Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S90–S108 Video Session 10dUrogynecology/Pelvic Reconstruction (4:12 PM d 4:20 PM)
Laparoscopic Sacrocolpopexy Using Bidirectional Barbed Suture Oliveira MAP,1 Crispi CP,2 Raymundo TS,1,2 Pereira TD,1,2 Evangelista AH.1,2 1Gynecology, State University of Rio de Janeiro, Rio de Janeiro, Brazil; 2Endometriosis Treatment Center, Rio de Janeiro, Brazil Laparoscopic surgery for vaginal vault prolapse offers a minimally invasive access for vault suspension, combining the advantages of the apparent longterm success rates of the abdominal approach with the reported low morbidity and short hospitalization of the vaginal surgery. A major problem with laparoscopic sacrocolpopexy is that it requires expertise in laparoscopic suturing. Laparoscopic suturing is time consuming in inexperienced hands prolonging the operating time. The objective is to demonstrate the technique of fixation of polypropylene mesh in laparoscopic sacral colpopexy and peritoneal closure using thee bidirectional barbed suture.This technique was used in two consecutive cases, decreased in 15 minutes operative time required to fix the mesh (50 to 25 minutes) and 10 minutes for peritoneal closure (20 to 10 minutes). The use of the bidirectional barbed suture may decrease by half the time needed to fix the mesh and the peritoneal closure in laparoscopic sacrocolpopexy.
Video Session 10dUrogynecology/Pelvic Reconstruction (4:21 PM d 4:29 PM)
Laparoscopic Vesicovaginal Fistula Repair Stanford EJ. Urogynecology, University of Tennessee, Memphis, Memphis, Tennessee To demonstrate a laparoscopic vesicovaginal fistula repair. Patient: 38 yo female with prior cervical carcinoma treated with hysterectomy and BSO and radiation therapy who developed right renal dysfunction and a vesicovaginal fistula. Principles: The principles of repair are similar to open repair of a vesicovaginal fistula. After opening the bladder, the fistula is isolated from the vagina and repaired. The vaginal fistula opening is closed. Once the repair is water-tight an omental fat flap is brought down between the suture lines. Continence was maintained in postoperative follow up.
Video Session 10dUrogynecology/Pelvic Reconstruction (4:30 PM d 4:38 PM)
McCall Culdoplasty Combined with Total Laparoscopic Hysterectomy for Pelvic Organ Prolapse and Adenomyosis Song JI,3 Liberman O,3 Song J.1,2,3 1Obstetrics & Gynecology, New York University School of Medicine, New York, New York; 2Obstetrics & Gynecology, State University of New York at Stony Brook, Stony Brook, New York; 3Obstetric & Gynecology, Nassau University Medical Center, East Meadow, New York The McCall culdoplasty was performed for mild/moderate pelvic organ prolapse along with total laparoscopic hysterectomy for the indication of adenomyosis. Bipolar electrocoagulator was a simple and efficacious instrument for total laparoscopic hysterectomy procedure. Procedure could be done briefely with minor hemorrhage. It is crucial to identify bladder, ureter and other adjacent organs prior to vaginal vault suspension by modified McCall’s method to minimize urinary complications. It is a major part of culdoplasty to obliterate culdesac with delayed absorbable and non-absorbable suture materials. Video guided culdoplasty has an advantage of lower risk of ureteral damage than vaginal procedure. McCall’s culdoplasty is a safe and efficacious way to manage the range of minor to moderate pelvic relaxation combined with other minimally invasive procedures.
Video Session 10dUrogynecology/Pelvic Reconstruction (4:39 PM d 4:47 PM)
Robotic Transperitoneal Recto-Vaginal Fistula Repair Puntambekar SP, Rayate NV, Joshi SN, Rajamanickam S, Deshmukh AV. Minimally Invasive Oncology, Galaxy Care Laparoscopy Institute, Pune, Maharashtra, India Minimally invasive surgery for diseases in the pelvis are gaining popularity due to advancesin technology and the benefit to the patient. We report a patient who underwentrobotic transabdominal repair of a high rectovaginal fistula. The patient developed the high fistula following a vaginal hysterectomy. Vaginography revealed a communication between the vaginal vaultand the upper rectum. After evaluation of the colon and the vagina, the patient was planned for a robotic repair. The DaVinci Surgical robot was used. A total of 5ports were used to complete the entire procedure which included adhesiolysis, recreation of thevaginal vault, repair of the fistula and omental interposition. Besides the advantages of minimally invasive surgery for the patient, the surgeon benefits by the ease of suturing deep in the pelvis afforded by the articulating robotic arms.
Video Session 10dUrogynecology/Pelvic Reconstruction (4:48 PM d 4:56 PM)
Posterior Mesh Augmentation – A Kit-Less Approach Mattox F. Urogynecology, Carolina Continence Center, Greenville, South Carolina Video Summary – The purpose of this video is to demonstrate that mesh can be placed vaginally using known surgical planes and approaches without using a kit. The procedure has a short learning curve and is a straightforward approach for most surgeons experienced in vaginal surgery. Using this technique, with the Coloplast mesh, Novasilk, our mesh exposure rate has been less than one percent.
Video Session 10dUrogynecology/Pelvic Reconstruction (4:57 PM d 5:03 PM)
Laparoscopic Removal of a Urachal Remnant in an Adult Shepherd JA,1 Pasic R,1 Smith C.2 1Minimally Invasive Surgery, University of Louisville, Louisville, Kentucky; 2Urology, University of Louisville, Louisville, Kentucky Urachal remnants have potential for infectious complications and malignancy and are treated surgically to reduce these complications. When an urachal cyst or remnant is diagnosed, they have traditionally been removed through an open abdominal approach. With a laparoscopic approach, the advantage is fewer complications, safety and superior cosmesis. Design: 52 year old female patient with an urachal remnant diagnosed on routine CT scan. Past medical history of colon cancer, appendiceal cancer and a surgical history of a total abdominal hysterectomy, colon resection and cholecystectomy. Secondary to her extensive history, she was referred to our center for a laparoscopic approach to the removal of this pathology. Results: The outcome of the surgery was successful and the patient was discharged on postoperative day 2 with no complications. Conclusion: The laparoscopic approach allows the management of urachal abnormalities to be feasible and technically easy while allowing the patient to recover quickly.
Video Session 10dUrogynecology/Pelvic Reconstruction (5:04 PM d 5:10 PM)
Analysis on Laparoscopic Ureteroureterostomy of 4w5 Days Detected Ureter Injured during Laparoscopic Hysterectomy Eun D, Choi J, Choi Y, Jeong B, Shin K, Park J. Obstetrics & Gynecology, Eun’s Hospital, Gwang-Ju, Jeonlanamdo, Republic of Korea