AGES XXIII Annual Scientific Meeting 2013 Abstracts & Program

AGES XXIII Annual Scientific Meeting 2013
Free Communications Chairmen’s Choice - Friday 8 March
All patients had post-operative ultrasound between 6 to
10 weeks, which show intact uterine wall with no evidence
of scar defect and resolution of hydrometra. Six patients
underwent IVF cycle with a mean of 2.17 cycles (1-3 cycles).
There were 5 clinical pregnany and 4 live births recorded. The
time interval from repair of scar defect to delivery was 15
months (12-19 months). 1 patient was lost to follow-up.
CONCLUSION: Caesarean scar defect is an underrecognized
contributing factor to secondary infertility 1 .
Repair of caesarean scar defect laparoscopically may improve
pregnancy outcome in these patients 2 . Laparoscopic repair of
caesarean scar defect has the advantage of being minimally
invasive while allowing optimal view during dissection of
vesico-vaginal space and restoring of integrity of the uterine
wall, without major cormobidty to the patients 3 .
REFERENCES:
1. Gubbini G, Centini G, Nascetti D, Marra E, Moncini
I, Bruni L, Petraglia F, Florio P. Surgical hysteroscopic
treatment of cesarean-induced isthmocele in restoring
fertility: prospective study. J Minim Invasive Gynecol.
2011 Mar-Apr;18(2):234-7
2. Donnez O, Jadoul P, Squifflet J, Donnez J. Laparoscopic
repair of wide and deep uterine scar dehiscence after cesarean
section. Fertil Steril. 2008 Apr;89(4):974-80. Epub 2007 Jul 10
3. Klemm P, Koehler C, Mangler M, Schneider U, Schneider
A. Laparoscopic and vaginal repair of uterine scar
dehiscence following cesarean section as detected by
ultrasound. J Perinat Med. 2005;33(4):324-31
AUTHOR AFFILIATION: K. Y. Kong 1 , D. Angstetra 2 ,
G. Reid 3 ; 1. Women’s & Children’s Health, St George
Hospital, Sydney, Australia. 2. Department of Obstetrics &
Gynaecology, Gold Coast Hospital, Southport, Queensland,
Australia. 3. Department of Obstetrics & Gynaecology,
Liverpool Hospital, Sydney, Australia.
SESSION 7 - Free COMMUNICATIONS
Chairmen’s Choice / 1320-1330
Establishment of robotic surgical programme for
benign gynaecology in an advanced laparoscopic
centre – proctorship and beyond
Choi S, Rosen D, Chou D, Reyftmann L, De Rosnay
P, Greg Cario G
BACKGROUND: In this oral presentation, we share our
experience in establishing a robotic surgery programme
dedicated to treatment of benign gynaecological conditions
in an advanced laparoscopic centre. Our early data, including
those in the proctorship period, are discussed.
METHODS: Prospective data were collected from July 2012
to January 2013 for all women undergoing robot-assisted
procedures performed by the three advanced laparoscopic
surgeons within Sydney Women’s Endosurgery Centre
(SWEC). Patient demographic, intraoperative, perioperative
and postoperative data were collected.
RESULTS: Twenty robot-assisted cases were performed within
SWEC. Seven cases of total robot-assisted hysterectomy were
performed during proctorship. Only one patient required
conversion to conventional laparoscopic procedure. No major
complications were recorded. The mean hospital stay was 1.3
+/- 0.2 days. A trend of reduction in docking time, surgeon
console time, total operation time and anaesthetic time was
observed with gaining experience and technical refinement.
CONCLUSION: Our experience with robotic-assisted
hysterectomy appears promising even during the initial
learning curve. The technique, docking time and operative
time gradually improved with experience.
AUTHOR AFFILIATION: S. Choi, D. Rosen, D. Chou,
L. Reyftmann, P. De Rosnay, G. Cario; Sydney Women’s
Endosurgery Centre (SWEC), St. George Private Hospital,
Kogarah, New South Wales, Australia.
SESSION 7 - Free COMMUNICATIONS
Chairmen’s Choice / 1330-1340
Laparoscopic myomectomy of an 1.8kg
pedunculated fibroid causing uterine torsion
Cebola M, Cario G, Rosen D, Reyftmann L, De
Rosnay P, Choi S, D
This is a surgical video presentation of a laparoscopic
myomectomy of a 17cm pedunculated fibroid in a 47 years old
nulliparous lady. The patient primarily had pressure symptoms
including urinary frequency, bloating and pelvic discomfort.
Preoperative MRI confirmed pedunculated nature of the
fibroid. Intraoperatively, the uterus was noted to be in 270 deg
torsion in clockwise direction, such that the left cornua was
located posteriorly. Left adnexal vasculatures were congested
but blood supply to the fibroid was unaffected. Following
detortion of the uterus and injection of dilute Vasopressin, the
thick pedicle was suture ligated with Roeder, extracorporeal
slip knot. The long arm of the sutures were not cut so that the
knot could be easily tightened further with knot pusher as they
inevitable loosen as one works towards dividing the fibroid
from it’s pedicle. The pedicle was further coagulated and
sutured for additional haemostatic measure. The fibroid was
extracted with a 15mm electrical morcellator.
AUTHOR AFFIILIATION: M. Cebola, G. Cario, D. Rosen, L.
Reyftmann, P. De Rosnay, S. Choi, D. Chou; Sydney Women’s
Endosurgery Centre (SWEC), St. George Private Hospital,
Kogarah, New South Wales, Australia.
SESSION 7 - Free COMMUNICATIONS-
Chairmen’s Choice / 1340-1350
To excise or ablate endometriosis A prospective
randomized double blinded trial after 5 years
follow-up
Healey M, Kaur H, Cheng C
BACKGROUND: At present, gynaecologists performing
laparoscopic treatment of endometriosis choose to excise
or to ablate lesions. The current medical literature does not
provide evidence to support one method over the other (1).
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