Surgical Foundations of Presacral Anatomy

S10 Abstracts / Journal of Minimally Invasive Gynecology 19 (2012) S1–S35

26 Video Session 1dAnatomy

(11:00 AM d 11:06 AM)

Application of Knowledge of Pelvic Anatomy for Difficult Situations

in Gynaecological Endoscopies – Tips and Tricks

Desai RY, Puntambekar SP, Puntambekar SS, Galagali AS. Oncosurgery,

Galaxy CARE Laparoscopy Institute, Pune, Maharastra, India

Pelvic anatomy forms the basis of advanced laparoscopic gynaecologicalsurgeries. Difficult situations in Gynaec laparoscopic can be tackledsuccessfully if one learns the tips and tricks of handling vascularstructures and the ureters.This video depicts various such situations such as stage IV endometriosis,multiple laparotomies, previous caesarean section, large uterus etc wherethis approach helps to overcome the difficulties encountered.


(11:07 AM d 11:15 AM)

Surgical Foundations of Presacral Anatomy

King CR,1 Lee TTM.2 1OB/GYN, Baystate Medical Center, Springfield,

Massachusetts; 2OB/GYN, Magee Womens Hospital of UPMC, Pittsburgh,

Pennyslvania

Knowledge of the anatomical relationships within the presacral space isparamount when operating within the interiliac triangle. The purpose ofthis video is to demonstrate presacral anatomy in relationship to theureters by observing techniques used in a laparoscopic presacralneurectomy, sacrocolpopexy, and anterior bowel resection. By displayingthe anatomy from 3 separate perspectives, the viewer gains an enhancedappreciation of various anatomical structures and their spatialrelationships. The anatomy and skills obtained from performinga laparoscopic presacral neurectomy has been found to provide a concretefoundation for which additional presacral procedures can be mastered. Aclear understanding of presacral anatomy facilitates safe and effectiveexecution of multiple laparoscopic procedures.


(11:16 AM d 11:24 AM)

Overcoming the Large Uterus: Retroperiotneal Approach to Robotic

Hysterectomy

Orady ME. OB/GYN and Women’s Health Institute, Cleveland Clinic,

Cleveland, Ohio

Hysterectomy is one of the most common gynecologic proceduresperformed for benign indications. One of the main challenges ofperforming a laparoscopic hysterectomy on an enlarged is in gainingaccess to the vascular blood supply to the uterus secondary to difficultynavigating around the distorted anatomy. This is a contributing factor tothe high rate of laparotomy for hysterectomy in the United States today.The enhanced vision, range of motion, and precision of daVinci roboticinstruments have assisted in overcoming some of these challengesallowing the performance of more complex hysterectomy. This videoillustrates an easy method of gaining entry into the retroperitoneal spacein order to control the vascular blood supply, dissect out the criticalanatomy thus facilitating the performance of a minimally invasivehysterectomy even on an extremely enlarged uterus. A stepwise approachand the importance of careful dissection of the anatomy and hemostasiswill be discussed.


(11:25 AM d 11:33 AM)

Laparoscopic Approach to the Pelvic Sidewall

Lum D, Lee T, Mansuria S. Obstetrics, Gynecology, and Reproductive

Sciences, Magee-Womens Hospital of UPMC, Pittsburgh, Pennyslvania

Knowledge of pelvic sidewall anatomy is essential in advanced laparoscopicgynecologic surgery. Familiarity with pelvic sidewall anatomy is necessaryto identify the ureter and uterine artery to avoid injury and to accomplishsurgery when the anatomy is distorted by disease processes such asendometriosis and fibroids. In this video, we review the paravesical andpararectal spaces which make up the pelvic sidewall. We present clinicalscenarios when retroperitoneal dissection of the pelvic sidewall isnecessary, and introduce 3 basic approaches to dissection of the pelvicsidewall.


(11:34 AM d 11:40 AM)

Posterior Approach to Uterine Artery Ligation for Anterior Cul-de-

Sac Obliteration

Chamsy DJ, Lee T. Minimally Invasive Gynecologic Surgery, University of

Pittsburgh, Pittsburgh, Pennyslvania

Pelvic surgeries, such as cesarean sections and myomectomies, can causeextensive adhesions between the uterus, bladder and anterior abdominalwall, frequently leading to complete obliteration of the anterior cul desac. Hysterectomies in that setting can pose a great challenge even in thehands of experienced laparoscopists.Gynecologists traditionally begin a hysterectomy by performingadhesiolysis to create a bladder flap, and then proceed with theidentification and ligation of the uterine vessels. In the setting ofextensive pelvic scarring, adhesiolysis can cause increased blood loss, andidentification of uterine vessels can be difficult secondary to distortedpelvic anatomy.In this brief video, we describe an innovative technique to ligate the uterineblood supply using a posterior approach prior to bladder mobilization.Once the uterine vessels are secured, blood loss from adhesiolysis isminimized, making the procedure simpler to perform and less timeconsuming.


(11:41 AM d 11:49 AM)

Anatomy of the Ureter – A Primer on Avoiding Ureteral

Complications

Dassel MW, Pasic RP. Department of Minimally Invasive Gynecologic

Surgery, University of Louisville, Louisville, Kentucky

The ureter is an important structure in gynecologic surgery and is injured inapproximately 0.35-0.40% of gyencologic surgical cases. Understandingthe anatomy of the ureter is essential to avoiding surgical complicationsinvolving the urinary tract and is becoming increasingly relevant as thecomplexity of surgical cases performed by laparoscopy increases. Thisvideo presents the anatomy of the ureter in a multi-disciplinary fashionintegrating diagrams and surgical video clips from both live surgery andcadaveric dissections. Concepts regarding ureteral protection strategiesare alo presented showing transperitoneal visualization, ureterolysis,and ureteral stenting/catheterization as methods used to avoid ureteralinjury.


(11:50 AM d 11:57 AM)

Anatomical Planes of the Abdominal Wall through an Optical Trocar

Pons JC, Colmenares KB, Chapellin MC, Katiraee B. Unidad de Cirug�ıaM�ınima Invasiva Ginecologica, Centro Clinico Profesional Caracas/

Hospital de Clinicas Caracas, Caracas, DF, Venezuela

Described in the video, the initial approach to the abdominal cavity withthe use of an optical trocar (Visiport), which consists of a hollow stopper,which transparent edge allows entry of the laparoscope into the interiorof shutter, and this in the trocar sleeve, which carries at its end a lens

Documents

Surgical Foundations of Presacral Anatomy