scientific program • symposia - American Society for Reproductive ...

VIDEO PROGRAM
Tuesday, October 18, 2011 4:15 pm – 6:15 pm
ASRM Video Session II
REPRODUCTIVE SURGERY
Moderators: TBD
V-11 4:20 PM
LAPAROSCOPIC ASSISTED MYOMECTOMY.
M. Catenacci, M. Attaran, T. Falcone. Cleveland Clinic
Foundation, Cleveland, OH.
OBJECTIVE: The objective of this video is to demonstrate our
technique for a laparoscopic assisted myomectomy.
DESIGN: Laparoscopic assisted myomectomy uses three
5 mm traditional laparoscopic ports and a Gelpoint
laparoscopic port for the minilaparotomy incision. The
fibroid(s) is enucleated from the uterus using traditional
laparoscopic technique. Dilute vasopressin is first injected
subserosally. A monopolar hook or Harmonic scalpel is
then used to incise the serosa over the myoma. Sharp and
blunt dissection is used to remove the fibroid from its uterine
attachment. The fibroid is then morcellated through the
minilaparotomy incision and the myometrial defect is then
closed.
MATERIALS AND METHODS: Laparoscopic assisted
myomectomy offers benefits of both abdominal and
laparoscopic procedures with an overall decrease in
operative time, quicker patient recovery and an open
closure of the myometrial defect. The Gelpoint laparoscopic
port can be useful as it allows for easy conversion between
laparoscopy and laparotomy.
__________________________________________________________
V-12 4:26 PM
ROBOTIC MYOMECTOMY WITH FLEXIBLE CO2 LASER.
A. R. Gargiulo. Center for Infertility and Reproductive
Surgery, Brigham and Women’s Hospital/Harvard Medical
School, Boston, MA.
OBJECTIVE: We describe the use of a flexible carbon
dioxide (CO2) laser system recently made commercially
available by OmniGuide (Cambridge, Massachusetts) in
the management of uterine fibroids in a robot-assisted
procedure. Conventional optic fibers transmit light through a
solid core whereas the novel flexible fibers employed in this
case have a hollow core.
DESIGN: The patient was a 35 year old with menorrhagia
and pelvic pain. The CO2 laser was the only form of thermal
energy employed in this case to enucleate a 7 transmural
and a 4 cm subserosal myoma. An 8 mm robotic needle
driver was used to grasp the 2 mm laser fiber introducer.
The design of the delivery system also assisted with blunt
tissue dissection. The OmniGuide delivery system was set to
create a cutting beam at a distance of 2-3 mm from the
tip of the device to the tissue. A low flow of helium gas was
delivered through the hollow core of the fiber effectively
dried the target tissue, enhancing the laser hemostatic
effect. A relevant safety feature of this CO2 laser system
was the absence of plume. The laser also allowed easy
excision of an area of peritoneum with endometriosis.
For this application, we used the system at a low power,
allowing tissue penetration under 500 microns. There were
no complications.
MATERIALS AND METHODS: Our initial experience suggests
that the introduction of a truly flexible, fiber-based CO2 laser
Chapin Theatre
98
to robotic gynecologic surgery presents opportunities to
bring a higher level of precision to a variety of reproductive
surgery applications. The ability to bend the laser delivery
system in any direction works particularly well in combination
with the expanded degree of motion freedom allowed
by robotic platforms. Furthermore, the three-dimensional
vision, high accuracy and absence of tremor that is typical
of robotic surgery may allow a level of laser safety that is
superior to that observed in conventional laparoscopy.
Acknowledgement: less than 25% of this video is comprised
of commercial video/photo material.
__________________________________________________________
V-13 4:40 PM
LAPAROSCOPIC BILATERAL GONADECTOMY FOR ANDROGEN
INSENSITIVITY SYNDROME.
M. S. Miller, R. W. Naumann, R. S. Usadi. OB/GYN, Carolinas
Medical Center, Charlotte, NC.
OBJECTIVE: Androgen Insensitivity Syndrome is a disorder
of sexual development caused by a defect in androgen
receptor function. This defect inhibits the virilization of
46, XY males despite the presence of testes and normal
testosterone production. The complete form of androgen
insensitivity results in a phenotypic female with a short
vaginal pouch, absent uterus and tubes, absent pubic hair,
and normal breast development. Testes are present, but
often abnormally positioned in the inguinal canals. The main
risk associated with cryptorchidism is the development of
gonadal tumors, particularly gonadoblastoma. Treatment
consists of gonadectomy performed between ages
16-18, postoperative estrogen therapy, and referral to
psychological and genetic counseling. Traditionally,
gonadectomies have been performed through large
abdominal incisions. There are several case studies that
document successful laparoscopic gondectomies in
individuals with complete androgen insensitivity syndrome.
This eliminates the need for laparotomy and results in
more rapid recovery, shorter less expensive hospital stays,
and decreased blood loss. This short film presents the
laparoscopic gonadectomy of a 17 year old phenotypic
female with complete androgen insensitivity syndrome.
DESIGN: Video.
MATERIALS AND METHODS: Laparoscopy is a safe and
effective method for gonadectomy in individuals
with androgen insensitivity syndrome and associated
cryptorchidism.
__________________________________________________________
V-14 4:47 PM
LAPAROSCOPIC GONADECTOMY IN ANDROGEN
INSENSITIVITY SYNDROME.
J. Kim, N. Crawford, S. Patel, S. Kehoe, O. Tan, B. Carr.
Department of Ob/Gyn, University of Texas Southwestern
Medical Center, Dallas, TX.
OBJECTIVE: Androgen insensitivity syndrome (AIS), a
X-linked recessive disorder, is the most common form of
male disorders of sex development occurring in 1/20000
genetic male. Due to mutations on the androgen
receptor gene, patients are subject to varying degrees
of undermasculinization despite the presence of normal
androgen production by the testes and peripheral