Apr 20, 2019 | 364 Views
This video outlines the approach to the hysteroscopic management of a stenotic cervix using video from cases performed in an outpatient hysteroscopy setting.
Sep 27, 2019 | 236 Views
A 42-year-old G1P1 woman presented with a history of adenocarcinoma in situ that was treated with a complete LEEP excision. She had severe cervical stenosis with no external os visible that prevented ongoing endocervical monitoring. Due to a desire to preserve fertility, she declined a hysterectomy. She underwent multiple attempted hysteroscopies without any success. Thus, she was booked for an interventional radiology (IR)-guided cannulation of her cervix and hysteroscopic release of cervical stenosis. Here, we demonstrate a case of IR-guided access to uterine cavity in a case of severe cervical stenosis.
Sep 24, 2020 | 177 Views
In this video we present a laparoscopic approach to trachelectomy following supracervical hysterectomy. We outline statistics regarding supracervical versus total hysterectomy, the reasons why some patients may initially choose to keep their cervix, and the sequelae that eventually prompt trachelectomy in several cases. The main purpose of the video is to demonstrate a stepwise approach to trachelectomy using a relatively uncomplicated patient case. The five steps are to restore anatomy, create a bladder flap, perform anterior and posterior colpotomy, lateralize the uterine artery pedicles and finally, to close the vaginal cuff. We highlight this straightforward five-step process as potentially feasible for any practitioner who is already performing total laparoscopic hysterectomy. Although other cases may bear more complexity than the one demonstrated in this video, adherence to our approach can also be successfully applied in those situations.
Sep 24, 2020 | 120 Views
Cervical myomectomy is a surgical challenge and the risk of subsequent cervical incompetence is unknown. We presented the case of a 30-year-old woman, nulligravida, with a 12 cm cervical leiomyoma, who consulted for heavy menstrual bleeding and pelvic pain. After failure of multiple medical therapies, a laparoscopic cervical myomectomy was successfully performed. Adjuvant pre-operative uterine artery embolization with gelatin sponges was used to reduce surgical blood loss, as an alternative to intra-operative ligation of uterine arteries when access to the retroperitoneum is limited by the size and location of leiomyomas. In order to prevent cervical incompetence, a concomitant laparoscopic cerclage was achieved since the integrity of the cervix has been compromised by the myomectomy.