperative complication; vaginal vault cellulitis, was treated with intravenous antibiotics. Conclusion. With proper instruments, surgical training, and patient selection, TLH is a safe, effective procedure, and applicable to a rural hospital.
Objective. To describe a retroperitoneal approach to managing deep infiltrating endometriosis. Measurements and Main Results. Thirty-eight women with endometriotic lesions of the pouch of Douglas or broad ligament and no evidence of other potential cause of pain on physical examination, laparoscopy, or tra_nsvaginal ultrasonography underwent total excision of the lesions by retroperitoneal approach. Complete ureterolysis was often required. Lateral pelvic peritoneum was incised starting from a healthy area; the more extensive retroperitoneal lesions are, the closer the incision must be to the pelvic brim. The ureter was progressively freed under visual control. Endometriotic lesions, including those with important lateral extension, were completely excised, leaving the ureter in total safety. In cases with deep endometriosis infiltrating the rectovaginal septum with partiaJly or totally obliterated pouch of Douglas in midline and the rectum adhering to the internal surface of uterosacral ligaments, the laparoscopic part of surgery started with dissection of the two pararectal spaces. Peritoneum was opened from the internal edge of the uterosacral ligament to the external lateral edge of the rectum. Lateral dissection made it easier to identify the median plane between the rectum and the nodule. Average operating time was 135 minutes and intraoperative blood loss was minimal. Average postoperative hospital stay was 2.9 days. No major intraoperative complications occurred. One woman was readmitted with symptoms of subocclusion but did not require reintervention. Thirty-two patients (84.2%) were free of symptoms at follow-up (range 6-24 too). Five patients had only partial relief but did not require additional surgery. One woman had relapse of dyspareunia and dysmenorrhea after 12 months and was scheduled for second-look laparoscopy. Conclusion. Laparoscopic surgery for deep infiltrating endometriosis is effective treatment and offers significant symptom relief. A retroperitoneal approach starting in a region free of pathology makes it easier
154. Replacement of Endopelvic Fascia with Different Xenogeneic Grafts in Posterior Vaginal Wall Prolapse 1j Ross, 2MR Preston. 1Salinas, California; 2St. Lukes Roosevelt Hospital, New York, New York.
Objective. To evaluate the efficacy of two xenogeneic grafts for endopelvic fascia (EPF) replacement in posterior vaginal wall prolapse. Measurements and Main Results. Porcine dermis and small intestine submucosa (SIS) were used in 18 and 13 patients, respectively, to replace posterior vaginal EPF in stage I or greater (POP-Q) defects. Multiple intraoperative and postoperative parameters were monitored including ease of use and tissue attachment, wall support, restoration of organ function, and tissue biocompatibility. There were no operative or postoperative complications in either group. On a Likert scale grading system, both dermis and SIS were easy to use and to attach to tissue, and formed strong wall support. SIS had slightly higher quality of life scores. At 3 to 6 months, SIS had statistically significant better biocompatibility scores than dermis, with softer and more pliable tissue at the implant site. Conclusion. Porcine dermis and SIS are effective short-term EPF replacement materials in posterior
$47