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Use of the Hemi-Pelvis for Teaching Pelvic Anatomy and Single-Incision Slings
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Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S25–S46 Video Session 3dSurgical Education (2:32 PM d 2:35 PM)
Clinical Applications of Suturing in Parallel and Perpendicular Planes Hudgens JL, Pasic RP. Gynecologic Endoscopy, University of Louisville, Louisville, Kentucky Laparoscopic suturing is a complex task that requires many hours of practice and experience to perform proficiently. This video will highlight some clinical applications of suturing using parallel and perpendicular planes in a systematic and geometric approach. This video will demontrate vaginal cuff closure techniques using extra-corporeal and intra-corporeal knot tying. We will also present a myomectomy closure with emphasis on intra-corporeal knot tying, running suturing and suture managment as well as a laparoscopic techhnique for a baseball stitch closure. 95
Video Session 3dSurgical Education (2:36 PM d 2:44 PM)
Suturing in Parallel and Perpendicular Planes: A Systematic and Geometric Approach to Laparoscopic Suturing and Intracorporeal Knot Tying Hudgens JL, Pasic RP. Gynecologic Endoscopy, University of Louisville, Louisville, Kentucky Laparoscopic suturing is a complex task that requires many hours of practice and experience to perfrom proficiently. The main obstacle in learning to suture laparoscopically is overcoming the perception of a three dimensional operative field presented on a 2 dimensional monitor. The purpose of this video is to present a systematic approach to laparoscopic suturing based on geometric principles. This system highlights the importance of understanding and utilizing perpendicular and parallel planes and can be applied regardless of port configuration. We will also highlight visual cues that experienced surgeons utilize to aid in depth perception and that help improve surgical accuracy and efficiency. 96
Video Session 3dSurgical Education (2:45 PM d 2:53 PM)
Laparoscopic Anatomy: Avoiding Common Gynecologic Surgical Injuries Tang K. Legacy Health System, Portland, Oregon The purpose of this video is to introduce the resident trainee or other beginning laparoscopist to core aspects of gynecologic surgical anatomy. The video also discusses common iatrogenic surgical injuries resulting from gynecologic laparoscopic procedures, and provides guidance in avoiding these injuries. Areas covered include patient positioning and ergonomics, principles of laparoscopic entry; the pelvic visceral structures; and retroperitoneal structures, particularly the ureter. 97
Video Session 3dSurgical Education (2:54 PM d 3:01 PM)
Flexible Tip Laparoscope To Facilitate Gynecologic Surgery Solnik MJ, Fong A. Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California The purpose of this video is to demonstrate the advantages of a flexible tip lens for traditional laparoscopic procedures, allowing for both on-axis and off-axis visualization, which may be useful when instructing residents, particularly in complex surgeries. For most procedures, using a zero degree lens may be sufficient, but it becomes substantially more challenging to introduce an angled lens, which requires added dexterity, to a resident already accommodating to a complex set of skills. The use of a flexible tip lens may enhance surgical ergonomics while allowing the surgeon to work around pelvic pathology and virtually see around corners.
98
Video Session 3dSurgical Education (3:02 PM d 3:10 PM)
Use of the Hemi-Pelvis for Teaching Pelvic Anatomy and SingleIncision Slings Rosenblatt PL,1 Lotze PM,2 Lind LR,3 Serels SR.4 1Division of Urogynecology, Mount Auburn Hospital, Cambridge, Massachusetts; 2 Women’s Pelvic Health & Continence Center, Houston, Texas; 3Division of Urogynecology, North Shore Long Island Jewish Health System, Great Neck, New York; 4Urology Associates of Norwalk, Norwalk, Connecticut Although fresh cadavers are useful for teaching pelvic anatomy and reconstructive pelvic surgery, they do have limitations, since only tactile feedback is possible with procedures that are performed deep in the pelvis. The fresh hemi-pelvis is a useful adjunct to the traditional whole pelvis. The hemi-pelvis is created by cutting a mid-sagittal plane through a whole fresh pelvis. The Space of Retzius, vesicovaginal space, and rectovaginal space can be dissected, exposing the pelvic side wall structures. The ureter can be catheterized, which aids in identification of its relationship with neighboring structures. Various structures, including the obturator internus, ileococcygeus, coccygeus, sacrospinous ligament, and obturator neurovascular bundle can be identified and labeled. Procedures such as sacrospinous ligament suspension can be taught with a better understanding of the anatomy deep in the pelvis, without compromising the integrity of the anatomic relationships that are often destroyed with traditional dissection techniques. 99
Video Session 3dSurgical Education (3:11 PM d 3:17 PM)
Laparoscopic Management of Cornual Ectopic Pregnancy Kondrup JD. Obstetrics and Gynecology, Lourdes Hospital, Binghamton, New York The incidence of cornual pregnancy is rare. However this can be a life threatening situation if not recognized early. Laparoscopic management can be utilized with minimal blood loss and fertility preservation when simple basic techniques are employed. Pitressin is used to reduce blood flow, suture technques and gentle tissue handling reapproximate muscle and the Lapra-Ty(Ethicon Endo)is used to secure knots. 100
Video Session 3dSurgical Education (3:19 PM d 3:27 PM)
Treatment of Recurrent Adnexal Torsion Sharon A, Anderman S, Shachar A, Hallak M. Ob/Gyn, Hillel Yaffe Medical Center, Hadera, Israel A patient, 15 years old, underwent laparoscopic left adnexal detorsion of 3 circles. Six months later, another laparoscopy was performed, and detorsion of 6 circles of left adnexa was done. After another 6 months, we found left adnexal torsion with 12 circles, and during detorsion, we found a true note of the left tube. We did not fix the adnexa since the ligaments were edematous and very long. So we readdmit her after a month to make an adexal fixation by sutures. However, some adhesions were found during laparoscopy which stabilized the adnexa spontaneously. 101
Video Session 3dSurgical Education (3:28 PM d 3:34 PM)
Why Your Patients Are Asking about Essure Garcia AL. Minimally Invasive Surgery, Center for Women’s Surgery, Albuquerque, New Mexico Hysteroscopic tubal occlusion with Essure has been shown to be the most effective and least invasive sterilization method available for women. Essure is safely and comfortably performed in the office, adding benefits for the patient. While Essure was FDA approved in 2002 many women’s healthcare providers such as family practice physicians and nurse practitioners do not know about the procedure and it’s benefits. The purpose of the video is to educate these providers about Essure so they
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S25–S46 Video Session 3dSurgical Education (2:32 PM d 2:35 PM)
Clinical Applications of Suturing in Parallel and Perpendicular Planes Hudgens JL, Pasic RP. Gynecologic Endoscopy, University of Louisville, Louisville, Kentucky Laparoscopic suturing is a complex task that requires many hours of practice and experience to perform proficiently. This video will highlight some clinical applications of suturing using parallel and perpendicular planes in a systematic and geometric approach. This video will demontrate vaginal cuff closure techniques using extra-corporeal and intra-corporeal knot tying. We will also present a myomectomy closure with emphasis on intra-corporeal knot tying, running suturing and suture managment as well as a laparoscopic techhnique for a baseball stitch closure. 95
Video Session 3dSurgical Education (2:36 PM d 2:44 PM)
Suturing in Parallel and Perpendicular Planes: A Systematic and Geometric Approach to Laparoscopic Suturing and Intracorporeal Knot Tying Hudgens JL, Pasic RP. Gynecologic Endoscopy, University of Louisville, Louisville, Kentucky Laparoscopic suturing is a complex task that requires many hours of practice and experience to perfrom proficiently. The main obstacle in learning to suture laparoscopically is overcoming the perception of a three dimensional operative field presented on a 2 dimensional monitor. The purpose of this video is to present a systematic approach to laparoscopic suturing based on geometric principles. This system highlights the importance of understanding and utilizing perpendicular and parallel planes and can be applied regardless of port configuration. We will also highlight visual cues that experienced surgeons utilize to aid in depth perception and that help improve surgical accuracy and efficiency. 96
Video Session 3dSurgical Education (2:45 PM d 2:53 PM)
Laparoscopic Anatomy: Avoiding Common Gynecologic Surgical Injuries Tang K. Legacy Health System, Portland, Oregon The purpose of this video is to introduce the resident trainee or other beginning laparoscopist to core aspects of gynecologic surgical anatomy. The video also discusses common iatrogenic surgical injuries resulting from gynecologic laparoscopic procedures, and provides guidance in avoiding these injuries. Areas covered include patient positioning and ergonomics, principles of laparoscopic entry; the pelvic visceral structures; and retroperitoneal structures, particularly the ureter. 97
Video Session 3dSurgical Education (2:54 PM d 3:01 PM)
Flexible Tip Laparoscope To Facilitate Gynecologic Surgery Solnik MJ, Fong A. Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California The purpose of this video is to demonstrate the advantages of a flexible tip lens for traditional laparoscopic procedures, allowing for both on-axis and off-axis visualization, which may be useful when instructing residents, particularly in complex surgeries. For most procedures, using a zero degree lens may be sufficient, but it becomes substantially more challenging to introduce an angled lens, which requires added dexterity, to a resident already accommodating to a complex set of skills. The use of a flexible tip lens may enhance surgical ergonomics while allowing the surgeon to work around pelvic pathology and virtually see around corners.
98
Video Session 3dSurgical Education (3:02 PM d 3:10 PM)
Use of the Hemi-Pelvis for Teaching Pelvic Anatomy and SingleIncision Slings Rosenblatt PL,1 Lotze PM,2 Lind LR,3 Serels SR.4 1Division of Urogynecology, Mount Auburn Hospital, Cambridge, Massachusetts; 2 Women’s Pelvic Health & Continence Center, Houston, Texas; 3Division of Urogynecology, North Shore Long Island Jewish Health System, Great Neck, New York; 4Urology Associates of Norwalk, Norwalk, Connecticut Although fresh cadavers are useful for teaching pelvic anatomy and reconstructive pelvic surgery, they do have limitations, since only tactile feedback is possible with procedures that are performed deep in the pelvis. The fresh hemi-pelvis is a useful adjunct to the traditional whole pelvis. The hemi-pelvis is created by cutting a mid-sagittal plane through a whole fresh pelvis. The Space of Retzius, vesicovaginal space, and rectovaginal space can be dissected, exposing the pelvic side wall structures. The ureter can be catheterized, which aids in identification of its relationship with neighboring structures. Various structures, including the obturator internus, ileococcygeus, coccygeus, sacrospinous ligament, and obturator neurovascular bundle can be identified and labeled. Procedures such as sacrospinous ligament suspension can be taught with a better understanding of the anatomy deep in the pelvis, without compromising the integrity of the anatomic relationships that are often destroyed with traditional dissection techniques. 99
Video Session 3dSurgical Education (3:11 PM d 3:17 PM)
Laparoscopic Management of Cornual Ectopic Pregnancy Kondrup JD. Obstetrics and Gynecology, Lourdes Hospital, Binghamton, New York The incidence of cornual pregnancy is rare. However this can be a life threatening situation if not recognized early. Laparoscopic management can be utilized with minimal blood loss and fertility preservation when simple basic techniques are employed. Pitressin is used to reduce blood flow, suture technques and gentle tissue handling reapproximate muscle and the Lapra-Ty(Ethicon Endo)is used to secure knots. 100
Video Session 3dSurgical Education (3:19 PM d 3:27 PM)
Treatment of Recurrent Adnexal Torsion Sharon A, Anderman S, Shachar A, Hallak M. Ob/Gyn, Hillel Yaffe Medical Center, Hadera, Israel A patient, 15 years old, underwent laparoscopic left adnexal detorsion of 3 circles. Six months later, another laparoscopy was performed, and detorsion of 6 circles of left adnexa was done. After another 6 months, we found left adnexal torsion with 12 circles, and during detorsion, we found a true note of the left tube. We did not fix the adnexa since the ligaments were edematous and very long. So we readdmit her after a month to make an adexal fixation by sutures. However, some adhesions were found during laparoscopy which stabilized the adnexa spontaneously. 101
Video Session 3dSurgical Education (3:28 PM d 3:34 PM)
Why Your Patients Are Asking about Essure Garcia AL. Minimally Invasive Surgery, Center for Women’s Surgery, Albuquerque, New Mexico Hysteroscopic tubal occlusion with Essure has been shown to be the most effective and least invasive sterilization method available for women. Essure is safely and comfortably performed in the office, adding benefits for the patient. While Essure was FDA approved in 2002 many women’s healthcare providers such as family practice physicians and nurse practitioners do not know about the procedure and it’s benefits. The purpose of the video is to educate these providers about Essure so they