Exhibitors - AGES

AGES XX Annual Scientific Meeting – 2010
Free Communications Friday 28 May
Free Communications Abstracts SESSIONS F/G
INTrODUCING ThE ‘MAGNET METhOD’ INTO
GyNECOlOGICAl SINGlE POrT SUrGEry
FRIDAy 28 MAy / FREE COMMuNICATIONS F
hySTERECTOMy / ECTOPIC PREGNANCy
1521-1530
Takaki Y, Andou M
INTRODUCTION: SPS (single port surgery) is being applied to more and
more complicated cases recently, however many problems have arisen
from having only two forceps in restricted working space. As a result we
came to desire additional independent forceps without further invasion. This
prompted us to introduce a novel technique, the "magnet method".The
"magnet method" is manipulating the metal forceps in the body with a
magnet placed on the abdominal surface. This technique was reported for
the first time by Dr Hayashi of Saku General Hospital’s general surgeon
group and is already known to be a useful technique to general surgeons.
We modified it and introduced our modified version into our original
procedure and found that it is also useful in gynecologic surgery. We will
report these finding in our video presentation.
MATERIALS/METHOD: We applied the "magnet method" in a total
laparoscopic hysterectomy case where the patient had fibroids. We used
laparoscopic hemostatic forceps, a metal ring, and a strong magnet and
linked them with threads despite the bull-dog shaped hemostatic forceps is
used in the original method. The magnet used is a neodymium magnet which
has amazing power (up to 160kg) and is available in any hardware shop.
RESULTS: The linked forceps that were inserted before placing the port
were taken up again and loaded on the handle and then attached on the
fallopian tube and pulled to the opposite side to the working area by the
magnet placed on the abdominal surface. We were able to obtain a good
view and appropriate traction forces with this simple method.
CONCLUSIONS: The magnet controlled forceps make it possible to regain
the lost counter traction and good view which is essentially and necessary
for a safe laparoscopic operation without any additional incisions. By this
method we were able to enlarge the application of SPS while
maintainingminimum invasion.
AUTHOR AFFILIATION: Y. Takaki, M. Andou; Kurashiki Medical Center
KurashikiI-shi, Okayama Prifecture, Japan
BUBBlES IN ThE UTErUS – A lIFE ThrEATENING
SITUATION
FRIDAy 28 MAy / FREE COMMuNICATIONS G
COMPlICATIONS / 1400-1409
Kaur H
INTRODUCTION: Uterine clostridium perfringens (formally known as
Clostridium welchii) with associated sepsis is extremely rare in women who
have not had prior uterine manipulation. A recent case managed at the
Royal Womens Hospital Melbourne will be discussed.
MATERIALS/METHOD: Case report and Medline English literature review.
RESULTS: 52 year old nullipara presented with a two day history of fever,
PV bleeding, offensive vaginal discharge and severe abdominal pain on a
BACKGROUND of multifibroid uterus (intramural fibroids measuring 14cm,
3.3cm and 2.2cm). She had never been sexually active and was
commenced on Primolut by her GP for menorrhagia 3 months prior to her
presentation. On examination, she was febrile 39C, normotensive and had a
tender 34 week sized uterus with offensive, bloody PV discharge.
Ultrasound suggested a complex ovarian mass with abnormal thickened
endometrium and CA125=264. She was fluid resuscitated and
commenced on IV antibiotics. Within 12 hours she developed coagulopathy,
haematuria, jaundice and haemolytic anemia, despite treatment with IV
cetriaxone, gentamicin and metranidazole. High vaginal swabs showed
gram positive bacilli and MRI showed a 25cm uterus with gas containing
structures. After discussion with haematology, infectious disease and
gynae-oncology, the working diagnosis was a probable uterine malignancy
with secondary sepsis. Within 24 hours of her admission, she had an
uncomplicated hysterectomy and bilateral salpingo-oophrectomy with
peritoneal washings after stabilization with fluid resuscitation and blood
products. Histopathology showed a 32cm uterus with a degenerative
uterine fibroid, normal tubes, ovaries and peritoneal washings. Microbiology
showed clostridium perfringens in the degenerative fibroid, uterine tissue,
high vaginal swab and blood cultures. She became afebrile within 12 hours
and had 7 days of IV penicillin. She was discharged home on day 8.
CONCLUSIONS: Clostridium perfringens is a gram positive anaerobic
bacillus that produces exotoxins which cause tissue necrosis and
haemolysis that can rapidly lead to multiorgan failure and death if left
untreated in 50-70% cases1 .
According to a recent English literature search, there are only 2 other cases
of C.perfringens sepsis complicating a degenerative uterine leiomyoma. 2,3
Reductions in mortality appear to rely on promptness in diagnosis,
supportive care, broad spectrum antibiotics and surgical debridement.
Penicillin is the drug of choice; however, recent data shows that
combination antimicrobial therapy with penicillin and clindamycin or
tetracycline may further reduce mortality through the reduction in toxin
synthesis 4 .
Hysterectomy without surgical resection of the adnexal structures may be
inadequate because of rapid C. perfringens involvement of extrauterine
structures 5. Hyperbaric oxygen (HBO) has been used to treat C. perfringens
infections with varying efficacy and the role of HBO remains controversial.
In conclusion, this case illustrates the need for prompt recognition and
treatment which is essential for improved survival.
gynaecological endoscopy: has it come of age? 26 – 29 May 2010 Sydney Australia
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