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Conclusion: Our technique is a simple, quick, reliable and safe method to

conrm the accurate insertion of the Veress needle.

310 Open Communications 17dLaparoscopy
(4:50 PM d 4:55 PM)
Combination VideoAssisted Thoracoscopic Surgery and Video
Assisted Laparoscopic Surgery for Treatment of Endometriosis: A
Multidisciplinary Approach
Miller JM,
Paka C,
Beygui R,
Nezhat C.
1 1
Stanford University Hospital,
Department of Obstetrics and Gynecology, Center for Special Minimally
Invasive and Robotic Surgery, Palo Alto, California;
Stanford University
Hospital, Department of Cardiothorasic Surgery, Stanford Cardiothorasic
Surgery, Mountain View, California
Study Objective: To report our institutions experience of systematically
combining video assisted thoracoscopic surgery (VATS) and video
assisted laparoscopic surgery (VALS) for the treatment of abdomino-
pelvic, diaphragmatic and thoracic endometriosis.
Design: Retrospective study.
Setting: Tertiary referral center.
Patients: Patients with signs and symptoms consistent with abdomino-
pelvic, diaphragmatic and thoracic endometriosis.
Intervention: All patients, who met criteria, underwent a combined VATS
and VALS treatment of potential endometriosis from 1/2008 to 8/2012.
Measurements and Main Results: Current data set includes 19 patients
with the average age at time of surgical intervention being 37 years (25 -
60). All patients except one had an extensive history of dysmenorrhea and
dyspareunia. Eighty-nine percent had complaints of catamenial chest pain
and in 53% this was their only chest complaint. Catamenial pneumothorax
was noted in 26%, shoulder pain in 21% and 16% had hemoptysis. Eighty-
four percent of patients had undergone previous surgery for treatment of
endometriosis. For those who underwent previous surgery for
endometriosis, the average time to a combined, multidisciplinary surgical
treatment was 10 years from initial surgical diagnosis of endometriosis.
Only three out of the 19 cases had no previous diagnosis of endometriosis.
Eighty-nine percent of the cases (17) had no major postoperative
complications. There was one major thoracic complication and one major
pelvic complication of a vaginal cuff hematoma occurring after
a hysterectomy requiring two additional VALS and a blood transfusion.
Conclusion: Clinical suspicion and preoperative assessment is crucial in the
diagnosis of thoracic endometriosis and allows for a multidisciplinary
preconsultation. Combination of VATS and VALS for treatment of
endometriosis optimally addresses the pelvis, diaphragm and thoracic
cavity in a single operation. This case series represents an opportunity to
further evaluate extragenital manifestations of endometriosis and surgical
treatment options in a multidisciplinary setting.
311 Video Session 9dHysteroscopy
(3:20 PM d 3:26 PM)
Outpatient Resection of Fibroid: A Patients View
Penketh R, Bruen E, Groves L, Hill S, Patwardhen A, Lindsay P,
Grifths A. Obstetrics and Gynaecology, Cardiff and Vale University
Health Board, Cardiff, Wales, United Kingdom
Following the award of a Health Foundation Shine 2010 grant the team
started resection of broids and polyps in the outpatient clinic (ofce).
Over 350 resections have been attempted with over 90% success and less
than 2% failure of resection Eight or 10 mm Storz monopolar
resectoscope (gravity fed glycine, maximum 9L, minimal decit).
Contemporaneous pain scores averaged 3.5/10, and independent evaluation
of patient experience was extremely positive.
Comparative cost analysis reveals savings of 650 ($1000) compared with
general anaesthetic in theatre and over 270 ($400) compared to
disposable bipolar instrumentation.
Tissue weights are available in 268specimens and 70 of these (26%) weighed
over 2 grammes, regarded as the upper limit for removal in outpatients
During the resection of a particularly large broid (29G) the patient
produced her iphone and captured unique footage of the procedure and
312 Video Session 9dHysteroscopy
(3:27 PM d 3:33 PM)
The Diverse Hysteroscopic Appearance in Cases of Retained
Products of Conception
Smorgick N, Barel O, Vaknin Z, Halperin R, Pansky M. Obstetrics and
Gynecology, Assaf Harofe Medical Center, Tel Aviv University, Beer
Yaakov, Israel
Retained products of conception (RPOC), also called residual throphoblastic
tissue, may occur after any type of delivery or pregnancy termination.
Hysteroscopy is considered the gold standard for the diagnosis of RPOC.
From our experience, different types of RPOC have different
hysteroscopic appearance. The purpose of this video is to describe the
hysteroscopic ndings in cases of RPOC and the hysteroscopic approach
used to treat these cases.
313 Video Session 9dHysteroscopy
(3:34 PM d 3:42 PM)
Management of AUB in a Bicornuate Uterus: Endometrial Ablation
in a Complex Medical Patient
Chudnoff SG, Levie M, Lieberman E. Obstetrics & Gynecology and
Womens Health, Monteore Medical Center / Albert Einstein College of
Medicine, Bronx, New York
The management of abnormal uterine bleeding (AUB) is routine in many
gynecologic practices, however, certain medical considerations may create
difculty in its management. We present a case of a patient with a history
of peripartum cardiomyopathy, hypertention, a bicornuate uterus, and who
has Essure coils in-situ who has failed other managements for her AUB or
was not a candidate for those managements. We managed the patient by
performing an endometrial ablation with the hydrothermal ablation
system. We demonstrate our approach for dealing with uterine anomalies
with this technique. The patient tolerated the procedure well and reported
ammenorrhea at 6 months post-procedure.
314 Video Session 9dHysteroscopy
(3:43 PM d 3:51 PM)
Fertility Sparing (Minimally Invasive) Treatment of Arteriovenous
Malformation of the Uterus with Mullerian Anomaly
Khan Z,
Woodrum DA,
Jensen JR.
1 1
Department of Obstetrics &
Gynecology, Division of Reproductive Endocrinology & Infertility, Mayo
Clinic, Rochester, Minnesota;
Department of Rdiology, Division of
Vascular & Interventional Radiology, Mayo Clinic, Rochester, Minnesota
Arteriovenous malformation of the uterus is a rare condition that may be
congenital or acquired. While hysterectomy is the denitive therapy,
uterine artery embolization appears to be an effective uterine sparing
option. More than 85 cases of embolization of uterine arteriovenous
malformation have been reported. Restoration of normal menstrual cycles
and successful pregnancies have been reported in 2 cases.
We present the case of a 24 year old G1P0010 patient who was diagnosed
with a septate uterus and a heterogenous mass in the uterus. MR and
ultrasonographic imaging suggested presence of an arteriovenous
malformation in the uterus.
The patient underwent a bilateral uterine artery embolization where the
arteriovenous malformation in the uterus was targeted. Following
resolution of the vascular lesion a hysteroscopic septoplasty was
performed without any complications.
The patient recovered from the procedure and is currently pregnant in her
second trimester.
S98 Abstracts / Journal of Minimally Invasive Gynecology 20 (2013) S95S132