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Adnexal masses: techniques, principles
When dealing with adnexal masses, it is fundamental to learn how to diagnose them, to exclude functional cysts, and to address benign and malignant conditions properly. Looking back on past history, the main factor is the patient’s age, considering that the risk of malignancy increases significantly after menopause. An appropriate selection of patients has helped in the reduction of occurrence of unexpected cancer managed by laparoscopy to 4-6/1000 women with adnexal masses. The operator should always follow surgical principles which include careful examination of the external surface of the tumor, peritoneal cytology, prevention of cyst rupture, prevention of contact between the cyst and the abdominal wall and frozen section examination in case of suspicious lesion. The dermoid cyst is the most common type of ovarian germ cell tumor and the recommended treatment is cystectomy following conventional principles: ovarian capsule incision, cyst wall dissection (making sure not to open it), selective coagulation of bleeders and ovarian closure according to the case. In the case of endometriotic cysts it is recommended to preserve as much ovarian tissue as possible and to preserve the vascularization in the ovarian hilus. Finally during cyst removal from the abdominal cavity, the use of plastic bags has been associated with the lowest rate of cyst spillage.
B Van Herendael
Лекции
7 лет назад
4727 просмотров
97 лайков
0 комментариев
29:56
Adnexal masses: techniques, principles
When dealing with adnexal masses, it is fundamental to learn how to diagnose them, to exclude functional cysts, and to address benign and malignant conditions properly. Looking back on past history, the main factor is the patient’s age, considering that the risk of malignancy increases significantly after menopause. An appropriate selection of patients has helped in the reduction of occurrence of unexpected cancer managed by laparoscopy to 4-6/1000 women with adnexal masses. The operator should always follow surgical principles which include careful examination of the external surface of the tumor, peritoneal cytology, prevention of cyst rupture, prevention of contact between the cyst and the abdominal wall and frozen section examination in case of suspicious lesion. The dermoid cyst is the most common type of ovarian germ cell tumor and the recommended treatment is cystectomy following conventional principles: ovarian capsule incision, cyst wall dissection (making sure not to open it), selective coagulation of bleeders and ovarian closure according to the case. In the case of endometriotic cysts it is recommended to preserve as much ovarian tissue as possible and to preserve the vascularization in the ovarian hilus. Finally during cyst removal from the abdominal cavity, the use of plastic bags has been associated with the lowest rate of cyst spillage.
Robotic assisted ovary preserving excision of a benign serous cystadenoma in a prepubertal symptomatic girl
Symptomatic ovarian cysts or larger incidentally diagnosed ovarian cysts require treatment. If features of malignancy can be reasonably ruled out, minimally invasive procedures can be offered to not only excise the lesion but also preserve the ovary at the same time.
A 10-year-old female child was referred to our department with complaints of right lower abdominal pain which lasted for 6 months. She had no history of vomiting. On examination, her abdomen was soft, non-tender, with no palpable mass, and not distended. Abdominal sonography revealed a 5 by 4.5cm simple cyst in the right adnexa with a 1.7mm wall thickness, with no solid component or septation. Her right ovary was not seen separately. Her left ovary and uterus showed no abnormalities. Malignancy work-up revealed nothing suspicious (Beta-HCG: 2.9 IU/L, AFP: 1.3ng/mL, CA125: 10.9, all within normal range). A robotic-assisted complete cyst excision with preservation of the ovary was performed using 3 arms of the Da Vinci Xi™ robotic surgical system. The patient resumed oral food intake the same evening. He was discharged the following day within 24 hours of the procedure on paracetamol only. The patient was healthy and well. The biopsy reported a benign serous cystadenoma. At a 1-year follow-up, the child is asymptomatic and ovarian preservation was confirmed on postoperative ultrasound. While oophorectomy is eminently feasible with a minimally invasive approach, ovary preservation in benign lesions is quite challenging using pure laparoscopy. Robotic assistance, with its 3D binocular high-definition vision, articulating instruments, and availability of simultaneous energy in both arms, provides better precision and a maximum range of movements. It also helps to preserve the ovary while removing the cyst completely. The case report with a stepwise video of the procedure is demonstrated.
S Kumaravel, A Shenoy
Хирургические операции
1 месяц назад
543 просмотра
8 лайков
1 комментарий
05:24
Robotic assisted ovary preserving excision of a benign serous cystadenoma in a prepubertal symptomatic girl
Symptomatic ovarian cysts or larger incidentally diagnosed ovarian cysts require treatment. If features of malignancy can be reasonably ruled out, minimally invasive procedures can be offered to not only excise the lesion but also preserve the ovary at the same time.
A 10-year-old female child was referred to our department with complaints of right lower abdominal pain which lasted for 6 months. She had no history of vomiting. On examination, her abdomen was soft, non-tender, with no palpable mass, and not distended. Abdominal sonography revealed a 5 by 4.5cm simple cyst in the right adnexa with a 1.7mm wall thickness, with no solid component or septation. Her right ovary was not seen separately. Her left ovary and uterus showed no abnormalities. Malignancy work-up revealed nothing suspicious (Beta-HCG: 2.9 IU/L, AFP: 1.3ng/mL, CA125: 10.9, all within normal range). A robotic-assisted complete cyst excision with preservation of the ovary was performed using 3 arms of the Da Vinci Xi™ robotic surgical system. The patient resumed oral food intake the same evening. He was discharged the following day within 24 hours of the procedure on paracetamol only. The patient was healthy and well. The biopsy reported a benign serous cystadenoma. At a 1-year follow-up, the child is asymptomatic and ovarian preservation was confirmed on postoperative ultrasound. While oophorectomy is eminently feasible with a minimally invasive approach, ovary preservation in benign lesions is quite challenging using pure laparoscopy. Robotic assistance, with its 3D binocular high-definition vision, articulating instruments, and availability of simultaneous energy in both arms, provides better precision and a maximum range of movements. It also helps to preserve the ovary while removing the cyst completely. The case report with a stepwise video of the procedure is demonstrated.
Strategy for laparoscopic total hysterectomy with a big adnexal mass
Hysterectomy when managing a big adnexal mass has always been a challenging situation for laparoscopic surgeons. Complete preoperative assessment, surgical experience and strategy are fundamental to address adnexal pathology laparoscopicallly, both for benign and malignant conditions. Adequate trocar placement, full inspection of the abdominal cavity, comprehensive evaluation of the tumor’s surface, cytology and definition of the nature of the adnexal mass are truly essential. In addition, proper identification of standard anatomical landmarks is fundamental to perform hysterectomy with adnexectomy, which helps to prevent damage to surrounding structures. Final assessment of the vaginal cuff may lead to the diagnosis of pelvic floor disorders that should be repaired during vaginal cuff closure. In this video, we present a case of hysterectomy and adnexectomy by laparoscopy in a 46-year-old patient complaining of abdominal pain secondary to the presence of a 13cm simple adnexal cyst with normal CA 125 values.
A Wattiez, C Zacharopoulou, J Albornoz, M Puga, E Faller
Хирургические операции
7 лет назад
4864 просмотра
139 лайков
0 комментариев
28:57
Strategy for laparoscopic total hysterectomy with a big adnexal mass
Hysterectomy when managing a big adnexal mass has always been a challenging situation for laparoscopic surgeons. Complete preoperative assessment, surgical experience and strategy are fundamental to address adnexal pathology laparoscopicallly, both for benign and malignant conditions. Adequate trocar placement, full inspection of the abdominal cavity, comprehensive evaluation of the tumor’s surface, cytology and definition of the nature of the adnexal mass are truly essential. In addition, proper identification of standard anatomical landmarks is fundamental to perform hysterectomy with adnexectomy, which helps to prevent damage to surrounding structures. Final assessment of the vaginal cuff may lead to the diagnosis of pelvic floor disorders that should be repaired during vaginal cuff closure. In this video, we present a case of hysterectomy and adnexectomy by laparoscopy in a 46-year-old patient complaining of abdominal pain secondary to the presence of a 13cm simple adnexal cyst with normal CA 125 values.
Laparoscopic resection of endometriotic fibrotic nodule extending from the posterior lateral aspect of the uterus to the left pelvic sidewall, encasing the internal iliac vessels and adherent to the mid-sigmoid colon
Deep endometriosis is one of the most complex and risky surgeries. Its laparoscopic management requires a systematic approach, a good anatomical knowledge, and a high level of surgical competency.
This is the case of a 37-year-old lady presenting with a complex deep pelvic endometriosis. She had a long history of severe dysmenorrhea, colicky abdominal pain, back pain, and constipation. Imaging studies (MR) showed a large fibrotic endometriotic nodule extending from the posterior lateral aspect of the uterus to the left pelvic sidewall, encasing the internal iliac vessels, nerves, and adherent to a 4cm segment of the mid-sigmoid colon.
This patient has a complicated past history of left ureter ligation during a caesarean section (in 2011), which resulted in a left-sided nephrectomy in 2012. She got a pneumothorax complication, lung drainage, right-side thoracotomy in 2013, and finally a total pleurectomy in 2014.
A Wattiez, R Nasir, I Argay
Хирургические операции
2 года назад
5552 просмотра
315 лайков
2 комментария
42:42
Laparoscopic resection of endometriotic fibrotic nodule extending from the posterior lateral aspect of the uterus to the left pelvic sidewall, encasing the internal iliac vessels and adherent to the mid-sigmoid colon
Deep endometriosis is one of the most complex and risky surgeries. Its laparoscopic management requires a systematic approach, a good anatomical knowledge, and a high level of surgical competency.
This is the case of a 37-year-old lady presenting with a complex deep pelvic endometriosis. She had a long history of severe dysmenorrhea, colicky abdominal pain, back pain, and constipation. Imaging studies (MR) showed a large fibrotic endometriotic nodule extending from the posterior lateral aspect of the uterus to the left pelvic sidewall, encasing the internal iliac vessels, nerves, and adherent to a 4cm segment of the mid-sigmoid colon.
This patient has a complicated past history of left ureter ligation during a caesarean section (in 2011), which resulted in a left-sided nephrectomy in 2012. She got a pneumothorax complication, lung drainage, right-side thoracotomy in 2013, and finally a total pleurectomy in 2014.
Laparoscopy for peritonitis of gynecological origin, how far can we go?
This video shows the second and final laparoscopic treatment of a generalized peritonitis. The case is that of a 38-year-old woman who was initially managed with a first laparoscopy for peritonitis due to a pyosalpinx with left salpingectomy, adhesiolysis, and lavage. In the postoperative course, despite medical treatment, she continues to complain of a persistent severe biologic inflammatory syndrome (multidrug-resistant Bacteroides fragilis). At day 8, a second laparoscopy was decided upon, with suction, lavage, collapse, and lavage of residual pockets, adhesiolysis of bowel and both ovaries and remnant tube, and drainage. The patient recovered quickly.
JB Dubuisson
Хирургические операции
2 года назад
5399 просмотров
588 лайков
0 комментариев
08:01
Laparoscopy for peritonitis of gynecological origin, how far can we go?
This video shows the second and final laparoscopic treatment of a generalized peritonitis. The case is that of a 38-year-old woman who was initially managed with a first laparoscopy for peritonitis due to a pyosalpinx with left salpingectomy, adhesiolysis, and lavage. In the postoperative course, despite medical treatment, she continues to complain of a persistent severe biologic inflammatory syndrome (multidrug-resistant Bacteroides fragilis). At day 8, a second laparoscopy was decided upon, with suction, lavage, collapse, and lavage of residual pockets, adhesiolysis of bowel and both ovaries and remnant tube, and drainage. The patient recovered quickly.
Laparoscopic retroperitoneal access to ovarian cysts fixed by severe pelvic adhesions: a case report
Left cystectomy or left adnexectomy can be difficult in cases of frozen pelvis, with an adnexa entirely covered with the sigmoid colon and stuck to the pelvic sidewall.
This video clearly demonstrates the advantages of the left retroperitoneal access to the adnexa, limiting the risks of injury of the ureter and the perforation of the sigmoid colon. The different steps of the operation are as follows: 1) Lysis of adhesions between the sigmoid colon and the left pelvic sidewall to visualize the tube. 2) Division of adhesions between the sigmoid colon and the uterus to visualize the left ovary. 3) Left retroperitoneal access to the ovary with a longitudinal incision of the peritoneum, laterally. 4) Division of the utero-ovarian pedicle. 5) Retroperitoneal dissection of the ureter to completely release the ovary from the ureter. 6) Lysis of the upper surface of the ovary from the sigmoid colon.
JB Dubuisson, J Dubuisson
Хирургические операции
3 года назад
5686 просмотров
299 лайков
0 комментариев
08:20
Laparoscopic retroperitoneal access to ovarian cysts fixed by severe pelvic adhesions: a case report
Left cystectomy or left adnexectomy can be difficult in cases of frozen pelvis, with an adnexa entirely covered with the sigmoid colon and stuck to the pelvic sidewall.
This video clearly demonstrates the advantages of the left retroperitoneal access to the adnexa, limiting the risks of injury of the ureter and the perforation of the sigmoid colon. The different steps of the operation are as follows: 1) Lysis of adhesions between the sigmoid colon and the left pelvic sidewall to visualize the tube. 2) Division of adhesions between the sigmoid colon and the uterus to visualize the left ovary. 3) Left retroperitoneal access to the ovary with a longitudinal incision of the peritoneum, laterally. 4) Division of the utero-ovarian pedicle. 5) Retroperitoneal dissection of the ureter to completely release the ovary from the ureter. 6) Lysis of the upper surface of the ovary from the sigmoid colon.
Severe complex endometriosis with ascites: laparoscopic management
Frozen pelvis due to endometriosis is one of the most complex and risky situations which surgeons sometimes face. Its laparoscopic management requires a systematic approach, a good anatomical knowledge and a high level of surgical competency. This is a frozen pelvis case secondary to a complicated severe endometriosis in a young nulliparous lady. She had hemorrhagic abdominal ascites secondary to endometriosis, with a sub-occlusive syndrome. Her disease was further complicated with upper abdominal and pelvic fibrosis with a large umbilical endometriotic nodule as well as splenic, omental and sigmoid endometriosis. This video demonstrates the strategy of the laparoscopic management of this condition.
A Wattiez, R Nasir, A Host
Хирургические операции
4 года назад
4162 просмотра
162 лайка
0 комментариев
31:22
Severe complex endometriosis with ascites: laparoscopic management
Frozen pelvis due to endometriosis is one of the most complex and risky situations which surgeons sometimes face. Its laparoscopic management requires a systematic approach, a good anatomical knowledge and a high level of surgical competency. This is a frozen pelvis case secondary to a complicated severe endometriosis in a young nulliparous lady. She had hemorrhagic abdominal ascites secondary to endometriosis, with a sub-occlusive syndrome. Her disease was further complicated with upper abdominal and pelvic fibrosis with a large umbilical endometriotic nodule as well as splenic, omental and sigmoid endometriosis. This video demonstrates the strategy of the laparoscopic management of this condition.
Strategy for laparoscopic total hysterectomy and bilateral salpingectomy in case of large uterus
This video demonstrates the case of a 46-year-old patient presented with menorrhagia and anemia.
Clinical examination revealed a large mass almost reaching the level of the umbilicus.
The uterus appeared much bigger than usual on MRI, with a large myoma coming out of the pelvis.
It was decided to perform total laparoscopic hysterectomy combined with bilateral salpingectomy.
This video demonstrates the appropriate strategy to safely perform total laparoscopic hysterectomy in case of large uterus, showing the appropriate surgical steps and providing safety tips. The specimen weighed more than 1kg.
A Wattiez, F Asencio, J Faria, I Argay, L Schwartz
Хирургические операции
4 года назад
9359 просмотров
312 лайков
0 комментариев
25:01
Strategy for laparoscopic total hysterectomy and bilateral salpingectomy in case of large uterus
This video demonstrates the case of a 46-year-old patient presented with menorrhagia and anemia.
Clinical examination revealed a large mass almost reaching the level of the umbilicus.
The uterus appeared much bigger than usual on MRI, with a large myoma coming out of the pelvis.
It was decided to perform total laparoscopic hysterectomy combined with bilateral salpingectomy.
This video demonstrates the appropriate strategy to safely perform total laparoscopic hysterectomy in case of large uterus, showing the appropriate surgical steps and providing safety tips. The specimen weighed more than 1kg.
Big rectovaginal endometriotic nodule with right hypogastric nerve entrapment followed by ultra-low rectum discoid resection using a hemorrhoidal stapler
This video demonstrates the laparoscopic management of a 30-year-old woman with a large, symptomatic rectovaginal endometriotic nodule, associated with right hypogastric nerve entrapment, extending up to the ipsilateral sciatic spine, as well as transmural vaginal and rectal invasion. In order to perform a complete nodule resection, the right hypogastric nerve was sacrificed, the vagina had to be opened, and an ultra-low rectum discoid resection using a hemorrhoidal stapler was performed.
A Wattiez, J Leroy, J Faria, I Argay, F Asencio, L Schwartz, K Afors, R Fernandes, C Meza Paul
Хирургические операции
4 года назад
3652 просмотра
91 лайк
0 комментариев
18:38
Big rectovaginal endometriotic nodule with right hypogastric nerve entrapment followed by ultra-low rectum discoid resection using a hemorrhoidal stapler
This video demonstrates the laparoscopic management of a 30-year-old woman with a large, symptomatic rectovaginal endometriotic nodule, associated with right hypogastric nerve entrapment, extending up to the ipsilateral sciatic spine, as well as transmural vaginal and rectal invasion. In order to perform a complete nodule resection, the right hypogastric nerve was sacrificed, the vagina had to be opened, and an ultra-low rectum discoid resection using a hemorrhoidal stapler was performed.
Laparoscopic segmental resection in a patient with deep infiltrating endometriosis
We present the case of a 33-year-old-woman suffering from deep infiltrating endometriosis. In her previous history, three laparoscopies had been performed due to endometriosis. In the first two laparoscopies, bilateral ovarian cystectomies had been carried out while the third laparoscopy had been indicated to puncture the ovaries after hormonal stimulation for in vitro fertilization (IVF), due to the impossibility of reaching follicles transvaginally.
The patient presented with dysmenorrhea, dyspareunia and dyschezia, as well as rectorrhagia and diarrhea. The patient’s physical examination demonstrated the presence of a retrouterine mass suggestive of adhesions. Preoperative work-up included MRI and colonoscopy. MRI showed an endometriotic nodule affecting the rectosigmoid junction and infiltrating its wall. A colonoscopy was performed and allowed to visualize the endometriotic nodule.
A Wattiez, C Redondo Guisasola, M Puga, J Alves, R Fernandes
Хирургические операции
6 лет назад
2695 просмотров
31 лайк
0 комментариев
18:50
Laparoscopic segmental resection in a patient with deep infiltrating endometriosis
We present the case of a 33-year-old-woman suffering from deep infiltrating endometriosis. In her previous history, three laparoscopies had been performed due to endometriosis. In the first two laparoscopies, bilateral ovarian cystectomies had been carried out while the third laparoscopy had been indicated to puncture the ovaries after hormonal stimulation for in vitro fertilization (IVF), due to the impossibility of reaching follicles transvaginally.
The patient presented with dysmenorrhea, dyspareunia and dyschezia, as well as rectorrhagia and diarrhea. The patient’s physical examination demonstrated the presence of a retrouterine mass suggestive of adhesions. Preoperative work-up included MRI and colonoscopy. MRI showed an endometriotic nodule affecting the rectosigmoid junction and infiltrating its wall. A colonoscopy was performed and allowed to visualize the endometriotic nodule.
Laparoscopic oophorectomy for solid ovarian mass
We present the case of a 28-year-old woman with no relevant previous surgical or medical history. The patient was addressed for the removal of a right ovarian mass. She presented with dysmenorrhea and occasional dyspareunia. There were no other symptoms. Her physical examination showed a right adnexal mass to the vaginal touch. Preoperative work-up included a pelvic ultrasound, which showed a tumor apparently originating from the right ovary, of solid homogeneous appearance. MRI confirmed the presence of the solid mass, measuring approximately 6cm. No other pathological findings were present in the rest of the abdominal cavity. Tumor markers were negative. The patient had not completed childbearing and desired a conservative surgical approach. The different aspects of the surgical management were explained, including the possibility of performing an oophorectomy if no healthy ovarian tissue could be identified.
A Wattiez, C Redondo Guisasola, M Puga, R Fernandes, J Alves
Хирургические операции
6 лет назад
5509 просмотров
84 лайка
0 комментариев
08:33
Laparoscopic oophorectomy for solid ovarian mass
We present the case of a 28-year-old woman with no relevant previous surgical or medical history. The patient was addressed for the removal of a right ovarian mass. She presented with dysmenorrhea and occasional dyspareunia. There were no other symptoms. Her physical examination showed a right adnexal mass to the vaginal touch. Preoperative work-up included a pelvic ultrasound, which showed a tumor apparently originating from the right ovary, of solid homogeneous appearance. MRI confirmed the presence of the solid mass, measuring approximately 6cm. No other pathological findings were present in the rest of the abdominal cavity. Tumor markers were negative. The patient had not completed childbearing and desired a conservative surgical approach. The different aspects of the surgical management were explained, including the possibility of performing an oophorectomy if no healthy ovarian tissue could be identified.
Segmental bowel resection and transanal specimen extraction for Deep Infiltrating Endometriosis (DIE)
Endometriosis can affect the bowel in 5-15% of cases and the most common sites are the rectum, the sigmoid colon, the appendix, and the small bowel. Patients may present dysmenorrhea, dyspareunia and chronic pelvic pain, as well as digestive symptoms such as dyschezia, constipation and diarrhea during menstruation. Preoperative work-up includes transanal ultrasound and magnetic resonance imaging, which according to the nodule’s location, can accurately describe the lesions. The laparoscopic approach includes adhesiolysis (shaving), partial thickness wall excision (mucosal skinning), discoid resection, and segmental bowel resection. In this video, we present the case of a 30-year-old patient complaining from severe dysmenorrhea, dyspareunia and dyschezia associated with deep infiltrating endometriosis (DIE) of the sigmoid colon that was treated by means of nodule excision, segmental bowel resection, and transanal specimen extraction.
A Wattiez, J Leroy, J Albornoz, E Faller, M Puga
Хирургические операции
7 лет назад
2476 просмотров
15 лайков
0 комментариев
10:12
Segmental bowel resection and transanal specimen extraction for Deep Infiltrating Endometriosis (DIE)
Endometriosis can affect the bowel in 5-15% of cases and the most common sites are the rectum, the sigmoid colon, the appendix, and the small bowel. Patients may present dysmenorrhea, dyspareunia and chronic pelvic pain, as well as digestive symptoms such as dyschezia, constipation and diarrhea during menstruation. Preoperative work-up includes transanal ultrasound and magnetic resonance imaging, which according to the nodule’s location, can accurately describe the lesions. The laparoscopic approach includes adhesiolysis (shaving), partial thickness wall excision (mucosal skinning), discoid resection, and segmental bowel resection. In this video, we present the case of a 30-year-old patient complaining from severe dysmenorrhea, dyspareunia and dyschezia associated with deep infiltrating endometriosis (DIE) of the sigmoid colon that was treated by means of nodule excision, segmental bowel resection, and transanal specimen extraction.
Laparoscopic left parametrectomy for Deep Infiltrating Endometriosis (DIE)
Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, which induces a chronic inflammatory reaction.
Deep infiltrating endometriosis nodules extend beyond 5mm beneath the peritoneum and may involve the uterosacral ligaments, vagina, bowel, bladder and ureters. This is the case of a 40-year-old multiparous woman complaining of significant dysmenorrhea, mild dyspareunia, and left inguinal pain.
In this video, we show the dissection of the left parametrium and the resection of an endometriotic nodule that had exerted an extrinsic compression over the obturator nerve.
A Wattiez, J Albornoz, E Faller, P Messori
Хирургические операции
7 лет назад
3204 просмотра
21 лайк
0 комментариев
09:32
Laparoscopic left parametrectomy for Deep Infiltrating Endometriosis (DIE)
Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, which induces a chronic inflammatory reaction.
Deep infiltrating endometriosis nodules extend beyond 5mm beneath the peritoneum and may involve the uterosacral ligaments, vagina, bowel, bladder and ureters. This is the case of a 40-year-old multiparous woman complaining of significant dysmenorrhea, mild dyspareunia, and left inguinal pain.
In this video, we show the dissection of the left parametrium and the resection of an endometriotic nodule that had exerted an extrinsic compression over the obturator nerve.
Total laparoscopic removal of huge uterus using the Ligasure™ device, classical bipolar and barbed V-Loc™ suture
We present the case of a 54-year-old woman with pelvic pain. The ultrasound shows a huge uterus with multiple fibroids. The abdominal exploration shows a uterus size equivalent to a 24-week gestation. In this video, we demonstrate that total laparoscopic hysterectomy can be performed without too much difficulty despite uterine size, thanks to alternative technologies such as a Ligasure™ device, barbed suture and Clermont-Ferrand uterine manipulator. An adequate knowledge of the anatomy and surgical technique is necessary for this procedure.
A Wattiez, A Vázquez Rodriguez, R Rovira Negre, S Maia, J Alcocer
Хирургические операции
8 лет назад
3432 просмотра
20 лайков
0 комментариев
07:55
Total laparoscopic removal of huge uterus using the Ligasure™ device, classical bipolar and barbed V-Loc™ suture
We present the case of a 54-year-old woman with pelvic pain. The ultrasound shows a huge uterus with multiple fibroids. The abdominal exploration shows a uterus size equivalent to a 24-week gestation. In this video, we demonstrate that total laparoscopic hysterectomy can be performed without too much difficulty despite uterine size, thanks to alternative technologies such as a Ligasure™ device, barbed suture and Clermont-Ferrand uterine manipulator. An adequate knowledge of the anatomy and surgical technique is necessary for this procedure.
Total laparoscopic hysterectomy with bilateral adnexectomy: standard technique
Despite much enthusiasm at the early stages of laparoscopic surgery, laparoscopy did not develop as expected. Detractors of laparoscopic surgery mention its difficulty and its length. This could explain that only about 12% of hysterectomies are perfomed laparoscopically (Wu JM et al., 2007). Nevertheless, we believe that the standardization of total laparoscopic hysterectomy (TLH) can simplify this surgery, make it faster and also more reproducible. This video demonstrates the 10 key steps of a TLH with adnexectomy that can help any gynecologic surgeon to safely reproduce the procedure.
A Wattiez, A Vázquez Rodriguez, S Maia, J Alcocer
Хирургические операции
8 лет назад
21457 просмотров
354 лайка
0 комментариев
07:32
Total laparoscopic hysterectomy with bilateral adnexectomy: standard technique
Despite much enthusiasm at the early stages of laparoscopic surgery, laparoscopy did not develop as expected. Detractors of laparoscopic surgery mention its difficulty and its length. This could explain that only about 12% of hysterectomies are perfomed laparoscopically (Wu JM et al., 2007). Nevertheless, we believe that the standardization of total laparoscopic hysterectomy (TLH) can simplify this surgery, make it faster and also more reproducible. This video demonstrates the 10 key steps of a TLH with adnexectomy that can help any gynecologic surgeon to safely reproduce the procedure.
Laparoscopic hysterectomy: removal of a large (1300g) uterus
Some believe that laparoscopy is almost impossible to perform in cases of very big uterus or large adnexal masses that obstruct our view to the pelvis. However, if the same surgical steps are always followed and a specific strategy is determined, it is feasible and safe to choose laparoscopy even in the case of large organs. In this video, we present the case of a 45-year-old patient with a large fibromatous uterus, suffering from abdominal discomfort and bleeding. The patient was anemic and decision was made to perform a laparoscopic total hysterectomy. With the appropriate surgical steps and some safety tips, the operation took place quickly and with success. The weight of the specimen was 1300g.
A Wattiez, P Trompoukis, J Nassif, B Gabriel
Хирургические операции
9 лет назад
5401 просмотр
54 лайка
0 комментариев
10:21
Laparoscopic hysterectomy: removal of a large (1300g) uterus
Some believe that laparoscopy is almost impossible to perform in cases of very big uterus or large adnexal masses that obstruct our view to the pelvis. However, if the same surgical steps are always followed and a specific strategy is determined, it is feasible and safe to choose laparoscopy even in the case of large organs. In this video, we present the case of a 45-year-old patient with a large fibromatous uterus, suffering from abdominal discomfort and bleeding. The patient was anemic and decision was made to perform a laparoscopic total hysterectomy. With the appropriate surgical steps and some safety tips, the operation took place quickly and with success. The weight of the specimen was 1300g.
Laparoscopic myomectomy: tips 'n tricks
Surgery is the treatment of choice for myomas. Myomectomy has undergone a dramatic evolution over the years. Laparoscopic myomectomy provides a preferable alternative to abdominal myomectomy for women with symptomatic fibroids who desire uterine preservation. It is also an excellent method for women who have infertility primarily related to fibroids. A lot of patients prefer myomectomy over hysterectomy even if they do not desire pregnancy. However, laparoscopic myomectomy is not easy and needs some practice. Together with the basic steps, some tips and tricks are provided to make this technique even more safe and feasible for surgeons. For good results, the use of a few technical tricks provides an optimal solution for all issues.
A Wattiez, P Trompoukis, AM Furtado Lima, J Nassif, B Gabriel
Хирургические операции
9 лет назад
10167 просмотров
192 лайка
0 комментариев
08:35
Laparoscopic myomectomy: tips 'n tricks
Surgery is the treatment of choice for myomas. Myomectomy has undergone a dramatic evolution over the years. Laparoscopic myomectomy provides a preferable alternative to abdominal myomectomy for women with symptomatic fibroids who desire uterine preservation. It is also an excellent method for women who have infertility primarily related to fibroids. A lot of patients prefer myomectomy over hysterectomy even if they do not desire pregnancy. However, laparoscopic myomectomy is not easy and needs some practice. Together with the basic steps, some tips and tricks are provided to make this technique even more safe and feasible for surgeons. For good results, the use of a few technical tricks provides an optimal solution for all issues.
Laparoscopic sacrocolpopexy and subtotal hysterectomy for Pelvic Organ Prolapse
We report the clinical case of a 59-year-old patient with a previous obstetrical history of two normal deliveries and a previous surgical history of appendectomy, lobular breast cancer treated by breast-preserving surgery, radiation and hormone therapy.
This patient complains of vaginal bulge symptoms and of a mild Stress Urinary Incontinence.
On clinical examination, a cystocele stage III, uterine prolapse stage II, and rectocele stage I were found.
The urodynamic examination revealed no bladder instability, UCP: 89cm H20, normal compliance, and negative clinical stress test.
A Wattiez, AM Furtado Lima, P Trompoukis, B Gabriel, J Nassif
Хирургические операции
9 лет назад
5574 просмотра
53 лайка
0 комментариев
08:37
Laparoscopic sacrocolpopexy and subtotal hysterectomy for Pelvic Organ Prolapse
We report the clinical case of a 59-year-old patient with a previous obstetrical history of two normal deliveries and a previous surgical history of appendectomy, lobular breast cancer treated by breast-preserving surgery, radiation and hormone therapy.
This patient complains of vaginal bulge symptoms and of a mild Stress Urinary Incontinence.
On clinical examination, a cystocele stage III, uterine prolapse stage II, and rectocele stage I were found.
The urodynamic examination revealed no bladder instability, UCP: 89cm H20, normal compliance, and negative clinical stress test.
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
Хирургические операции
9 лет назад
616 просмотров
31 лайк
0 комментариев
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.
Laparoscopic ureteral anastomosis in a patient with hydronephrosis due to a severe endometriosis
Ureteral endometriosis is unfrequent and it is defined by the presence of endometrial glands in the ureteric or pre-ureteric tissue. The prevalence reported is less than 1% and usually confined to the lower one-third of the left ureter. This pathology generates a ureteral stenosis, with an extrinsic compression of the ureteral wall by the inflammatory response and fibrosis, or an intrinsic stenosis with the invasion of the uro-epithelium and submucosal layer of the ureteral wall. We present a short video describing the technique of the laparoscopic segmental ureteral resection followed by the re-anastomosis.
I Miranda-Mendoza, J Nassif, E Kovoor, A Wattiez
Хирургические операции
9 лет назад
3495 просмотров
9 лайков
0 комментариев
07:57
Laparoscopic ureteral anastomosis in a patient with hydronephrosis due to a severe endometriosis
Ureteral endometriosis is unfrequent and it is defined by the presence of endometrial glands in the ureteric or pre-ureteric tissue. The prevalence reported is less than 1% and usually confined to the lower one-third of the left ureter. This pathology generates a ureteral stenosis, with an extrinsic compression of the ureteral wall by the inflammatory response and fibrosis, or an intrinsic stenosis with the invasion of the uro-epithelium and submucosal layer of the ureteral wall. We present a short video describing the technique of the laparoscopic segmental ureteral resection followed by the re-anastomosis.