Appendectomy in Gynecology

Apr 15, 2019 | 298 Views

Elissa Tepperman, Mara Sobel, Ally Murji, Nicholas Leyland

This video reviews the gynecologic indications for appendectomy, the relevant anatomy, steps of the procedure, and possible complications.

Minimizing Ovarian Damage When Resecting Endometriomas

Apr 15, 2019 | 267 Views

Andrew Zakhari, Jessica Papillon-Smith, Jonathon Solnik, Ally Murji

In this video, the authors review techniques to help minimize ovarian damage when resecting endometriomas.

Restoring Anatomy in Deep Infiltrating Endometriosis

Apr 15, 2019 | 297 Views

Ari Sanders, Jonathon Solnik

Through a single surgical case, this video discusses technical tips in restoring anatomy in the setting of deep infiltrating endometriosis.

Laparoscopic Presacral Neurectomy

Apr 15, 2019 | 273 Views

Mara Sobel, Ally Murji, Nicholas Leyland

This video reviews the indications for presacral neurectomy along with the anatomy, procedural steps, and potential complications.

A Video on Appendectomy in Gynecologic Surgery

Jul 5, 2019 | 525 Views

Mina Wesa, Sukhbir Sony Singh

This video outlines the indications for appendectomy during gynecologic surgery, discusses the surgical technique, and is presented in the context of clinical case scenarios.

Endometriosis Patient Education

Jul 8, 2019 | 239 Views

Sukhbir Sony Singh

This video outlines the surgical management of an endometrial niche (isthmocele) through a laparoscopic approach.

Ureteric Thermal Injury: An Attempt at Conservative Management

Jul 8, 2019 | 257 Views

Neeraj Mehra, Sukhbir Sony Singh, John Mahoney, Hassan Shenassa

This video reiews an interoperative thermal injury to the ureter followed by an attempt at concervative management.

Deep Endometriosis of the Bowel: A Surgical Approach

Sep 27, 2019 | 305 Views

Cici Zhu, Michael Suen, Shaheer Tadros, Sukhbir Sony Singh

The objectives of this video are to define bowel endometriosis and to explore various surgical parameters for the different types of surgical excision. Then, a specific surgical approach will be demonstrated. When planning a surgical approach to deep endometriosis of the bowel, patient characteristics such as age and BMI, as well as their specific symptoms and level of pain, quality of life and fertility goals must be considered. As well, the actual lesion must be investigated with respect to size, number, location, depth of infiltration, and amount of intestinal wall circumference involved. Then, various surgical techniques can be performed depending on these specific characteristics, such as nodule shaving, nodular resection and segmental resection and re-anastomosis. A surgical case is then utilized to demonstrate a nerve sparing and blood supply conserving technique of segmental resection after intra-operative sigmoidoscopy demonstrated luminal obstruction.

A Step-wise Approach to Laparoscopic Cystectomy of Ovarian Endometrioma

Sep 27, 2019 | 443 Views

Caroline Lee, Catherine Allaire

A 37-year-old G1P0 woman presented with dysmenorrhea and pelvic pain in the context of known bilateral endometriomas. She was being treated with dienogest as suppressive therapy. She requested conservative surgery for treatment of her endometriosis due to the presence of persistent pelvic pain despite medical therapy. Here, we present a step-by-step approach to laparoscopic cystectomy of ovarian endometriomas.

Genitofemoral Nerve Sparing Adhesiolysis

Sep 27, 2019 | 323 Views

Tina Ngan, John Thiel, Darrien Rattray

The Genitofemoral nerve originates from the ventral rami of L1-L2. Its injury is uncommon in benign minimally invasive gynecologic surgery. However, when there is distorted anatomy due to adhesions or severe endometriosis, the risk of injury is higher. Therefore, it is important to recognize the anatomical landmarks early in the surgery to prevent injury. In this video, the genitofemoral nerve location, innervation, and mechanisms of injury will be reviewed. The points will be illustrated by demonstrating dissection of this nerve in a case with significant adhesions.

Keep Your Landmarks Close, and the Hypogastric Nerve Closer: An Approach to Nerve-sparing Endometriosis

Sep 28, 2019 | 605 Views

Andrew Zakhari, Mohamed Mabrouk, Diego Raimondo, Manuela Mastronardi, Renato Seracchioli, Benedetta Mattei, Jessica Papillon-Smith, Meir Jonathon Solnik, Ally Murji, Nucelio Lemos

Extensive resections for endometriosis can cause damage to the autonomic nervous system of the pelvis resulting in urinary, anorectal, and sexual dysfunction. This educational video seeks to describe the autonomic neuroanatomy of the pelvis, illustrate the predictable location of the hypogastric nerve in relation to other pelvic landmarks, and demonstrate a technique for identifying, dissecting, and ultimately sparing the hypogastric nerve and consequently, the inferior hypogastric plexus. With laparoscopic footage, we detail: 1) transperitoneal identification of the hypogastric nerve, assisted by the pulling maneuver 2) Opening of the retroperitoneum at the level of the pelvic brim and retroperitoneal identification of the ureter 3) Medial dissection and identification of the hypogastric nerve 4) Lateralization of the hypogastric nerve, allowing for safe peritoneal resection.The hypogastric nerve follows a predictable course and can identified, dissected, and spared during pelvic surgery and is an important landmark for the preservation of pelvic autonomic innervation.

Parametrial Endometriosis Part 3: Introducing a Nerve Sparing Technique to the Parametrectomy

Sep 24, 2020 | 129 Views

Darl Edwards, Zi Ying Zhao, Jonathon Solnik, Nucelio Lemos

This is the third video of a series introducing the concept of parametrial endometriosis (PE) and describing our surgical approach in treating this particular disease presentation. The objective of this video is to review the anatomy and innervation of the parametrium and introduce the surgical technique and efficacy of the Laparoscopic Nerve-Sparing Ultralateral Resection (LaNSURe) of PE. This educational video introduces the nerve-sparing surgical treatment of PE and reviews initial results of a retrospective review of these patients. It is a compilation of anatomy schematics and surgical video clips demonstrating the novel LaNSURe surgical technique in patients diagnosed with PE. PE is a unique presentation of endometriosis with a specific constellation of signs and symptoms. This video introduces the surgical technique of our novel LaNSURe surgical technique of PE which has demonstrated encouraging initial results improving pain and quality of life. Long-term follow up will be completed in the future.

Parametrial Endometriosis Part 2: Clinical Diagnosis and Correlation of Medical Imaging with Laparos

Sep 24, 2020 | 154 Views

Darl Edwards, Zi Ying Zhao, Jonathon Solnik, Nucelio Lemos

This is the second video of a series introducing the concept of parametrial endometriosis (PE) and describing our approach to diagnosing and treating this particular disease presentation. The objective of this video is to discuss the presenting signs and symptoms associated to this condition as well as provide an approach for clinical workup and diagnosis. It is a compilation of anatomy schematics, medical imaging and surgical video clips demonstrating the anatomy, clinical and diagnostic findings, and describing the infiltration patterns of PE. We then present some pictorial cases correlating the clinical, imaging and surgical findings. PE is a unique presentation of endometriosis with a specific constellation of symptoms and clinical findings. This video series introduces this concept and teaches the approach to clinical diagnosis setting the bases for the next video in the series, which describes the surgical technique and results of the Laparoscopic Nerve-Sparing Ultralateral Resection (LaNSURe) of PE.

Parametrial Endometriosis Part 1: A Correlation of Parametrial Anatomy and Disease Presentation

Sep 24, 2020 | 197 Views

Darl Edwards, Zi Ying Zhao, Jonathon Solnik, Nucelio Lemos

This is the first video of a series introducing the concept of parametrial endometriosis (PE) and describing our approach to diagnosing and treating this particular disease. The objective of this video is to discuss anatomy and innervation of the parametrium and explain presenting signs and symptoms associated to this condition. This educational video includes a compilation of anatomy schematics, surgical video clips, and cadaveric dissections demonstrating the anatomy in the innervation of the parametrium and its correlation with the specific symptoms and signs of PE. This is part of an ongoing retrospective-prospective study that currently includes 28 patients who underwent surgical parametrectomies for the treatment of PE. PE is a unique presentation of endometriosis with a specific constellation of symptoms. This video introduces this concept and sets the fundamental anatomic bases for the next videos in the series which describe diagnosis, as well as the LaNSURe surgical technique.

The Visceral Slide Test and the Prediction of Intraadominal Adhesions

Sep 24, 2020 | 116 Views

Peter Thiel, Justin Mui

This video presents a description and demonstration of the visceral slide test, which can be used preoperatively to detect intraabdominal adhesions. The test is performed with the probe is aligned in the sagittal plane and settings optimized to visualize the plane between the rectus abdominis and the viscera. The patient is then asked to take a large breath in while the movement of the viscera is observed. This rapid and simple test can be completed in the clinic, on the day of surgery, or in the operating room following anesthesia. Possible benefits of the visceral slide test include more informed discussion regarding individual surgical risk, accurate prediction of adhesion presence or absence, and a reduced risk of bowel injury. The visceral slide test has been shown to be both sensitive and specific in the prediction of intraabdominal adhesions and is a valuable tool for the laparoscopic surgeon.

Laparoscopic Excision of Pericardial and Diaphragmatic Endometriosis

Sep 24, 2020 | 255 Views

Dong Bach Nguyen, Sebastien Gilbert, Kristina Arendas, Caitlin Jago, Sukhbir Sony Singh

This video presents a five-step approach to the laparoscopic excision of pericardial and diaphragmatic endometriosis. Clinically, endometriosis affects the thoracic cavity in less than 1% of cases, most commonly involving the diaphragm and treated using a VATS approach. Pericardial endometriosis is an even rarer entity, with only 4 case reports published to date. We present the case of a 35-year-old in order to illustrate the approach to a laparoscopic excision of diaphragmatic and pericardial endometriosis. In consultation with the Thoracic team, she is consented for a completion surgery of thoracic endometriosis identified at a prior laparoscopy, symptomatic for right shoulder and mid-chest pain, and unresponsive to medical therapy. The surgical approach consists of 5 reproducible steps: 1. Upper abdominal survey 2. Liver mobilization 3. Excision of diaphragmatic and pericardial lesions 4. Intra-thoracic laparoscopic exploration 5. Closure of the diaphragmatic defect

Laparoscopic Ureteroureterostomy to Treat Severe Ureteral Endometriosis

Sep 24, 2020 | 238 Views

Rahana Harjee, Christopher H. Wu, Michael Suen

Deeply infiltrating endometriosis can involve the bladder and ureters; this educational video demonstrates the steps for a laparoscopic ureteroureterostomy for ureteric obstruction and highlights the advantages of a multi-disciplinary approach. A 29-year-old G0 was referred to Urology with right sided flank pain, with a past history of surgically-excised endometriosis. Imaging showed a 6.6 cm right adnexal mass, with proximal hydroureter and hydronephrosis. A multi-disciplinary surgical approach was planned with Urology and Gynecology. Excision of endometriosis was initially performed, which included superficial endometriosis, a rectovaginal nodule and endometrioma cystectomy. Complete ureteric stricture due to endometriosis was confirmed; a laparoscopic ureteroureterostomy was performed, with closure using a barbed suture. Her post-operative recovery was uncomplicated, and follow-up imaging and ureteroscopy showed decreased hydroureter, and no evidence of obstruction. This video demonstrates the surgical steps and collaborative surgical decision-making during a complicated case.