Robotic Excision of Full Thickness Bladder Endometriosis

Robotic Excision of Full Thickness Bladder Endometriosis

S122 Abstracts / Journal of Minimally Invasive Gynecology 20 (2013) S95–S132 In this presentation, we will introduce total laparoscopic nerve-sparin...

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Abstracts / Journal of Minimally Invasive Gynecology 20 (2013) S95–S132

In this presentation, we will introduce total laparoscopic nerve-sparing radical hysterectomy focused on a detail anatomy of pelvic nerve system. 398

Video Session 11dAdvanced Endoscopy (8:32 AM d 8:40 AM)

Expanding Surgical Possibilities through Transvaginal Retrieval Kitaura Y, Okumura M, Andou M. Shirakawa Clinic, Fukuyama, Hiroshima, Japan Background: For patients, recovery time, pain, and cosmetic appearance of abdominal scars are very important post-operative issues. Laparoscopic surgery addresses these through its minimally invasive approach. In gynecologic surgery, transvaginal retrieval possible, allowing expansion of the surgery while maintaining minimally invasive goals. Methods: We present three transvaginal retrieval cases. Case 1 is a myomectomy, case 2 a huge ovarian tumor, and case 3 is a dermoid cyst containing bone and teeth. For transvaginal retrieval, we remove the uterine manipulator and insert a vaginal fornix delineator (VagiPipe). After creating an incision at the posterior vaginal fornix, the specimen is removed transvaginally. Due to the lack of support of the uterine manipulator, we required a round ligament suspension technique. Results: We can manage removal the specimen transvaginally in all cases. Conclusion: Utilizing transvaginal retrieval, it is possible to expand the adaptation of gynecologic laparoscopic surgery and keep incisions in the abdomen minimal. 399

Video Session 11dAdvanced Endoscopy (8:41 AM d 8:49 AM)

Ambulatory Laparoscopic Removal of an 8 cm Degenerated Myoma LeBlanc M, Lemyre M. Departement d’Obstetrique et de Gynecologie, CHU de Quebec, Quebec, Canada This patient is a 31 years old G1P1 who had pelvic pressure symptoms because of a large uterine leiomyoma. She received three months of GnRH agonists before surgery. She was found to have an 8 cm subserosal degenerated myoma extending into the left broad ligament. A laparoscopic myomectomy was done using vasopressine injection to facilitate dissection and to reduce blood loss. A Harmonic scalpel was used to make the serosal incision. The dissection was meticulous in order to limit the fragmentation of the degenerated myoma. Intracorporeal sutures were done to close the uterine serosa after chromopertubation confirmed that the endometrial cavity was intact. The myoma was morcellated. Blood loss was minimal and the patient was discharged the day of the surgery. This video presents a safe way of doing a laparoscopic myomectomy in presence of a degenerated myoma. 400

Video Session 11dAdvanced Endoscopy (8:50 AM d 8:55 AM)

Single-Port Laparoscopically-Assisted Transumbilical Ultraminilaparotomic Myomectomy (SPLA-TUM) Lee DH, Kang JH, Lee JH. Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea We describe our initial experience with single-port laparoscopically assisted transumbilical ultraminilaparotomic myomectomy (SPLA-TUM) in a woman with about 8 cm sized intramural myoma. The operating time, hemoglobin change, return of bowel activity, and length of hospital stay were 60 minutes, 1.1 g/dL, 46.5 hours, and 3 days, respectively. SPLATUM, which was designed by integrating the surgical techniques of single-port laparoscopy and laparotomy, can reduce the operating time compared with SP-LM by permitting comfortable suturing and reliable knotting while maintaining the advantages of single-port laparoscopy. SPLA-TUM is a feasible alternative in selected patients with symptomatic myoma.


Video Session 11dAdvanced Endoscopy (8:56 AM d 9:04 AM)

Robotic Excision of Full Thickness Bladder Endometriosis Mosbrucker CM. Franciscan Health Systems, Gig Harbor, Washington This is the presentation of the case of a 51 yo female with endometriosis within the bladder wall extending full thickness from serosa to mucosa. The patient previously underwent LAVH in 2008, but in 2013 was found to have persistent endometriosis on the vaginal cuff as well as the bladder wall. Her symptoms were significant anterior pelvic pain, and urinary urgency and frequency. She underwent a robotic partial cystectomy and apical vaginectomy as well as bilateral ureterolysis in order to remove all visible remaining endometriosis. Her postoperative course was uneventful except for the rapid and nearly complete resolution of her pain and urinary symptoms. The video presentation outlines her presenting symptoms, preop ultrasound, surgical procedure, and postop outcomes. It concludes with a brief summary of urinary tract endometriosis. 402

Video Session 11dAdvanced Endoscopy (9:05 AM d 9:12 AM)

Laparoscopic Temporary Clipping of the Uterine Blood Supply Navas JJ, Zisow DL. Minimally Invasive Gynecologic Surgery, Northwest Hospital, Randallstown, Maryland Our goal is to demonstrate the effectiveness and practicality of laparoscopic temporary occlusion of the uterine vascular supply as a means for controlling intraoperative blood loss. Bipolar coagulation of uterine vessels and uterine artery embolization results in permanent devascularization. These methods may also cause thermal injury to surrounding tissues and impair fertility capacity and endometrial perfusion, respectively. Vasopressin is an additional alternative, but potential cardiopulmonary complications have been documented. Its effect is also limited by a short half-life, requiring repeat injections and increasing bleeding between dosages. Laparoscopic temporary clipping of the uterine blood supply avoids the above complications. It is also a reasonably safe and useful technique for preventing hemorrhage during laparoscopic myomectomy. 403

Video Session 11dAdvanced Endoscopy (9:13 AM d 9:20 AM)

Laparoscopic Wedge Resection of a Cornual Ectopic Pregnancy Ng VS, Guan X. Dept. of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas Cornual pregnancies are rare, accounting for 2-6% of ectopic pregnancies. However they have an increased mortality rate of 2-2.5%. Patients with a cornual pregnancy have a seven-fold increase in their mortality when compared with ectopic pregnancies in general. Because it is adjacent to the rich blood supply of both the uterine and ovarian artery, cornual pregnancies have an increased potential for hemorrhage and death. Thus, control of potential bleeding is paramount during the surgical management of a cornual ectopic. This video will demonstrate the laparoscopic surgical management of a cornual ectopic pregnancy with coagulation of the ipsilateral uterine and ovarian artery, use of a pursestring stitch around the cornua, and myometrial injection of vasopressin. 404

Video Session 11dAdvanced Endoscopy (9:21 AM d 9:28 AM)

Safe Endoscopic Excision and Vaporization of Peritoneal Endometriosis Via CO2 Laser Parsa A, Nezhat C. Center for Special Minimally Invasive and Robotic Surgery, Stanford University, Palo Alo, California Endometriosis of sensitive areas like the bowel, bladder, ureters and blood vessels are often excluded from surgical treatment due to risk of injury. The use of CO2 laser along with hydro dissection allows for safe surgical