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Ultrasound in the Diagnosis of Endometriosis
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253 pain and rectal tenesmus. She had infertility over the 3 years. Laparoscopic exploration showed a obliteration of douglas, right ovarian endometrioma, sigmoid colon nodularity which is causing partial occlusion of passage. Anatomical landmarks must be identified before suchoperations. Bilateraly ureter must be seen and protected due to complex anatomic structure, sacrouterin ligaments and rectovaginal fascia have to identified. Endometriosis is very destructive benign disease. In this case it affects sigmoid bowel-rectum and bladder. Our approach includes bladder shaving, ovarian stripping, sigmoid colon nodule excision resection and segmental resection of colon.
460 Ultrasound in the Diagnosis of Endometriosis Agarwal S,1 Della Zazzera V,1 Fraser MA,2 Singh S.1 1Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada; 2Department of Medical lmaging, The Ottawa Hospital, Ottawa, Ontario, Canada Ultrasound is the first line of investigative modality in the diagnosis of endometriosis. However, routine gynecological ultrasound may not be enough in the diagnosis as it usually focusses on the ovarian endometriosis, missing other forms of endometriosis. With this video we propose different levels of ultrasound based on clinical indication to improve the diagnostic outcome as well as help in preoperative planning. 461 Laparoscopic Management of Juvenile Cystic Adenomyoma Pabuccu EG,1 Seval M,2 Sonmezer M,2 Atabekoglu C.2 1 Obstetrics and Gynecology, Ufuk University School of Medicine, Ankara, Turkey; 2Ankara University School of Medicine, Ankara, Turkey Adenomyomas are uncommon pathologies composed of endometriotic glands mostly containing hemorrhagic material. Different management options are available according to age and anatomical localization of the cystic mass. A 20-year-old girl was presented with severe dysmenore that ongoing for 6 months. Laparoscopic excision was decided following confirmation of adenomyotic cyst localized on right anterior wall just below the cornual end. Transverse incission was performed and cystic lesion was reached. Endometriotic cyst wall was then delineated from the myometrial tissue using hydro- and sharp dissections. Finally, cyst wall was completely enucleated. The myometrial defect was repaired with absorbable suture material. Post-operative period was uneventful. Laparoscopic removal of adenomyotic cyst is a feasible option for adolescants. This technique not only provides better and faster recovery, but also minimizes the adhesion formation risk that might contribute to tubal factor infertility. 462
Video Posters – Hysteroscopy, Endometrial Ablation and Sterilization
Intraoperative Evaluation of Squamous Intraepithelial Lesions by Microcolpohysteroscopy Montevecchi L. Private Office, Roma, Italy Microcolpohysteroscopy is an endoscopic technique, developed in 1980 by Jacques Hamou, that allows the observation of the cervical epithelium ‘‘in vivo’’ at 150 magnifications. The aim of this short video is to show the use of the Hamou’s Microcolpohysteroscope to evaluate intraoperatively – immediately before the excisional prodedure – the size and the location of the Squamous Intraepithelial Lesion (SIL), in order to assess the precise boundaries and obtain a minimal invasive removal of the entire pathology. By measuring the endocervical extension of the lesion microcolpohysteroscopy allows surgical tailored cones, thus improving the outcome of the treatment of the Cervical Intraepithelial Neoplasia
S141
(CIN), using a real mininvasive technique, and avoiding under and overtreatments. 463 Management of False Passage in the Cervical Canal During Operative Hysteroscopy Abuzeid OM, Raju R, Hebert J, Ashraf M, Abuzeid MI. Ob/Gyn, Hurley Medical Center, Flint, Michigan False passage is a rare complication during diagnostic and operative hysteroscopy. It is more common to occur when the uterus is in a retroverted or acutely anti-flexed, anteverted position. This complication can lead to a misdiagnosis of intrauterine scar tissue, cancellation of the procedure, high fluid deficit of the distension media and possible uterine perforation. The aim of this video presentation is two-folds, the first is to increase awareness of this possible complication among gynecologists; the second is to illustrate a simple technique to overcome this situation and enable the gynecologists to complete the planned hysteroscopy.
464 Hysteroscopic Resection of Large Endometrial Polyp Secondary to Tamoxifen Therapy for Breast Cancer Oraif A,1 Vilos G,2 Vilos A,2 Abduljabar H,2 Abu-Rafea B.2 1Obstetrics and Gynecology, Faculty of Medicine, King AbdulAziz University, Jeddah, Western Region, Saudi Arabia; 2The Fertility Clinic, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Western University, London, Ontario, Canada A 49-year-old woman presented with abnormal uterine bleeding. She was on tamoxifen therapy for 4 years for breast cancer. A sonohysterogram was performed and a large 4X3 cm polyp was identified. an endometrial biopsy was done which showed proliferative endometrium. The patient was offered hysteroscopic endometrial resection as treatment for the polyp. Conclusion: hysteroscopic resection of endometrial polyps secondary to tamoxifen therapy is feasible and an effective treatment for patients presenting with abnormal uterine bleeding.
465 Hysteroscopic Excision of Cesarean Scar Ectopic Hendessi P, Bell S, Vilkins A, Holalkere N, Liu Z. Boston Medical Center, Boston, Massachusetts Two cases of cesarean scar ectopic pregnancy are presented. Hysteroscopic excision for each case is demonstrated.
466 Transcervical Hysteroscopic Resection of Complete Uterus Septum Xue X, Gong P. The Department of Gynaecology and Obstetrics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China Uterine septum is a type of congenital uterine malformations, which results from incomplete resorption of the paramesonephric muellerian ducts. Uterine septum is associated with recurrent pregnancy loss, preterm labor, abnormal fetal presentation and infertility. This patient suffered from infertility for 3 years. This video shows the resection of complete longitudinal vaginal septum and the resection of the septum in uterine cavity. There are a variety of surgical techniques for hysteroscopic operation. For example, when the septum in uterine cavity is excised, a probe can be inserted into the other side of the uterine cavity as an indicator.
460 Ultrasound in the Diagnosis of Endometriosis Agarwal S,1 Della Zazzera V,1 Fraser MA,2 Singh S.1 1Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada; 2Department of Medical lmaging, The Ottawa Hospital, Ottawa, Ontario, Canada Ultrasound is the first line of investigative modality in the diagnosis of endometriosis. However, routine gynecological ultrasound may not be enough in the diagnosis as it usually focusses on the ovarian endometriosis, missing other forms of endometriosis. With this video we propose different levels of ultrasound based on clinical indication to improve the diagnostic outcome as well as help in preoperative planning. 461 Laparoscopic Management of Juvenile Cystic Adenomyoma Pabuccu EG,1 Seval M,2 Sonmezer M,2 Atabekoglu C.2 1 Obstetrics and Gynecology, Ufuk University School of Medicine, Ankara, Turkey; 2Ankara University School of Medicine, Ankara, Turkey Adenomyomas are uncommon pathologies composed of endometriotic glands mostly containing hemorrhagic material. Different management options are available according to age and anatomical localization of the cystic mass. A 20-year-old girl was presented with severe dysmenore that ongoing for 6 months. Laparoscopic excision was decided following confirmation of adenomyotic cyst localized on right anterior wall just below the cornual end. Transverse incission was performed and cystic lesion was reached. Endometriotic cyst wall was then delineated from the myometrial tissue using hydro- and sharp dissections. Finally, cyst wall was completely enucleated. The myometrial defect was repaired with absorbable suture material. Post-operative period was uneventful. Laparoscopic removal of adenomyotic cyst is a feasible option for adolescants. This technique not only provides better and faster recovery, but also minimizes the adhesion formation risk that might contribute to tubal factor infertility. 462
Video Posters – Hysteroscopy, Endometrial Ablation and Sterilization
Intraoperative Evaluation of Squamous Intraepithelial Lesions by Microcolpohysteroscopy Montevecchi L. Private Office, Roma, Italy Microcolpohysteroscopy is an endoscopic technique, developed in 1980 by Jacques Hamou, that allows the observation of the cervical epithelium ‘‘in vivo’’ at 150 magnifications. The aim of this short video is to show the use of the Hamou’s Microcolpohysteroscope to evaluate intraoperatively – immediately before the excisional prodedure – the size and the location of the Squamous Intraepithelial Lesion (SIL), in order to assess the precise boundaries and obtain a minimal invasive removal of the entire pathology. By measuring the endocervical extension of the lesion microcolpohysteroscopy allows surgical tailored cones, thus improving the outcome of the treatment of the Cervical Intraepithelial Neoplasia
S141
(CIN), using a real mininvasive technique, and avoiding under and overtreatments. 463 Management of False Passage in the Cervical Canal During Operative Hysteroscopy Abuzeid OM, Raju R, Hebert J, Ashraf M, Abuzeid MI. Ob/Gyn, Hurley Medical Center, Flint, Michigan False passage is a rare complication during diagnostic and operative hysteroscopy. It is more common to occur when the uterus is in a retroverted or acutely anti-flexed, anteverted position. This complication can lead to a misdiagnosis of intrauterine scar tissue, cancellation of the procedure, high fluid deficit of the distension media and possible uterine perforation. The aim of this video presentation is two-folds, the first is to increase awareness of this possible complication among gynecologists; the second is to illustrate a simple technique to overcome this situation and enable the gynecologists to complete the planned hysteroscopy.
464 Hysteroscopic Resection of Large Endometrial Polyp Secondary to Tamoxifen Therapy for Breast Cancer Oraif A,1 Vilos G,2 Vilos A,2 Abduljabar H,2 Abu-Rafea B.2 1Obstetrics and Gynecology, Faculty of Medicine, King AbdulAziz University, Jeddah, Western Region, Saudi Arabia; 2The Fertility Clinic, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Western University, London, Ontario, Canada A 49-year-old woman presented with abnormal uterine bleeding. She was on tamoxifen therapy for 4 years for breast cancer. A sonohysterogram was performed and a large 4X3 cm polyp was identified. an endometrial biopsy was done which showed proliferative endometrium. The patient was offered hysteroscopic endometrial resection as treatment for the polyp. Conclusion: hysteroscopic resection of endometrial polyps secondary to tamoxifen therapy is feasible and an effective treatment for patients presenting with abnormal uterine bleeding.
465 Hysteroscopic Excision of Cesarean Scar Ectopic Hendessi P, Bell S, Vilkins A, Holalkere N, Liu Z. Boston Medical Center, Boston, Massachusetts Two cases of cesarean scar ectopic pregnancy are presented. Hysteroscopic excision for each case is demonstrated.
466 Transcervical Hysteroscopic Resection of Complete Uterus Septum Xue X, Gong P. The Department of Gynaecology and Obstetrics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China Uterine septum is a type of congenital uterine malformations, which results from incomplete resorption of the paramesonephric muellerian ducts. Uterine septum is associated with recurrent pregnancy loss, preterm labor, abnormal fetal presentation and infertility. This patient suffered from infertility for 3 years. This video shows the resection of complete longitudinal vaginal septum and the resection of the septum in uterine cavity. There are a variety of surgical techniques for hysteroscopic operation. For example, when the septum in uterine cavity is excised, a probe can be inserted into the other side of the uterine cavity as an indicator.