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Ureterolysis at the Time of Total Laparoscopic Hysterectomy: Safe and Effective Technique
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Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S1–S44
Patients included in group B had more pain and intestinal symptoms than those in group A; quality of life and sexual function were worse. Conclusion: Bowel endometriosis untreated during laparoscopy is associated with lower spontaneous pregnancy rates after surgery but it does not influence the pregnancy rate after in vitro fertilization. Untreated bowel endometriosis is associated with worse symptoms and quality of life after surgery. 49
Open Communications 2 - Endometriosis (12:59 PM - 1:04 PM)
Ureterolysis at the Time of Total Laparoscopic Hysterectomy: Safe and Effective Technique Ramirez ER,1 Ghozland D,2 Ehrenburg M,3 Mallare L.4 1OBGYN, Community Memorial Hospital, Oxnard, California; 2OBGYN, St. Johns Santa Monica, Santa Monica, California; 3OBGYN, Community Memorial Hospital, Ventura, California; 4OBGYN, Ventura County Medical Center, Ventura, California Study Objective: To determine whether ureterolysis during total laparoscopic hysterectomy decreases the overall incidence of ureteral injury. Design: All patients underwent total laparoscopic hysterectomy with ureterolysis for benign and complex disease from September 1, 2011 to September 30, 2013. Setting: Community Hospital. Patients: Total laparoscopic hysterectomy with ureterolysis was performed in 126 consecutive cases. Intervention: A posterior parametrial approach was used to easily identify the surgical landmarks of the pararectal space. Blunt dissection is performed until the desired distal ureter is identified. Intraoperative cystoscopy with indigo carmine was performed to evaluate for the presence or absence of extravasation or ureteral injury. Measurements and Main Results: One cystotomy and one rectotomy was discovered intraoperatively and repaired during surgery. There were no ureteral injuries and all patients with the exception of the rectotomy were discharged home on postoperative day 1. Conclusion: Ureteral dissection can be safely performed using a posterior parametrial approach and should be routine in all high risk cases. 50
Open Communications 3 - Laparoscopy (12:05 PM - 12:10 PM)
Risk of Leakage and Tissue Dissemination with Various in Bag Morcellation (IBM) Techniques: In Vitro Pilot Study Greenberg JA,1 Cohen SL,2 Wang KC,2 Gargiulo AR,3 Srouji S,3 Pozner C,4 Cibas ES,5 Hoover N,5 Einarsson JI.2 1Gynecology, Brigham & Women’s Faulkner Hospital, Jamaica Plain, Massachusetts; 2Minimally Invasive Gynecologic Surgery, Brigham & Women’s Hospital, Boston, Massachusetts; 3Reproductive Endocrinology and Infertility, Brigham & Women’s Hospital, Boston, Massachusetts; 4STRATUS Center for Medical Simulation, Brigham & Women’s Hospital, Boston, Massachusetts; 5 Division of Cytology, Brigham & Women’s Hospital, Boston, Massachusetts Study Objective: To evaluate risk of leakage and tissue dissemination with various in bag morcellation (IBM) techniques. Design: In vitro study. Setting: Hospital simulation lab. Intervention: Beef tongue specimens weighing 400-500 grams were stained with 5 cc of indigo carmine dye and morcellated with varying techniques under laparoscopic guidance within a plastic box trainer. In bag morcellation was performed employing three separate techniques: 1) stitched-sealed rip-stop nylon (TRS200, Anchor Surgical) bag and multiport approach, 2) 50x50cm isolation (Lahey) bag (Becton-Dickinson) and multi-port approach or 3) 50x50cm isolation bag and single-site approach. All bags were insufflated to within 15-25 mmHg pressure with a standard CO2 insufflator. Open tissue morcellation was performed as a control.
Visual evidence of spilled tissue or dye was recorded, and fluid washings of the box trainer were sent for cytologic analysis. Measurements and Main Results: Four trials of each contained morcellation method were performed and compared to the open morcellation control. Blue dye spill was noted in only one of the 12 contained morcellation trials wherein spillage was visualized from a seam
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S1–S44
Patients included in group B had more pain and intestinal symptoms than those in group A; quality of life and sexual function were worse. Conclusion: Bowel endometriosis untreated during laparoscopy is associated with lower spontaneous pregnancy rates after surgery but it does not influence the pregnancy rate after in vitro fertilization. Untreated bowel endometriosis is associated with worse symptoms and quality of life after surgery. 49
Open Communications 2 - Endometriosis (12:59 PM - 1:04 PM)
Ureterolysis at the Time of Total Laparoscopic Hysterectomy: Safe and Effective Technique Ramirez ER,1 Ghozland D,2 Ehrenburg M,3 Mallare L.4 1OBGYN, Community Memorial Hospital, Oxnard, California; 2OBGYN, St. Johns Santa Monica, Santa Monica, California; 3OBGYN, Community Memorial Hospital, Ventura, California; 4OBGYN, Ventura County Medical Center, Ventura, California Study Objective: To determine whether ureterolysis during total laparoscopic hysterectomy decreases the overall incidence of ureteral injury. Design: All patients underwent total laparoscopic hysterectomy with ureterolysis for benign and complex disease from September 1, 2011 to September 30, 2013. Setting: Community Hospital. Patients: Total laparoscopic hysterectomy with ureterolysis was performed in 126 consecutive cases. Intervention: A posterior parametrial approach was used to easily identify the surgical landmarks of the pararectal space. Blunt dissection is performed until the desired distal ureter is identified. Intraoperative cystoscopy with indigo carmine was performed to evaluate for the presence or absence of extravasation or ureteral injury. Measurements and Main Results: One cystotomy and one rectotomy was discovered intraoperatively and repaired during surgery. There were no ureteral injuries and all patients with the exception of the rectotomy were discharged home on postoperative day 1. Conclusion: Ureteral dissection can be safely performed using a posterior parametrial approach and should be routine in all high risk cases. 50
Open Communications 3 - Laparoscopy (12:05 PM - 12:10 PM)
Risk of Leakage and Tissue Dissemination with Various in Bag Morcellation (IBM) Techniques: In Vitro Pilot Study Greenberg JA,1 Cohen SL,2 Wang KC,2 Gargiulo AR,3 Srouji S,3 Pozner C,4 Cibas ES,5 Hoover N,5 Einarsson JI.2 1Gynecology, Brigham & Women’s Faulkner Hospital, Jamaica Plain, Massachusetts; 2Minimally Invasive Gynecologic Surgery, Brigham & Women’s Hospital, Boston, Massachusetts; 3Reproductive Endocrinology and Infertility, Brigham & Women’s Hospital, Boston, Massachusetts; 4STRATUS Center for Medical Simulation, Brigham & Women’s Hospital, Boston, Massachusetts; 5 Division of Cytology, Brigham & Women’s Hospital, Boston, Massachusetts Study Objective: To evaluate risk of leakage and tissue dissemination with various in bag morcellation (IBM) techniques. Design: In vitro study. Setting: Hospital simulation lab. Intervention: Beef tongue specimens weighing 400-500 grams were stained with 5 cc of indigo carmine dye and morcellated with varying techniques under laparoscopic guidance within a plastic box trainer. In bag morcellation was performed employing three separate techniques: 1) stitched-sealed rip-stop nylon (TRS200, Anchor Surgical) bag and multiport approach, 2) 50x50cm isolation (Lahey) bag (Becton-Dickinson) and multi-port approach or 3) 50x50cm isolation bag and single-site approach. All bags were insufflated to within 15-25 mmHg pressure with a standard CO2 insufflator. Open tissue morcellation was performed as a control.
Visual evidence of spilled tissue or dye was recorded, and fluid washings of the box trainer were sent for cytologic analysis. Measurements and Main Results: Four trials of each contained morcellation method were performed and compared to the open morcellation control. Blue dye spill was noted in only one of the 12 contained morcellation trials wherein spillage was visualized from a seam