Download pdf - Conservative Endoscopic Management of Two Oversized Adnexal Masses Based on the Jacobs Index

S126 Abstracts / Journal of Minimally Invasive Gynecology 20 (2013) S95–S132

excision of the fistula defect, closure of both vaginal and bladder defect, aswell as placement of the omental flap between the bladder and the vaginalrepair. Cystoscopy at the completion of the procedure revealed bilateralureteral patency and adequate closure of the vesicovaginal fistula.

426 Video Session 13dAdvanced Endoscopy

(8:24 AM d 8:32 AM)

LESS Conservative Management of Huge Ovarian Cyst

Aldakhyel L,1 Alobaid A.2 1King Saud University, Riyadh, Saudi Arabia;2King Fahad Medical City, Riyadh, Saudi Arabia

We present a 22 years old single patient who was referred with a huge pelvi-abdominal mass. Her exam revealed a huge mass that was reaching till thexiphi-sternum. History, physical examination, tumor markers andradiological findings were in favour of a benign nature of the cyst.A 2.5 cm umbilical incision was made. The inspection of the cyst revealeda huge unilocular cyst with smooth wall. The cyst was drainedlaparoscopically. 8.5 litres of serous fluid was aspirated. We thenperformed partial salpingo-oopherectomy. There were no intra or post-operative complications and the blood loss was minimal. Thehistopathology report revealed a benign Serous cystadenofibroma. Followup ultrasound revealed normal ovaries.In conclusion, we believe that huge cysts can be safely managed usingLESS. Conservative management should be attempted. Before any cystaspiration, the malignancy index should be very low. Proper patientsselection and expertise are essential.


(8:33 AM d 8:40 AM)

Laparoscopic Excision of Sacrocolpopexy Mesh

Manoucheri E, Einarsson JI. Brigham & Women’s Hospital, Boston,

Massachusetts

The objective of the video is to highlight the laparoscopic approach ofa complete excision of sacrocolpopexy mesh. The patient had undergonean abdominal hysterectomy and sacrocolpopexy ten years prior to herpresentation. She had ten years of dyspareunia, discharge and post-coitalbleeding. She was found to have apical mesh exposure. After multipleattempts to excise the exposed mesh vaginally, she was referred to ourdepartment for further management. We show the initial pelvic anatomywith the appendix adhered to the mesh. After an appendectomy isperformed, we show the complete excision of the mesh from the sacralpromontory to the vagina with closure of the vaginal cuff and subsequentuterosacral ligament suspension to prevent recurrent prolapse. We hope toshow that a laparoscopic approach to excise a sacral colpopexy mesh canbe performed successfully.


(8:41 AM d 8:49 AM)

Myomectomy of a Single Myoma Weighing 3,000 Grams in a 27-

Year-Old Woman, Preserving Her Uterus

Birlain M, Matabuena P. OBGyn, Hospital �Angeles de Quer�etaro,Quer�etaro, Mexico

Objetive : To demonstrate that myomectomy -even in giant myomaspresented in young women, can preserve their fertility.Design and methods: to show a technique of myomectomy in a 3,000 grammyoma in a nulliparous 27-year-old woman, preserving a functionalendometrium and tubal patency for future reproduction.

Results: we showed how we planned the surgical strategies to avoidpossible lessions on vital structures and seek for a better outcome in orderto have a fertile uterus.We showed an HisteroMRI with an endometrialcavity recovered to, nearly, its normal size and probe permeability of thefallopian tubes; same result was obtained with an histeroscopic evaluation.

Conclusion: with a good knowledge of the anatomy and fisiology of theuterus we could be able to ensure fertility in spite of the size of theirmyomas.


(8:50 AM d 8:57 AM)

Robot-Assisted Vaginal Vault Suspension without Mesh at the Time

of Hysterectomy

Brazell HD, Tulikangas PK. Obstetrics and Gynecology, Hartford

Hospital, Hartford, Connecticut

Our objective is to demonstrate robot-assisted uterosacral vaginal vaultsuspension for women with apical prolapse as well to educate generalgynecologists in the use of this technique for women in whomhysterectomy is performed for non-prolapse indications.This is a common operation for the management of apical prolapse but istypically performed vaginally. Generally, when a vaginal hysterectomy isperformed for non-prolapse indications, gynecologists perform a McCallculdoplasty as prophylaxis for future vault prolapse. However, as theincidence of robotic hysterectomy increases, we demonstrate a roboticprocedure for vaginal vault support after hysterectomy for non-prolapseindications. Apical support is achieved by suturing the full-thickness ofthe vaginal cuff to the mid-uterosacral ligament on either side.In conclusion, uterosacral suspension not only offers excellent pelvicsupport for patients with prolapse, but should also be considered asa prophylactic measure for vaginal vault suspension in cases of robotichysterectomy for non-prolapse indications.


(8:58 AM d 9:06 AM)

Conservative Endoscopic Management of Two Oversized Adnexal

Masses Based on the Jacobs Index

Canseco-Lima JM, Canseco-Olvera JDJ. Gynecologic Endoscopy, OBGIN

SC, San Luis Potosi, Mexico

Study Objective: To detemine the factibility of laparoscopic approach ofoversized adnexal masses in young women.

Design: Case Report

Setting: OBGIN SC affiliated hospitals.

Patients: 22 yrs old nulliparous female with a left unilocular with glassground echogenicity adnexal mass of 26x20x15cm,Ca 125 of 103.6U/ml.A 20 yrs old nulliparous female with right adnexal unilocular cystic massof 16x15x14cm,Ca 125 of 9 U/ml.

Interventions: Malignancy risk assessment with Jacobs index.Four portlaparoscopy was carried out.The ovarian cortex was preserved andcomplete dissection of the capsules was performed

Main Outcome Measure: Correlation between Jacobs Index andHistopathology

Results: Case 1 Ultrasound: Unilocular cyst with glass ground echogenicityvalue=0. Menopausal Status: Premenopausic Value=1. Ca 125=103.6Jacobs Index:0x1x103.6=0 Histopathology: Left ovarian endometriomacapsule of 25x18x14cm. Case 2 Ultrasound: Unilocular cyst value=0.Menopausal Status:Premenopausic Value=1.Ca 125=9. Jacobs Index:0x1x9=0. Histopathology: Simple serous right ovarian cyst capsule of15x14x10cm

Conslusion: 97% specificity value of Jacobs index allows a conservativeapproach being laparoscopy the first treatment option instead of laparotomy.


(9:07 AM d 9:15 AM)

Management of Ovarian Cancer in 14th Gestational Week of

Pregnancy by Robotic Approach

Chen C-H, Chiu L-H, Chan C, Liu W-M. Department of Obstetrics and

Gynecology, Taipei Medical University Hospital, Taipei, Taiwan