AGES XXIII Annual Scientific Meeting 2013 Abstracts & Program

The Pelvis in Pain
Digital Communications
Endometriosis and Beyond
The sensitivity, specificity, PPV and NPV for SVG in the
prediction of lateral DIE (uterosacral ligament nodules) was
40.0%, 97.6%, 50.0% and 97.6%, respectively.
CONCLUSION: SVG demonstrated a high specificity/NPV,
i.e. correlates highly with a “normal pelvis”. Office SVG
provides additional diagnostic information to conventional
pelvic sonography, which allows for the planning of specific
endometriosis surgery and the need for colorectal input.
AUTHOR AFFILIATION: S. Reid 1,2 , C. Lu 3 , I. Casikar 3 , G.
Reid 4 , J. Abbott 5,6 , G. Cario 7 , D. Chou 7 , D. Kowalski 8 , M.
Cooper 8 , G. Condous 3 ; 1. University of Sydney, Sydney,
New South Wales, Australia. 2. Nepean Hospital, Penrith,
New South Wales, Australia. 3. Acute Gynaecology, Early
Pregnancy and Advanced Endosurgery Unit, Nepean
Medical School, Nepean Hospital, Penrith, New South Wales,
Australia. 4. Liverpool Public Hospital, Liverpool, New
South Wales, Australia. 5. University of New South Wales,
Kensington, New South Wales, Australia. 6. Prince of Wales
Private Hospital, Randwick, New South Wales, Australia.
7. St George Private Hospital, Kogarah, New South Wales,
Australia. 8. Royal Prince Alfred Hospital, Department of
Obstetrics and Gynaecology, University of Sydney, Sydney,
New South Wales, Australia.
Free COMMUNICATIONS / DIGITAL
COMMUNICATIONS SESSION
Small bowel injury at laparoscopy to drain
infected pelvic collection
Chohan K, Anpalagan A
Infected pelvic collection is not an uncommon
gynaecological problem. Treatment usually consists of
antibiotics, or antibiotics and surgical drainage. Surgical
drainage can be achieved via radiological guidance (CT or
Ultrasound), laparoscopy, or laparotomy. Herein we report
three cases of small bowel injury after attempted laparoscopic
drainage for infected pelvic collections.
In two of them the collections were due to tubo-ovarian
abscesses, and one was a post caesarean section collection.
Case 1, 2 and 3 had Veres needle and radially expanding
port, Veres needle and Optiview port, and palmers point
5mm port, direct entry respectively. All three patients
required midline laparotomy conversion to repair the
injury. The intended procedure was not completed in
any of them. Three different post advanced laparoscopic
fellowship surgeons were involved in each of these cases.
There appears to be no report of similar cases in the
literature. Should one require a surgical drainage, we
may consider image guided drainage as the first option in
our department in the future. If that fails an open entry
technique laparoscopy or laparotomy would be considered
rather than closed entry laparoscopy. A laparoscopy or
laparotomy is best done after at least 4-6 weeks of antibiotic
treatment to reduce the risk of injury due to acute
inflammation.
REFERNCES:
1. Journal of Pediatric Surgery 2011;46:1385-1389
2. Int J Colorectal Dis 2012;27:199-206
3. Infect Dis Obstet Gynecol 2003;11:45-51
AUTHOR AFFILIATION: K. Chohan, A. Anpalagan;
Department of Obstetrics and Gynaecology, Westmead
Hospital, Westmead, New South Wales, Australia.
Free COMMUNICATIONS / DIGITAL
COMMUNICATIONS SESSION
Laparoscopic excision of bladder endometriotic
nodule
Lanziz H, Swift G
The incidence of bladder endometriosis in the general
population is considered to be 1%. The lesion can involve
solely the peritoneum, or sometimes the full thickness of
the bladder. We present a video of the surgery performed
on a 30-year-old woman with bladder endometriosis. She
was referred with a history of menorrhagia, dysmenorrhoea,
and cyclical dysuria. Her pelvic computed tomography
and ultrasound revealed the presence of a mass within the
bladder wall. After discussion with the urological team, the
mass was thought to be an endometriotic nodule.
Joint surgery was organised involving the urologist for the
cystoscopic work and the gynaecologist for the laparoscopic
elements. 4 ports were used as the standard laparoscopic
approach, inserted after Hassan entry. The surgery
commenced with defining the lesion laparoscopically and
cystoscopically. After identifying the lateral margins, and
opening the vesico-vaginal fold, the lesion was then finally
mobilized. Once the lesion was mobile, the bladder was
entered and the lesion excised from the bladder, whilst
preserving as much healthy tissue as possible. The bladder
was then closed in vertical fashion from posterior to anterior.
2-0 PDS was used to close the bladder and the tightness
was checked at the end of procedure by filling the bladder
with 600ml of fluid. An in-dwelling urinary catheter was
left in situ for 10 days. The patient had an excellent recovery
and bladder function was normal at 6 weeks post-operative
follow-up.
Unique aspects of this case are the use of monopolar spatula
energy, the large size of the lesion requiring excision of a
large part of the bladder, and the vertical closure (rather than
the usual horizontal closure).
AUTHOR AFFILIATION: H. Lanziz, G. Swift; The Gold
Coast Hospital, Southport, Queensland, Australia.