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Total Laparoscopic Hysterectomy with Uterine Didelphys
Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201 nal cavity at the time of conventional laparoscopy, allowing for tactile feedback while maintaining high definition laparoscopic magnification. Advantages of using HALS include shortened learning curve of laparoscopic surgical procedures and decreased conversion to laparotomy. Additionally, when compared to laparotomy, HALS results in decreased blood loss, morbidity, postoperative pain and narcotic usage, and length of hospital stay. The objectives of this video are to present the surgical setup for HALS and specific techniques including uterine manipulation, organ retraction, ureteral identification, tissue extraction, blunt dissection, and suturing through the HALS port. 241
Video Session 5 – Laparoscopy (3:25 PM - 5:05 PM) 3:32 PM – GROUP A
Laparoscopic Repair of Posterior Cervical Perforation Toubia T,1 Carey E2. 1Obstetrics and Gynecology, Jennie Stuart Medical Center, Hopkinsville, Kentucky; 2Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina Uterine Perforation is a known complication during D&E. The risk of uterine perforation increases with increasing gestational age. Identification of this complication is critical. The location of the perforation could be in the cervical portion or lower uterine segment which could be challenging to repair. We present a case of uterine perforation during D&E of a twin gestation at 20 weeks. The laceration is located in the cervical portion of the uterus and this was repaired laparoscopically. The steps necessary for a safe laparoscopic repair are highlighted including retroperitoneal dissection and clear identification of the ureter and the uterine artery. Some valuable techniques are demonstrated including uterine stitch to provide uterine manipulation and access to the posterior cul-de-sac as well as a backhand stitch during the laparoscopic repair of the laceration. This video shows that laparoscopic repair of a cervical or lower uterine segment perforation is safe and feasible. 242
Video Session 5 – Laparoscopy (3:25 PM - 5:05 PM) 3:39 PM – GROUP A
Laparoscopic Transperitoneal Para-Aortic Lymphadenectomy Tsunoda AT,1 Azevedo BRB,2 Andrade CEMC,3 Linhares JC,1 Ribeiro R1. 1 Gynecologic Oncology, Hospital Erasto Gaertner and Instituto de Oncologia do Paraná, Curitiba, PR, Brazil; 2Surgical Oncology, Instituto de Hematologia e Oncologia de Curitiba, Curitiba, Brazil; 3Barretos Cancer Hospital, Curitiba, Brazil Laparoscopic transperitoneal para-aortic staging lymphadenectomy remains a challenging procedure, currently associated to a long time learning curve. This video demonstrates a feasible and reproducible technique, performed and taught in more than 500 surgical cases. Some principles are included: application of a regular 4 ports placement, 30 degree scope, peritoneal window transparietal suspension stitches, adequate exposure and identification of anatomical landmarks, and taking the aorta as a major vertical reference point. These combined technical key elements may reduce some of the major difficulties faced by the surgeons during this surgical procedure. 243
Video Session 5 – Laparoscopy (3:25 PM - 5:05 PM) 3:46 PM – GROUP A
Laparoscopic Adnexectomy Due to a Giant Adnexal Cyst Ribeiro R,1 Rebolho JC,1 Tsumanuma FK,2 Brandalize GG,2 Tsunoda AT1. 1 Gynecologic Oncology, Hospital Erasto Gaertner and Instituto de Oncologia do Paraná, Curitiba, PR, Brazil; 2Red Cross Hospital, Curitiba, Brazil
S91
A massive adnexal simple cyst without signs of extra gonadal spread was diagnosed in an 18y.o. patient. This video aims to describe the feasibility of a laparoscopic approach without peritoneal spillage or contamination of the abdominal wall. A 3 cm suprapubic incision was performed, and the content of the cyst was evacuated after placing a purse string suture, with abdominal wall protection. A regular laparoscopic pelvic approach was then performed. IP ligament and utero-ovarian ligaments were safely approached, with regular permanent instruments, including a bipolar forceps. The right adnexa was completely removed through the previous incision. This procedure seems to be a feasible and safe option to approach giant simple cystic adnexal masses.
244
Video Session 5 – Laparoscopy (3:25 PM - 5:05 PM) 3:57 PM – GROUP B
Laparoscopic Resection of Multiple Parasitic Fibroids Ajao MO, Einarsson JI. Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Boston, Massachusetts Parasitic fibroids occur when fibroids grow and derive their blood supply separate from the uterus. This is usually secondary to uterine surgery with tissue dissemination. Available data on this rare condition has been limited to small case series and case reports. While the parasitic growths can be asymptomatic, they often present with pain, pressure, urinary frequency and compressive bowel symptoms. When these fibroids are large or symptomatic, surgical resection should be performed. This video demonstrates resection of the multiple parasitic fibroids following minimally invasive hysterectomy.
245
Video Session 5 – Laparoscopy (3:25 PM - 5:05 PM) 4:04 PM – GROUP B
Total Laparoscopic Hysterectomy with Uterine Didelphys Blazek KK, Chohan L. Ob/Gyn, Baylor College of Medicine, Houston, Texas This is a video showing total laparoscopic hysterectomy with uterine didelphys. The patient is a 41yo G4P3013 with a known uterine didelphys who presented with abnormal uterine bleeding, leiomyomas, and dysmenorrhea. She had failed medical treatment and desired surgery. Her hysterectomy was successfully performed laparoscopically. The video discusses pertinent anatomy related to uterine didelphys and helpful surgical tips for performing laparoscopic hysterectomy in a patient with uterine didelphys.
246
Video Session 5 – Laparoscopy (3:25 PM - 5:05 PM) 4:11 PM – GROUP B
Total Laparoscopic Hysterectomy in Patient with Bilateral Kidneys Transplant Al Sawah E, Mikhail E. University of South Florida/Morsani College of Medicine, Tampa, Florida Background: Laparoscopic hysterectomy (LH) is a frequent modality of treatment of abnormal uterine bleeding and uterine fibroid. Attention to anatomy is critical in patients with renal transplant. Case: 41 year-old G4P0, with history of bilateral kidneys transplant, chronic pelvic pain, abnormal uterine bleeding, and large uterine fibroids, that failed medical management and uterine artery embolization. MRI was done for mapping the relationship between the uterus with fibroids and both kidneys present in the pelvis. Total LH, bilateral salpingectomy and cystoscopy were performed.
Video Session 5 – Laparoscopy (3:25 PM - 5:05 PM) 3:32 PM – GROUP A
Laparoscopic Repair of Posterior Cervical Perforation Toubia T,1 Carey E2. 1Obstetrics and Gynecology, Jennie Stuart Medical Center, Hopkinsville, Kentucky; 2Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina Uterine Perforation is a known complication during D&E. The risk of uterine perforation increases with increasing gestational age. Identification of this complication is critical. The location of the perforation could be in the cervical portion or lower uterine segment which could be challenging to repair. We present a case of uterine perforation during D&E of a twin gestation at 20 weeks. The laceration is located in the cervical portion of the uterus and this was repaired laparoscopically. The steps necessary for a safe laparoscopic repair are highlighted including retroperitoneal dissection and clear identification of the ureter and the uterine artery. Some valuable techniques are demonstrated including uterine stitch to provide uterine manipulation and access to the posterior cul-de-sac as well as a backhand stitch during the laparoscopic repair of the laceration. This video shows that laparoscopic repair of a cervical or lower uterine segment perforation is safe and feasible. 242
Video Session 5 – Laparoscopy (3:25 PM - 5:05 PM) 3:39 PM – GROUP A
Laparoscopic Transperitoneal Para-Aortic Lymphadenectomy Tsunoda AT,1 Azevedo BRB,2 Andrade CEMC,3 Linhares JC,1 Ribeiro R1. 1 Gynecologic Oncology, Hospital Erasto Gaertner and Instituto de Oncologia do Paraná, Curitiba, PR, Brazil; 2Surgical Oncology, Instituto de Hematologia e Oncologia de Curitiba, Curitiba, Brazil; 3Barretos Cancer Hospital, Curitiba, Brazil Laparoscopic transperitoneal para-aortic staging lymphadenectomy remains a challenging procedure, currently associated to a long time learning curve. This video demonstrates a feasible and reproducible technique, performed and taught in more than 500 surgical cases. Some principles are included: application of a regular 4 ports placement, 30 degree scope, peritoneal window transparietal suspension stitches, adequate exposure and identification of anatomical landmarks, and taking the aorta as a major vertical reference point. These combined technical key elements may reduce some of the major difficulties faced by the surgeons during this surgical procedure. 243
Video Session 5 – Laparoscopy (3:25 PM - 5:05 PM) 3:46 PM – GROUP A
Laparoscopic Adnexectomy Due to a Giant Adnexal Cyst Ribeiro R,1 Rebolho JC,1 Tsumanuma FK,2 Brandalize GG,2 Tsunoda AT1. 1 Gynecologic Oncology, Hospital Erasto Gaertner and Instituto de Oncologia do Paraná, Curitiba, PR, Brazil; 2Red Cross Hospital, Curitiba, Brazil
S91
A massive adnexal simple cyst without signs of extra gonadal spread was diagnosed in an 18y.o. patient. This video aims to describe the feasibility of a laparoscopic approach without peritoneal spillage or contamination of the abdominal wall. A 3 cm suprapubic incision was performed, and the content of the cyst was evacuated after placing a purse string suture, with abdominal wall protection. A regular laparoscopic pelvic approach was then performed. IP ligament and utero-ovarian ligaments were safely approached, with regular permanent instruments, including a bipolar forceps. The right adnexa was completely removed through the previous incision. This procedure seems to be a feasible and safe option to approach giant simple cystic adnexal masses.
244
Video Session 5 – Laparoscopy (3:25 PM - 5:05 PM) 3:57 PM – GROUP B
Laparoscopic Resection of Multiple Parasitic Fibroids Ajao MO, Einarsson JI. Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Boston, Massachusetts Parasitic fibroids occur when fibroids grow and derive their blood supply separate from the uterus. This is usually secondary to uterine surgery with tissue dissemination. Available data on this rare condition has been limited to small case series and case reports. While the parasitic growths can be asymptomatic, they often present with pain, pressure, urinary frequency and compressive bowel symptoms. When these fibroids are large or symptomatic, surgical resection should be performed. This video demonstrates resection of the multiple parasitic fibroids following minimally invasive hysterectomy.
245
Video Session 5 – Laparoscopy (3:25 PM - 5:05 PM) 4:04 PM – GROUP B
Total Laparoscopic Hysterectomy with Uterine Didelphys Blazek KK, Chohan L. Ob/Gyn, Baylor College of Medicine, Houston, Texas This is a video showing total laparoscopic hysterectomy with uterine didelphys. The patient is a 41yo G4P3013 with a known uterine didelphys who presented with abnormal uterine bleeding, leiomyomas, and dysmenorrhea. She had failed medical treatment and desired surgery. Her hysterectomy was successfully performed laparoscopically. The video discusses pertinent anatomy related to uterine didelphys and helpful surgical tips for performing laparoscopic hysterectomy in a patient with uterine didelphys.
246
Video Session 5 – Laparoscopy (3:25 PM - 5:05 PM) 4:11 PM – GROUP B
Total Laparoscopic Hysterectomy in Patient with Bilateral Kidneys Transplant Al Sawah E, Mikhail E. University of South Florida/Morsani College of Medicine, Tampa, Florida Background: Laparoscopic hysterectomy (LH) is a frequent modality of treatment of abnormal uterine bleeding and uterine fibroid. Attention to anatomy is critical in patients with renal transplant. Case: 41 year-old G4P0, with history of bilateral kidneys transplant, chronic pelvic pain, abnormal uterine bleeding, and large uterine fibroids, that failed medical management and uterine artery embolization. MRI was done for mapping the relationship between the uterus with fibroids and both kidneys present in the pelvis. Total LH, bilateral salpingectomy and cystoscopy were performed.