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Michael GRAHAM

Belfast Health and Social Care Trust
Belfast, United Kingdom
MRCOG
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Total laparoscopic Hudson’s procedure, pelvic and para-aortic node dissection, omentectomy with primary re-anastomosis and loop ileostomy
This patient previously underwent a right ovarian cystectomy for endometrioma with final histopathology confirming an endometrioid adenocarcinoma in association with endometriosis (at least FIGO 1C1). Preoperative MRI and CT-scan suggested endometriosis/disease in the rectouterine pouch, with no evidence of disease outside the pelvis. Completion surgery with a Hudson’s procedure and comprehensive surgical staging was planned as a laparoscopic intervention. On initial inspection, intravenous indocyanine green (ICG) was used to facilitate the identification of endometriosis disease in the pelvis. Following surgical staging, including ‘en bloc’ dissection of the uterus, tubes, ovaries, and rectosigmoid, the specimen was removed via the vagina with the aid of an Alexis wound retractor. For re-anastomosis, the distal descending colon was delivered through the vagina, the anvil applied, and the anastomosis completed laparoscopically. This anastomosis was then defunctioned via a loop ileostomy. ICG was used to confirm anastomotic perfusion. The ileostomy was successfully reversed after 10 days facilitating postoperative treatment with chemotherapy.
Surgical intervention
7 days ago
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25:31
Total laparoscopic Hudson’s procedure, pelvic and para-aortic node dissection, omentectomy with primary re-anastomosis and loop ileostomy
This patient previously underwent a right ovarian cystectomy for endometrioma with final histopathology confirming an endometrioid adenocarcinoma in association with endometriosis (at least FIGO 1C1). Preoperative MRI and CT-scan suggested endometriosis/disease in the rectouterine pouch, with no evidence of disease outside the pelvis. Completion surgery with a Hudson’s procedure and comprehensive surgical staging was planned as a laparoscopic intervention. On initial inspection, intravenous indocyanine green (ICG) was used to facilitate the identification of endometriosis disease in the pelvis. Following surgical staging, including ‘en bloc’ dissection of the uterus, tubes, ovaries, and rectosigmoid, the specimen was removed via the vagina with the aid of an Alexis wound retractor. For re-anastomosis, the distal descending colon was delivered through the vagina, the anvil applied, and the anastomosis completed laparoscopically. This anastomosis was then defunctioned via a loop ileostomy. ICG was used to confirm anastomotic perfusion. The ileostomy was successfully reversed after 10 days facilitating postoperative treatment with chemotherapy.