21st annual congress esge september 11-14, 2012, paris ?· abstracts 21st annual congress esge...
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21st Annual Congress ESGE September 11-14, 2012, Paris
A RARE CASE OF BILATERAL LIVE ECTOPIC PREGNANCY Case Reports
A. Khalil*, R. Karmarkar, A. Sohail North Hampshire Hospital ~ Basingstoke ~ United Kingdom
Summary (4 lines): We present a case of bilateral live ectopic preg- nancy after IVF treatment. Both fetuses showed cardiac activity on scan. The patient underwent bilateral salpingectomy to treat the condition. Introduction: Ectopic pregnancy is known to be occurring more often after IVF and related assisted conception techniques. Rate of bilateral ectopic pregnancy is about 1 in 200,000. To the best of our knowledge this is the first reported case of bilateral live ectopic pregnancy. A 34 year old women presented at five plus weeks after her IVF treatment. She had no risk factors for ectopic pregnancy and had unexplained subfertility. She attended for a dating and viability scan. She was completely asymptomatic. Trans-vaginal ultrasound scan revealed bilateral live ectopic pregnancy. Treatment options were dis- cussed with the patient. She chose surgical option and underwent bilateral salpingectomy on the same day. She had an uneventful recovery. Material and Methods: Written consent obtained from the patient. Results: Patient underwent laparoscopic bilateral salpingectomy. Discussion: We used the surgical method of laparoscopic bilateral salpingectomy to treat bilateral live ectopic pregnancies. As the patient was having IVF treatment, it was felt that her chances of achieving a successful intrauterine pregnancy would be higher with the damaged tubes removed. There was however, discussion about methotrexate, which was dropped as both fetuses showed cardiac activity and due to patient’s wishes.
LAPAROSCOPIC UTERINE ANASTOMOSIS FORTRAUMATIC SEPARATION OF CERVIX FROM THE UTERINE CORPUS CAUSED BY CLOSED PELVIC FRACTURE. A CASE REPORT AND LITERATURE REVIEW Case Reports
S. Yao* The first affiliate hospital of Sun yat-sen university ~ Guangzhou ~ China
Summary (4 lines): Laparoscopic uterine anastomosis for traumatic separation of cervix from the uterine corpus caused by closed pelvic fracture was reported. The young girl resume a normal menstruation after surgery. Introduction: The purpose of this case report is to describe the diagnosis and successful laparoscopic approximation of traumatic sep- aration of the cervix from the uterine corpus. Material and Methods: A 16-years girl with primary amenorrhea and cyclic abdominal pain was referred to our hospital. She had a car accident at the age of 2 years which resulted in closed pelvic fracture. A conservative management of pelvic fracture was given to her with a uneventful recovery. She has a cyclic abdominal pain in the past 3 years since the age of 13. Ultrasonography and laparoscopy examination find a complete separation of the uterine corpus from the cervix and a endometrioma in the left ovary. The uterine corpus was approximated to the cervix with circumferentially placed sutures under laparoscopy. The endometrioma was also resected concomitantly. Results: The cyclic menstruation resume 2 months after surgery. cyclic abdominal pain disappear after surgery. Discussion: This case demonstrates the successful laparoscopic ap- proximation of traumatic separation of the uterine corpus from the cervix which result primary amenorrhea. Normal menstruation can be resumed after surgery.
AREVIEWOFMAJORCOMPLICATIONSASSOCIATEDWITH 832 OPERATIVE GYNAECOLOGICAL LAPAROSCOPIES Complications
K. Niblock*, K. Johnston, D. Morgan, G. Mccracken Antrim Area Hospital ~ Antrim, N.Ireland ~ United Kingdom
Summary (4 lines): A large cohort of operative laparoscopic cases including a large number of advanced procedures demonstrating inci- dence, nature and management of major complications. Introduction: Operative laparoscopic surgery is now proliferating in volume and complexity in the United Kingdom. With experienced, trained surgeons this approach offers well established benefits with very low major complication rates. Material and Methods: Review of 832 operative laparoscopies from 2 centres over 4 yrs by 3 trained surgeons. Including 279 laparoscopic adnexal surgeries, 201 total laparoscopic hysterecto- mies, 135 laparoscopic excisions of endometriosis and, 63 pelvic floor repairs. Complications diagnosed intra and postoperatively were analysed.
Gynecol Surg (2012) 9 (Suppl 1):S1–S137 DOI 10.1007/s10397-012-0767-z
Results: Major complications namely visceral, ureteric, vascular injury and return to theatre occurred in 1.56 % (13/832). Injuries were 4/832 (0.5 %) bowel, 1/832 (0.1 %) vascular, 1/832 (0.1 %) ureteric, 4/832 (0.4 %) bladder and 4/832 (0.5 %) return to theatre. Most 10/13 (77 %) were recognised intra-operatively and all managed laparoscopically. Discussion: Operative gynaecological laparoscopy is now well estab- lished; with appropriately trained surgeons it is associated with a very low major complication rate.
EARLY CERVICAL CANCER: LAPAROSCOPIC APPROACH & MAJOR COMPLICATIONS Complications
C. De Valle Corredor*, L. Fernandez Munoz, V. Garcia Pineda, M.D. Rodriguez Garnica, P. Valenzuela Ruiz, A. Couso Gonzalez, A. Zapico Goñi Hospital Universitario Principe de Asturias ~ Alcalá de Henares ~ Spain
Summary (4 lines): Laparoscopy (LPS) has shown to be a feasible alternative to laparotomy (LPM) in early stage cervical cancer (ESCC) with low complications rate Introduction: Laparoscopic radical hysterectomy + pelvic lymphade- nectomy (RH + PL) is the standard approach for ESCC. LPS is done on our patients to reduce morbidity. Material and Methods: Retrospective & descriptive study of 57 patients with ESCC (IA1, IA2, IB1, IIA1) and operated by LPS in our hospital between 2000–2011. Surgery outcomes and major com- plications are analyzed. Results: The mean age were 49.2+−12,6(26–82) years. 51 (89,5 %) patients were scheduled for RH + PL: 44 (87,3 %) had RH + PL and in 7 (12,7 %), pelvic nodes were positive in intraoperative frozen section whereby paraortic lymphadenectomy (PALN) was performed. RH + PL had a mean hospital stay of 4,77±2,101 (2–11) days and its major surgical complications (MSC) were 2 (4,5 %) great vessel injuries (GVI) solved laparoscopically and 1 (2,2 %) GVI + ureteral lesion which required conversion into LPM. No MSC were seen in PALN and its mean hospital stay was 2,14± 0,378 (2–3) days. Major postoperative complications (MPC) happened in 3 cases (6,8 %) in RH + LP group [1 (33 %) intestinal injury which required colostomy on 5th day postsurgery, 1(33,3 %) vesicovaginal fistula, 1 (33,3 %) ureteral estenosis after 2 months]. No MPC were seen in PALN group. Discussion: LPS is an excellent approach for treatment and staging with little morbidity and complications.
HOW TO PREVENT TROCAR-RELATED COMPLICATIONS: TROCAR USE AND FASCIAL CLOSURE Complications
C. La Chapelle*, F.W. Jansen dept. of gynecology, Leiden University Medical Centre ~ Leiden ~ Netherlands
Summary (4 lines): As part of development of a multidisciplinary guideline on Minimally Invasive Surgery (MIS), we formulated evidence based recommendations for trocar use and fascial closure of trocarsites.
Introduction: Trocars are the most named in malpractice injury claims associated with MIS. Differences in trocar related complications (TRCs) may be attributable to different trocar types and fascial closure. Problem analysis for a guideline on MIS, revealed clinical heteroge- neity in trocar use and fascial closure. Material and Methods: A literature review of trocar use and fascial closure was performed. Conclusions were drawn, considerations dis- cussed and multidisciplinary recommendations formulated. Results: A meta-analysis of RCTs concluded that the use of radially expanding access (REA) vs cutting trocars leads to fewer trocar site bleedings (TSB). For secondary ports the use of REA vs cutting resulted in decreased postoperative pain. A retrospec- tive study showed non-cutting vs cutting trocars lead to fewer TSBs and trocar site herniation (TSH). No studies showed a reduced risk for TSH after fascial closure. Two retrospective studies found increased prevalence of TSH in 12 mm vs 10 mm ports. Evidence was balanced with other considerations. Discussion: To reduce the risk for TRCs, we recommend to -Use non-cutting trocars for 10–12 mm ports. -Close the fascia of trocar ports >10 mm. Fascial closure of smaller ports could be considered.
LAPAROSCOPIC EXCISION OF RV NODULES – SURGICAL OUTCOMES AND COMPLICATIONS. THE ADVANTAGES OF A COMBINED APPROACH. Complications
A. Kent*, T. Rockall MATTU ~ Guildford ~ United Kingdom
Summary (4 lines): A combined surgical approach was developed for the surgical management of severe DIE of the bladder, ureter and RV septum. Introduction: We present the operative outcomes and complications of the combined surgical practice of a single Gynaecologist (Kent) and Colorectal Surgeon (Rockall), the two surgeons operating together. Surgery was carried out in two stages with down regulation. Outcomes were rates of laparoscopy; laparotomy; conservative surgery; clearance surgery; bowel resection; disc resection; rectal shaves; colostomy rates and complications. Material and Methods: Prospective study of 201 patients under- going resection of bladder, ureteric, RV nodules, or combinations thereof. The aim was to remove visible/palpable nodules. The energy of choice was Harmonic. The decision to carry out segmental or disc resection was made at the time of surgery. Results: (n0201) Laparoscopy 96.0 % (193) Laparotomy 4.0 % (8) Conservative 69.5 % (140) Clearance 30.5 % (61) Resection 52.5 % (105) Disc 7.0 % (14) Shave 40.5 % (82) ‘os