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Laparoscopic management of bladder endometriosis
Endometriosis is an enigmatic disorder, which affects women in their reproductive age. Failure of recent clinical trials on non-surgical management of endometriosis confirms the role of surgery as a viable treatment of choice. However, recurrence after surgery is common. Recurrence rate varies according to the surgeon’s skills, instrumentation, surgical techniques, and to the postoperative intervention outcome. In patients with severe endometriosis, lesions usually involve the posterior cul-de-sac, anterior rectum, one or both pelvic sidewalls, involving the ureters, the rectosigmoid, and less commonly the anterior bladder, the appendix, and the small bowel. Ureteral retroperitoneal dissection becomes mandatory in extensive endometriosis due to pelvic anatomical distortion. It also leaves the bowel intact without injuring it as the pseudo-peritoneum is lifted along with the inflamed bowel. Consequently, in the surgical practice of benign pathologies, a proper knowledge of the retroperitoneal anatomy ensures complete clearance in cases of advanced endometriosis and frozen pelvis. Here, we present a very interesting case of bladder endometriosis associated with hematuria during menstruation. Partial cystectomy is the treatment of choice for patients with bladder endometriosis in most cases. Provided surgeons are skilled and lesions require no ureteral reimplantation, operative laparoscopy is a valid alternative to laparotomy for partial cystectomy.
D Limbachiya
Surgical intervention
4 years ago
2191 views
65 likes
0 comments
06:56
Laparoscopic management of bladder endometriosis
Endometriosis is an enigmatic disorder, which affects women in their reproductive age. Failure of recent clinical trials on non-surgical management of endometriosis confirms the role of surgery as a viable treatment of choice. However, recurrence after surgery is common. Recurrence rate varies according to the surgeon’s skills, instrumentation, surgical techniques, and to the postoperative intervention outcome. In patients with severe endometriosis, lesions usually involve the posterior cul-de-sac, anterior rectum, one or both pelvic sidewalls, involving the ureters, the rectosigmoid, and less commonly the anterior bladder, the appendix, and the small bowel. Ureteral retroperitoneal dissection becomes mandatory in extensive endometriosis due to pelvic anatomical distortion. It also leaves the bowel intact without injuring it as the pseudo-peritoneum is lifted along with the inflamed bowel. Consequently, in the surgical practice of benign pathologies, a proper knowledge of the retroperitoneal anatomy ensures complete clearance in cases of advanced endometriosis and frozen pelvis. Here, we present a very interesting case of bladder endometriosis associated with hematuria during menstruation. Partial cystectomy is the treatment of choice for patients with bladder endometriosis in most cases. Provided surgeons are skilled and lesions require no ureteral reimplantation, operative laparoscopy is a valid alternative to laparotomy for partial cystectomy.
Sutures transfixing bladder as a complication of laparoscopic burch colposuspension
Laparoscopic Burch colposuspension may be difficult in cases of stress urinary incontinence (SUI) associated with large lateral cystocele. In these cases, complications may occur. However, they are rare.
This video shows the cystoscopic treatment of intravesical adhesions, secondary to sutures transfixing the bladder during the Burch laparoscopic procedure and lateral suspension, without perioperative use of control cystoscopy. An office cystoscopy was performed after the operation, nine months later, because of gradual onset of entirely isolated pelvic pain at the end of urination. It showed intravesical synechia as bilateral pillars. The different steps of the operation are the following:
1) Diagnostic laparoscopy with a good status of the lateral suspension without mesh migration.
2) Operative laparoscopy with opening of Retzius’s space, dissection, adhesiolysis, and division of the non-absorbable sutures of the past colposuspension in order to mobilize the bladder, followed by reperitonization of Retzius’s space.
3) Diagnostic cystoscopy confirming adhesions as bilateral pillars, laterally to the trigone with normal ejaculation of both ureteral ostia.
4) Operative cystoscopy after catheterization of both ureters: division of the pillars with the monopolar electrode without visualization of the Burch sutures, as they probably migrated upward in the first postoperative months.
In the postoperative period, ureteral catheters are removed 48 hours after surgery. Pain resolves completely during urination. Normal kidneys and ureters are observed at ultrasound.
This video clearly demonstrates the advantages related to the routine use of cystoscopy at the end of the laparoscopic Burch procedure, especially in cases of large lateral cystocele.
JB Dubuisson, J Dubuisson, JM Wenger, A Caviezel
Surgical intervention
3 years ago
2393 views
96 likes
0 comments
07:41
Sutures transfixing bladder as a complication of laparoscopic burch colposuspension
Laparoscopic Burch colposuspension may be difficult in cases of stress urinary incontinence (SUI) associated with large lateral cystocele. In these cases, complications may occur. However, they are rare.
This video shows the cystoscopic treatment of intravesical adhesions, secondary to sutures transfixing the bladder during the Burch laparoscopic procedure and lateral suspension, without perioperative use of control cystoscopy. An office cystoscopy was performed after the operation, nine months later, because of gradual onset of entirely isolated pelvic pain at the end of urination. It showed intravesical synechia as bilateral pillars. The different steps of the operation are the following:
1) Diagnostic laparoscopy with a good status of the lateral suspension without mesh migration.
2) Operative laparoscopy with opening of Retzius’s space, dissection, adhesiolysis, and division of the non-absorbable sutures of the past colposuspension in order to mobilize the bladder, followed by reperitonization of Retzius’s space.
3) Diagnostic cystoscopy confirming adhesions as bilateral pillars, laterally to the trigone with normal ejaculation of both ureteral ostia.
4) Operative cystoscopy after catheterization of both ureters: division of the pillars with the monopolar electrode without visualization of the Burch sutures, as they probably migrated upward in the first postoperative months.
In the postoperative period, ureteral catheters are removed 48 hours after surgery. Pain resolves completely during urination. Normal kidneys and ureters are observed at ultrasound.
This video clearly demonstrates the advantages related to the routine use of cystoscopy at the end of the laparoscopic Burch procedure, especially in cases of large lateral cystocele.
Laparoscopic partial cystectomy for big bladder endometriosis nodule
Bladder endometriosis is the most common presentation of urinary tract endometriosis and is frequently associated with specific symptoms such as dysuria, hematuria and recurrent urinary tract infections. Although it may be associated with ureteral endometriosis in severe cases, in most cases, it presents as an isolated disease.
The laparoscopic approach for bladder endometriosis nodule excision requires careful dissection of the paravesical spaces and identification of both ureters entering each ureteral tunnel. The shaving technique until healthy tissue is reached should be attempted, but if mucosal invasion is found, complete wall excision should be performed. In some occasions, when the nodule invades the bladder trigone, a double-J catheter may be inserted and left in place for 6 to 8 weeks.
In this video, we present the case of a 23-year-old woman complaining with significant dysuria associated with hematuria, dysmenorrhea, dyspareunia, and chronic pelvic pain. Magnetic resonance imaging described a 5cm nodule located in the bladder dome, and cystoscopy confirmed the diagnosis. The patient was referred to our Endometriosis Centre after diagnostic laparoscopy.
A Wattiez, J Albornoz, M Puga, E Faller
Surgical intervention
7 years ago
1808 views
24 likes
0 comments
32:41
Laparoscopic partial cystectomy for big bladder endometriosis nodule
Bladder endometriosis is the most common presentation of urinary tract endometriosis and is frequently associated with specific symptoms such as dysuria, hematuria and recurrent urinary tract infections. Although it may be associated with ureteral endometriosis in severe cases, in most cases, it presents as an isolated disease.
The laparoscopic approach for bladder endometriosis nodule excision requires careful dissection of the paravesical spaces and identification of both ureters entering each ureteral tunnel. The shaving technique until healthy tissue is reached should be attempted, but if mucosal invasion is found, complete wall excision should be performed. In some occasions, when the nodule invades the bladder trigone, a double-J catheter may be inserted and left in place for 6 to 8 weeks.
In this video, we present the case of a 23-year-old woman complaining with significant dysuria associated with hematuria, dysmenorrhea, dyspareunia, and chronic pelvic pain. Magnetic resonance imaging described a 5cm nodule located in the bladder dome, and cystoscopy confirmed the diagnosis. The patient was referred to our Endometriosis Centre after diagnostic laparoscopy.
Laparoscopic anterior resection for locally advanced sigmoid cancer with 'en bloc' excision of bladder cuff
We present an operative video of a 61-year-old Chinese gentleman with locally advanced sigmoid carcinoma. Preoperative histology from endoscopy revealed an adenocarcinoma. The patient underwent laparoscopic anterior resection. Intraoperatively, the sigmoid tumor was adherent to the bladder with surrounding inflammation and edema. The colectomy had to be performed with an ‘en bloc’ excision of a bladder cuff. The bladder defect was repaired laparoscopically in two layers. Operative time was 4 hours 15 minutes and total blood loss was less than 100mL. The patient was discharged in good health conditions, four days after the operation with an outpatient cystogram performed before subsequent successful removal of the indwelling catheter. Final histology was pT4bN0 (0/31 lymph nodes) with clear margins. This case demonstrates that laparoscopic colectomy with ‘en bloc’ bladder cuff excision and subsequent laparoscopic repair of bladder defect are both feasible and safe.
S Mantoo, E Yong
Surgical intervention
3 years ago
3398 views
143 likes
0 comments
07:26
Laparoscopic anterior resection for locally advanced sigmoid cancer with 'en bloc' excision of bladder cuff
We present an operative video of a 61-year-old Chinese gentleman with locally advanced sigmoid carcinoma. Preoperative histology from endoscopy revealed an adenocarcinoma. The patient underwent laparoscopic anterior resection. Intraoperatively, the sigmoid tumor was adherent to the bladder with surrounding inflammation and edema. The colectomy had to be performed with an ‘en bloc’ excision of a bladder cuff. The bladder defect was repaired laparoscopically in two layers. Operative time was 4 hours 15 minutes and total blood loss was less than 100mL. The patient was discharged in good health conditions, four days after the operation with an outpatient cystogram performed before subsequent successful removal of the indwelling catheter. Final histology was pT4bN0 (0/31 lymph nodes) with clear margins. This case demonstrates that laparoscopic colectomy with ‘en bloc’ bladder cuff excision and subsequent laparoscopic repair of bladder defect are both feasible and safe.
Laparoscopic augmentation enterocystoplasty and Mitrofanoff for neurogenic bladder
As a complementary video to the Mitrofanoff technique, we present the case of a patient with neurogenic bladder secondary to spina bifida. This video demonstrates augmentation ileocystoplasty complementary to Mitrofanoff appendicovesicostomy performed laparoscopically. Preoperative bowel preparation was not performed. Average operative time was 4.30 hours. This video shows that it is a safe, feasible and effective laparoscopic procedure with shorter recovery time and good cosmesis.

References:
1. Bagrodia A,Gargollo P. Robot-assisted bladder neck reconstruction, bladder neck sling, and appendicovesicostomy in children: description of technique and initial results. J Endourol 2011:25;8:1299-305.
2. Farrugia MK, Malone PS. Educational article: The Mitrofanoff procedure. J Pediatr Urol 2010;6:330-7.
3. Berkowitz J, North AC, Tripp R, Gearhart JP, Laksmanan Y. Mitrofanoff continent catheterizable conduits: top down or bottom up? J Pediatr Urol 2009;5:122-5.
4. Arango Rave ME, Lince Varela LF, Salazar Sanín C, Hoyos Figueroa FC, Hurtado SN, Rendón Isaza JC. [Outcomes the Mitrofanoff technique in the management of patients with neurogenic bladder: the experience in the San Vicente de Paul Universitary Hospital]. Actas Urol Esp 2009;33:69-75.
5. Gundeti MS, Eng MK, Reynolds WS, Zagaja GP. Pediatric robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy: complete intracorporeal--initial case report. Urology 2008;72:1144-7.
6. Thakre AA, Yeung CK, Peters C. Robot-assisted Mitrofanoff and Malone antegrade continence enema reconstruction using divided appendix. J Endourol 2008;22:2393-6.
7. Sahadevan K, Pickard RS, Neal DE, Hasan TS. Is continent diversion using the Mitrofanoff principle a viable long-term option for adults requiring bladder replacement? BJU Int 2008;102:236-40.
8. Lendvay TS, Shnorhavorian M, Grady RW. Robotic-assisted laparoscopic Mitrofanoff appendicovesicostomy and antegrade continent enema colon tube creation in a pediatric spina bifida patient. J Laparoendosc Adv Surg Tech A 2008;18:310-2.
9. Mhiri MN, Bahloul A, Chabchoub K. [Mitrofanoff appendicovesicostomy in children: indication and results]. Prog Urol 2007;17:245-9.
10. Leslie JA, Dussinger AM, Meldrum KK. Creation of continence mechanisms (Mitrofanoff) without appendix: the Monti and spiral Monti procedures. Urol Oncol 2007;25:148-53.
11. Basavaraj DR, Harrison SC. The Mitrofanoff procedure in the management of intractable incontinence: a critical appraisal. Curr Opin Urol 2006;16:244-7.
12. Wille MA, Zagaja GP, Shalhav AL, Gundeti MS. Continence outcomes in patients undergoing robotic assisted laparoscopic mitrofanoff appendicovesicostomy. J Urol 2011;185:1438-43.
13. Wille MA,Jayram G,Gundeti MS Feasibility and early outcomes of robotic-assisted laparoscopic Mitrofanoffappendicovesicostomy in patients with prune belly syndrome BJU Int 2012;109:1:125-9.
14. Gundeti MS, Acharya SS, Zagaja GP, Shalhav AL. Paediatric robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy (RALIMA): feasibility of and initial experience with the University of Chicago technique. BJU Int 2011;107:962-9.
15. Chabchoub K, Ketata H, Fakhfakh H, Bahloul A, Mhiri MN. [Continent urinary diversion (Mitrofanoff principle). Physical mechanisms and urodynamic explanation of continence]. Prog Urol 2008;18:120-4.
16. Karsenty G, Chartier-Kastler E, Mozer P, Even-Schneider A, Denys P, Richard F. A novel technique to achieve cutaneous continent urinary diversion in spinal cord-injured patients unable to catheterize through native urethra. Spinal Cord 2008;46:305-10.
17. Nguyen HT, Passerotti CC, Penna FJ, Retik AB, Peters CA. Robotic assisted laparoscopic Mitrofanoff appendicovesicostomy: preliminary experience in a pediatric population. J Urol 2009;182:1528-34.
18. Vian E, Soustelle L, Viale S, Costa P. [A technique of continent vesicostomy with ileocystoplasty: study of 32 patients]. Prog Urol 2009;19:116-21.
19. Hsu TH, Shortliffe LD. Laparoscopic Mitrofanoff appendicovesicostomy. Urology 2004;64:802-4.
D Rey, VE Corona Montes, T Piéchaud
Surgical intervention
7 years ago
2043 views
32 likes
0 comments
09:45
Laparoscopic augmentation enterocystoplasty and Mitrofanoff for neurogenic bladder
As a complementary video to the Mitrofanoff technique, we present the case of a patient with neurogenic bladder secondary to spina bifida. This video demonstrates augmentation ileocystoplasty complementary to Mitrofanoff appendicovesicostomy performed laparoscopically. Preoperative bowel preparation was not performed. Average operative time was 4.30 hours. This video shows that it is a safe, feasible and effective laparoscopic procedure with shorter recovery time and good cosmesis.

References:
1. Bagrodia A,Gargollo P. Robot-assisted bladder neck reconstruction, bladder neck sling, and appendicovesicostomy in children: description of technique and initial results. J Endourol 2011:25;8:1299-305.
2. Farrugia MK, Malone PS. Educational article: The Mitrofanoff procedure. J Pediatr Urol 2010;6:330-7.
3. Berkowitz J, North AC, Tripp R, Gearhart JP, Laksmanan Y. Mitrofanoff continent catheterizable conduits: top down or bottom up? J Pediatr Urol 2009;5:122-5.
4. Arango Rave ME, Lince Varela LF, Salazar Sanín C, Hoyos Figueroa FC, Hurtado SN, Rendón Isaza JC. [Outcomes the Mitrofanoff technique in the management of patients with neurogenic bladder: the experience in the San Vicente de Paul Universitary Hospital]. Actas Urol Esp 2009;33:69-75.
5. Gundeti MS, Eng MK, Reynolds WS, Zagaja GP. Pediatric robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy: complete intracorporeal--initial case report. Urology 2008;72:1144-7.
6. Thakre AA, Yeung CK, Peters C. Robot-assisted Mitrofanoff and Malone antegrade continence enema reconstruction using divided appendix. J Endourol 2008;22:2393-6.
7. Sahadevan K, Pickard RS, Neal DE, Hasan TS. Is continent diversion using the Mitrofanoff principle a viable long-term option for adults requiring bladder replacement? BJU Int 2008;102:236-40.
8. Lendvay TS, Shnorhavorian M, Grady RW. Robotic-assisted laparoscopic Mitrofanoff appendicovesicostomy and antegrade continent enema colon tube creation in a pediatric spina bifida patient. J Laparoendosc Adv Surg Tech A 2008;18:310-2.
9. Mhiri MN, Bahloul A, Chabchoub K. [Mitrofanoff appendicovesicostomy in children: indication and results]. Prog Urol 2007;17:245-9.
10. Leslie JA, Dussinger AM, Meldrum KK. Creation of continence mechanisms (Mitrofanoff) without appendix: the Monti and spiral Monti procedures. Urol Oncol 2007;25:148-53.
11. Basavaraj DR, Harrison SC. The Mitrofanoff procedure in the management of intractable incontinence: a critical appraisal. Curr Opin Urol 2006;16:244-7.
12. Wille MA, Zagaja GP, Shalhav AL, Gundeti MS. Continence outcomes in patients undergoing robotic assisted laparoscopic mitrofanoff appendicovesicostomy. J Urol 2011;185:1438-43.
13. Wille MA,Jayram G,Gundeti MS Feasibility and early outcomes of robotic-assisted laparoscopic Mitrofanoffappendicovesicostomy in patients with prune belly syndrome BJU Int 2012;109:1:125-9.
14. Gundeti MS, Acharya SS, Zagaja GP, Shalhav AL. Paediatric robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy (RALIMA): feasibility of and initial experience with the University of Chicago technique. BJU Int 2011;107:962-9.
15. Chabchoub K, Ketata H, Fakhfakh H, Bahloul A, Mhiri MN. [Continent urinary diversion (Mitrofanoff principle). Physical mechanisms and urodynamic explanation of continence]. Prog Urol 2008;18:120-4.
16. Karsenty G, Chartier-Kastler E, Mozer P, Even-Schneider A, Denys P, Richard F. A novel technique to achieve cutaneous continent urinary diversion in spinal cord-injured patients unable to catheterize through native urethra. Spinal Cord 2008;46:305-10.
17. Nguyen HT, Passerotti CC, Penna FJ, Retik AB, Peters CA. Robotic assisted laparoscopic Mitrofanoff appendicovesicostomy: preliminary experience in a pediatric population. J Urol 2009;182:1528-34.
18. Vian E, Soustelle L, Viale S, Costa P. [A technique of continent vesicostomy with ileocystoplasty: study of 32 patients]. Prog Urol 2009;19:116-21.
19. Hsu TH, Shortliffe LD. Laparoscopic Mitrofanoff appendicovesicostomy. Urology 2004;64:802-4.
Laparoscopic excision of bladder endometriosis
This is the case of a 34-year-old woman, G1P0010, with a long standing history of chronic pelvic and bladder pain occurring on a monthly basis. The patient has had laparoscopic diagnosis of endometriosis in the past with no resection performed at that time. Given cyclic bladder pain, the patient also underwent cystoscopy, which revealed an implant of bladder endometriosis measuring approximately 2cm in diameter. She has failed medical therapy including oral contraceptives and Lupron from several months. Given her continued bladder pain and severe dysmenorrhea and dyspareunia for the last 5 years, the decision was made to proceed with a surgical intervention.
Operating room specificities:
The patient was positioned in the dorsal lithotomy position with arms tucked bilaterally.
A 12mm port was placed within the umbilicus for the laparoscope. A 5mm port was placed in the left lower quadrant about 2cm superior to the left anterior superior iliac spine. Another 5mm port was placed in the right upper quadrant about 8cm lateral and 2cm inferior to the umbilical port. A final 12mm port was placed in the right lower quadrant, about 2cm superior to the right anterior superior iliac spine. A 7cm clear view uterine manipulator was used.
The primary surgeon was positioned on the left side of the patient. The main surgical assistant, the resident, was positioned on the right side of the patient. The secondary surgical assistant, the fellow, was positioned between the patient’s legs.
M Milad, L Griffin, I Moy, S Bulun
Surgical intervention
7 years ago
2023 views
23 likes
0 comments
03:59
Laparoscopic excision of bladder endometriosis
This is the case of a 34-year-old woman, G1P0010, with a long standing history of chronic pelvic and bladder pain occurring on a monthly basis. The patient has had laparoscopic diagnosis of endometriosis in the past with no resection performed at that time. Given cyclic bladder pain, the patient also underwent cystoscopy, which revealed an implant of bladder endometriosis measuring approximately 2cm in diameter. She has failed medical therapy including oral contraceptives and Lupron from several months. Given her continued bladder pain and severe dysmenorrhea and dyspareunia for the last 5 years, the decision was made to proceed with a surgical intervention.
Operating room specificities:
The patient was positioned in the dorsal lithotomy position with arms tucked bilaterally.
A 12mm port was placed within the umbilicus for the laparoscope. A 5mm port was placed in the left lower quadrant about 2cm superior to the left anterior superior iliac spine. Another 5mm port was placed in the right upper quadrant about 8cm lateral and 2cm inferior to the umbilical port. A final 12mm port was placed in the right lower quadrant, about 2cm superior to the right anterior superior iliac spine. A 7cm clear view uterine manipulator was used.
The primary surgeon was positioned on the left side of the patient. The main surgical assistant, the resident, was positioned on the right side of the patient. The secondary surgical assistant, the fellow, was positioned between the patient’s legs.
Robotic-assisted bladder neck reconstruction using the Goebell-Stoeckel technique and Mitrofanoff appendicovesicostomy
This video reports our experience with robotic bladder neck reconstruction using the Goebell Stoeckel technique and Mitrofanoff appendicovesicostomy.
It is the case of a 62-year-old woman who initially had her urinary stress incontinence treated with a suburethral sling that resulted in the migration of the prosthetic material in the urethra. After prosthesis removal, two attempts of suburethral slings and an attempt at balloon implantation also resulted in erosions and migration of the prosthetic material.
We recommend a continent derivation according to Mitrofanoff principles along with a suburethral autologous sling using Goebell Stoeckel technique.
The video demonstrates that this procedure is feasible and safe with encouraging results.
D Rey, R Mazloum, VE Corona Montes, T Piéchaud
Surgical intervention
7 years ago
1843 views
21 likes
0 comments
14:36
Robotic-assisted bladder neck reconstruction using the Goebell-Stoeckel technique and Mitrofanoff appendicovesicostomy
This video reports our experience with robotic bladder neck reconstruction using the Goebell Stoeckel technique and Mitrofanoff appendicovesicostomy.
It is the case of a 62-year-old woman who initially had her urinary stress incontinence treated with a suburethral sling that resulted in the migration of the prosthetic material in the urethra. After prosthesis removal, two attempts of suburethral slings and an attempt at balloon implantation also resulted in erosions and migration of the prosthetic material.
We recommend a continent derivation according to Mitrofanoff principles along with a suburethral autologous sling using Goebell Stoeckel technique.
The video demonstrates that this procedure is feasible and safe with encouraging results.
Laparoscopic total hysterectomy and unilateral adnexectomy with resection of urinary bladder nodule for endometriosis
This video demonstrates the technique of a total laparoscopic hysterectomy with unilateral adnexectomy and the excision of a vesical endometriotic nodule.
This patient is a 46-year-old lady with a previous surgical history of one laparotomy for a hemoperitoneum (endometriotic ovarian cyst rupture) and 6 laparoscopies because of endometriosis, the last one 3 years ago with a segmental sigmoid resection. After this last surgery, the patient starts to complain of dysmenorrhea, chronic pelvic pain and dysuria. She has never had any urinary infection.
Because of urinary stress incontinence, she had botulinic toxin injection and underwent a cystoscopy, which revealed a bladder nodule.
A Wattiez, S Barata, AM Furtado Lima, P Trompoukis, B Gabriel, J Nassif
Surgical intervention
9 years ago
587 views
31 likes
0 comments
10:14
Laparoscopic total hysterectomy and unilateral adnexectomy with resection of urinary bladder nodule for endometriosis
This video demonstrates the technique of a total laparoscopic hysterectomy with unilateral adnexectomy and the excision of a vesical endometriotic nodule.
This patient is a 46-year-old lady with a previous surgical history of one laparotomy for a hemoperitoneum (endometriotic ovarian cyst rupture) and 6 laparoscopies because of endometriosis, the last one 3 years ago with a segmental sigmoid resection. After this last surgery, the patient starts to complain of dysmenorrhea, chronic pelvic pain and dysuria. She has never had any urinary infection.
Because of urinary stress incontinence, she had botulinic toxin injection and underwent a cystoscopy, which revealed a bladder nodule.
Radical cystoprostatectomy with intracorporeal orthotopic ileal neobladder reconstruction: 3D HD video laparoscopy
The author presents the case of a 64-year-old male patient with a high-grade urothelial carcinoma infiltrating the bladders (pT2-G2), with a CT-scan of the abdomen and thorax negative for secondary localizations. The patient was subjected to a radical cystoprostatectomy with intracorporeal orthotopic ileal neobladder reconstruction, performed entirely in 3D HD videolaparoscopy. After the intervention, the patient is mobilized early. Parenteral feeding is given until restoration of bowel peristalsis. The nasogastric tube is removed with restoration of bowel peristalsis. Continuous antibiotic treatment is administered for 7 days after surgery. Neobladder lavage is performed daily to evacuate mucus. Stents are inspected daily to ensure patency and sterile saline is used if there is any suspicion of obstruction. Deep vein thrombosis prophylaxis is continued. The drain is removed when the draining liquid is less than 50cc per day and when there is no urine leak. A cystogram is performed on postoperative day 14. The stents are removed sequentially at 24 hours of interval. The catheter is extracted from the neobladder 20 days after surgery. The patient is discharged from hospital 21 days after surgery. Two years after the intervention, he presents a negative oncology follow-up. The patient is in a satisfactory general health condition. He has fully recovered and returned to a normal professional life. He urinates regularly and empties his neobladder every 3 to 4 hours, with minimal stress incontinence, particularly in the evening when he is physically tired; he gains erectile activity with the use of medical devices, benefiting from a more effective intracavernous injection therapy and vacuum device, and pharmacotherapy proves less effective.
D Geddo
Surgical intervention
3 months ago
1588 views
12 likes
2 comments
17:33
Radical cystoprostatectomy with intracorporeal orthotopic ileal neobladder reconstruction: 3D HD video laparoscopy
The author presents the case of a 64-year-old male patient with a high-grade urothelial carcinoma infiltrating the bladders (pT2-G2), with a CT-scan of the abdomen and thorax negative for secondary localizations. The patient was subjected to a radical cystoprostatectomy with intracorporeal orthotopic ileal neobladder reconstruction, performed entirely in 3D HD videolaparoscopy. After the intervention, the patient is mobilized early. Parenteral feeding is given until restoration of bowel peristalsis. The nasogastric tube is removed with restoration of bowel peristalsis. Continuous antibiotic treatment is administered for 7 days after surgery. Neobladder lavage is performed daily to evacuate mucus. Stents are inspected daily to ensure patency and sterile saline is used if there is any suspicion of obstruction. Deep vein thrombosis prophylaxis is continued. The drain is removed when the draining liquid is less than 50cc per day and when there is no urine leak. A cystogram is performed on postoperative day 14. The stents are removed sequentially at 24 hours of interval. The catheter is extracted from the neobladder 20 days after surgery. The patient is discharged from hospital 21 days after surgery. Two years after the intervention, he presents a negative oncology follow-up. The patient is in a satisfactory general health condition. He has fully recovered and returned to a normal professional life. He urinates regularly and empties his neobladder every 3 to 4 hours, with minimal stress incontinence, particularly in the evening when he is physically tired; he gains erectile activity with the use of medical devices, benefiting from a more effective intracavernous injection therapy and vacuum device, and pharmacotherapy proves less effective.
Intravesical mini-laparoscopic repair of vesicovaginal fistulas
Vesicovaginal fistulas (VVF) constitute the most common type of genitourinary fistulas. In developed countries, VVF are almost always iatrogenic and frequently a secondary complication of gynecologic surgery. Some minimally invasive techniques have been introduced to decrease morbidity related to standard open procedures for the treatment of VVF. One such procedure is the intravesical mini-laparoscopic approach. The aim of this was to present our initial clinical experience using this technique for transvesical VVF repair. In 2014, we carried out a mini-laparoscopic repair of VVF in two women who did not respond to conservative treatment with a Foley catheter. The procedure was performed transvesically with a 3mm instrument and a 5mm, 30-degree scope. The fistulous tract was dissected and partially excised. The bladder and vaginal wall defects were closed in two layers with two separate running barbed, absorbable 3/0 sutures. Median operative time was approximately 100 minutes, and blood loss was not significant. Patients were discharged from hospital 24 hours after surgery. A Foley catheter was left in place for 14 days. Imaging examinations performed 6 weeks postoperatively revealed no VVF. In patients with simple fistulas, this technique provides a minimally invasive easily reproducible approach with few associated complications.
The advantages of this technique as compared to the conventional laparoscopic approach are described as follows:
- the risk of bleeding is reduced because the size of the incision made is smaller and access to the fistula site is easier and direct without manipulating abdominal structures;
- the length of hospital stay required is significantly shorter with intravesical mini-laparoscopic than laparoscopic surgery conventional approach.
A Llueca, JL Herraiz, M Rodrigo, Y Maazouzi, D Piquer, M Guijarro, A Cañete, J Escrig
Surgical intervention
3 years ago
3184 views
123 likes
0 comments
07:16
Intravesical mini-laparoscopic repair of vesicovaginal fistulas
Vesicovaginal fistulas (VVF) constitute the most common type of genitourinary fistulas. In developed countries, VVF are almost always iatrogenic and frequently a secondary complication of gynecologic surgery. Some minimally invasive techniques have been introduced to decrease morbidity related to standard open procedures for the treatment of VVF. One such procedure is the intravesical mini-laparoscopic approach. The aim of this was to present our initial clinical experience using this technique for transvesical VVF repair. In 2014, we carried out a mini-laparoscopic repair of VVF in two women who did not respond to conservative treatment with a Foley catheter. The procedure was performed transvesically with a 3mm instrument and a 5mm, 30-degree scope. The fistulous tract was dissected and partially excised. The bladder and vaginal wall defects were closed in two layers with two separate running barbed, absorbable 3/0 sutures. Median operative time was approximately 100 minutes, and blood loss was not significant. Patients were discharged from hospital 24 hours after surgery. A Foley catheter was left in place for 14 days. Imaging examinations performed 6 weeks postoperatively revealed no VVF. In patients with simple fistulas, this technique provides a minimally invasive easily reproducible approach with few associated complications.
The advantages of this technique as compared to the conventional laparoscopic approach are described as follows:
- the risk of bleeding is reduced because the size of the incision made is smaller and access to the fistula site is easier and direct without manipulating abdominal structures;
- the length of hospital stay required is significantly shorter with intravesical mini-laparoscopic than laparoscopic surgery conventional approach.
Anterior and posterior laparoscopic mesh removal due to pelvic pain, subtotal hysterectomy, mesh replacement, and Burch procedure
This is the case of a 69-year-old woman presenting with pelvic pain after laparoscopic sacrocolpopexy. The patient has a history of one vaginal birth, laparoscopic sacrocolpopexy with uterine preservation combined with a transobturator tape (TOT) sling procedure performed in 2013.
The following symptoms appeared after surgery: invalidating pelvic pain, especially in an upright position, severe terminal constipation, worsening of a previously mild stress urinary incontinence.
On clinical examination, a high rectocele (grade 2/3), a cystocele, and elective pain at the level of the TOT sling were observed. MRI revealed a perineal inflammation between the anterior aspect of the vagina and the urethra, at the level of the lower third of the urethra. A fibrotic area can be noted at the level of the rectovaginal space.
Her TOT sling was partially resected in January 2014.
Cystoscopy ruled out the presence of mesh erosion. Hysteroscopy was normal.
Endometrial biopsy demonstrated an atrophic endometrium.
In this surgery, the anterior and posterior meshes are removed. A subtotal hysterectomy combined with the replacement of meshes were performed, followed by a Burch procedure.
A Wattiez, I Argay, F Asencio, J Faria, L Schwartz
Surgical intervention
4 years ago
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33:56
Anterior and posterior laparoscopic mesh removal due to pelvic pain, subtotal hysterectomy, mesh replacement, and Burch procedure
This is the case of a 69-year-old woman presenting with pelvic pain after laparoscopic sacrocolpopexy. The patient has a history of one vaginal birth, laparoscopic sacrocolpopexy with uterine preservation combined with a transobturator tape (TOT) sling procedure performed in 2013.
The following symptoms appeared after surgery: invalidating pelvic pain, especially in an upright position, severe terminal constipation, worsening of a previously mild stress urinary incontinence.
On clinical examination, a high rectocele (grade 2/3), a cystocele, and elective pain at the level of the TOT sling were observed. MRI revealed a perineal inflammation between the anterior aspect of the vagina and the urethra, at the level of the lower third of the urethra. A fibrotic area can be noted at the level of the rectovaginal space.
Her TOT sling was partially resected in January 2014.
Cystoscopy ruled out the presence of mesh erosion. Hysteroscopy was normal.
Endometrial biopsy demonstrated an atrophic endometrium.
In this surgery, the anterior and posterior meshes are removed. A subtotal hysterectomy combined with the replacement of meshes were performed, followed by a Burch procedure.