Laparoscopic Myomectomy Experience with Ulipristal Acetate

Apr 15, 2019 | 168 Views

Ally Murji

This video outlines one surgeon’s laparoscopic experience with ulipristal acetate at myomectomy.

Vasopressin in Gynecological Procedures

Apr 15, 2019 | 201 Views

Tina Ngan, Jessica Papillon-Smith, Jonathon Solnik, Ally Murji

Vasopressin administration can be an effective method of reducing blood loss during gynecological procedures. This video outlines the physiology of vasopressin and clinical scenarios in which its administration can help mitigate blood loss.

Laparoscopic Subtotal Hysterectomy for a Large Cervical Fibroid

Apr 15, 2019 | 219 Views

Justin Mui, Fariba Mohtashami

This video presents the laparoscopic management of a large cervical fibroid through subtotal hysterectomy. If highlights the importance of access, visualization, anatomy, and hemostasis

STRATAFIX Symmetric PDS Plus Knotless Tissue Control Device: Myomectomy

Apr 15, 2019 | 138 Views

Chandrew Rajakumar

This video highlights the use of the STRATAFIX Symmetric PDS Plus Knotless Tissue Control Device is used to reapproximate the myometrium following myomectomy.

Surgical Strategy for Tackling Cervical Myoma

Apr 15, 2019 | 191 Views

Jonathon Solnik, Ari Sanders

This video outlines tips and tricks for the management of cervical myomas utilizing three case examples.

Proximal Uterine Artery Ligation: Navigating Anatomical Distortion of Large Fibroids During Hysterectomy

Apr 15, 2019 | 213 Views

Wilson Chan, Chandrew Rajakumar

This video outlines a technique for performing ligation of the proximal uterine arteries. This is a technique that can be used to mitigate blood loss during hysterectomy.

Approach to Minimizing Bleeding at Multiple Myomectomy

Jul 5, 2019 | 240 Views

Fady Shehata, Chandrew Rajakumar, Sukhbir Sony Singh

This video presents perioperative and intraoperative techniques to minimize bleeding at multiple myomectomy by laparotomy.

Inbag Contained Morcellation: The New Era in MIGS

Jul 5, 2019 | 178 Views

Emilie Gorak Savard

This video demonstrates a technique for contained power morcellation in a bag during TLH for symptomatic fibroids. It also highlights tips and tricks to make the procedure easier.

Radiofrequency Ablation of Symptomatic Uterine Fibroids: The Acessa Procedure

Jul 5, 2019 | 193 Views

David J. Levine

This video outlines the approach to radiofrequency ablation of uterine fibroids through the Acessa Procedure

Approach to the Difficult Laparoscopic Hysterectomy: Enlarged Uterus

Jul 8, 2019 | 326 Views

Neeraj Mehra, Sukhbir Sony Singh

This video outlines tips and tricks to help navigate an enlarged uterus at the time of laparoscopic hysterectomy.

In Bag Morcellation

Jul 8, 2019 | 352 Views

Sukhbir Sony Singh

This video demonstrates a step-wise approach to in bag mechanical morcellation.

Novel Technique for Hemostasis at Laparoscopic Myomectomy: Tourniquet Application

Jul 12, 2019 | 228 Views

Katie Phillips, Caitlin Dunne, Neeraj Mehra

This video demonstrates a novel in which a tourniquet is applied during laparoscopic myomectomy to achieve hemostasis.

Laparoscopic Myomectomy in the 2nd Trimester of Pregnancy

Sep 26, 2019 | 216 Views

Anjali Kulkarni, Carmen McCaffrey, Janet Bodley, Rose Kung

The purpose of this video is to demonstrate surgical management of a large symptomatic fibroid in the 2nd trimester of pregnancy. This patient is a 26 year old G1P0 who presented to a tertiary care centre at 18 weeks and 3 days gestational age with severe abdominal pain, not controlled with intravenous and oral narcotics. She was otherwise healthy and incidentally was diagnosed with a fibroid during her dating ultrasound. An MRI of her abdomen and pelvis delineated this to be a pedunculated fundal uterine fibroid, measuring 19.4 by 13.2 by 16.2cm, retroplacental in location. Ultimately, she was consented for a laparoscopic myomectomy, with mini-laparotomy and morcellation. Post-operatively, this patient’s pregnancy progressed well and was uncomplicated. She underwent an uncomplicated spontaneous vaginal delivery at 40 weeks gestational age.

Hysteroscopic Resection of Deep Sub-Endometrial Fibroid (FIGO stage III bordering on hybrid stage II)

Sep 26, 2019 | 176 Views

Amanda Michael , Essam Michael

Deep subendometrial fibroids represent a technical challenge for complete hysteroscopic removal. Such fibroids include deep type II submucosal fibroids, type III fibroids (intramyometrial abutting the endometrium), and hybrid stage II-V fibroids (intramyometrial extending in both directions, submucosa and subserosa) according to FIGO classification.This video demonstrates a case of a 34 year old female who had failed several embryo transfers with good quality blastocysts. After comprehensive testing for her recurrent implantation failure, the sole finding was a 2.3cm posterior wall, upper cavity, sub-endometrial fibroid 3mm from the serosa.The video presented captures the hysteroscopic removal of this 2.3cm intramural posterior wall fibroid in the upper cavity abutting and subtly elevating the posterior endometrium. The clip demonstrates the complete and safe removal of this technically challenging myoma, while offering some surgical tips. Following her myomectomy, the patient conceived after a subsequent embryo transfer and had a full-term caesarean delivery.

A Hysteroscopic Technique for Resection of Type 2 Uterine Fibroids

Sep 26, 2019 | 296 Views

Alicia Long, Michael Suen, Sukhbir Sony Singh

The objective of this video is to review a technique for the hysteroscopic resection of Type 2 uterine fibroids. This is an educational video review featuring a case patient. Visual identification of fibroid type, surgical technique, and perioperative considerations are discussed. Gynecologists frequently perform hysteroscopic fibroid resections; however, Type 2 fibroids present a unique challenge where long operative time, excessive blood loss and fluid absorption, incomplete resection, and uterine perforation are important considerations. Our case patient is a 35 year old G1P0A1 woman with a history of secondary infertility, dysmenorrhea and heavy menstrual bleeding. Ultrasound demonstrated a 4.0 x 4.6 x 4.3cm Type 2 uterine fibroid, with a maximal distance of 7.8mm between the outer edge of the fibroid and the uterine serosa. The hysteroscopic management of Type 2 fibroids includes perioperative optimization, including preoperative planning and medical optimization. Ultrasound images should be reviewed prior to surgery, to determine the type of fibroid and the distance to the serosa. Visual identification of fibroid type at the time of hysteroscopy is also possible by observing the angle between the fibroid at its intersection with the endometrium. The techniques demonstrated in this educational video demonstrate visual identification and hysteroscopic resection of a Type 2 fibroid, including the creation of an endometrial flap overlying the defect after resection, to minimize postoperative intrauterine adhesions. In this case, resection is performed in the operating room using a monopolar resectoscope. Identification of fibroid type, including visual diagnosis, as well as attention to surgical technique and perioperative considerations, are essential for hysteroscopic resection of Type 2 uterine fibroids.

Uterine Artery Occlusion at Myomectomy

Sep 27, 2019 | 330 Views

Andrew Zakhari, Ari Sanders, Ally Murji

In this video, we demonstrate three approaches to uterine artery occlusion at time of laparoscopic myomectomy as a blood-sparing intra-operative technique. A step-wise approach is applied prior to beginning the myomectomy which includes the following: 1) Selecting the appropriate approach to uterine artery occlusion (lateral vs. posterior vs. anterior) based on individual anatomy; 2) identification of relevant anatomy and important landmarks for the procedure 3) isolating the uterine artery and identifying the ureter; 4) occluding the uterine artery. As illustrated in this video, uterine artery occlusion can be performed by three different approaches, depending on both surgeon preference and unique patient anatomy. A systematic review and meta-analysis of the literature supports the efficacy of this procedure in terms of limiting blood loss, blood transfusion, and fibroid recurrence, albeit at slightly longer operative times.

Intraoperative Strategies to Minimize Blood Loss During Myomectomy

Sep 27, 2019 | 229 Views

Alysha Nensi, Deborah Robertson

Myomectomy is a common procedure performed by gynecologists for the conservative management of leiomyomas (fibroids). The surgical removal of fibroids can be associated with significant intraoperative blood loss and subsequent blood transfusion, which is an important morbidity associated with this elective procedure in reproductive-aged women. This video demonstrates various evidence-based strategies aimed at minimizing surgical bleeding during myomectomy. Techniques covered in this presentation include: (1) Preoperative use of medications such as vaginal/rectal misoprostal and intravenous tranexamic acid, (2) Intramyometrial injection of dilute vasopressin and (3) Temporary uterine artery occlusion with pericervical tourniquet. We demonstrate how these techniques can be used to minimize blood loss during abdominal, laparoscopic and robotic myomectomy.

Temporary Uterine Artery Occlusion at Laparoscopic Myomectomy - A Simple Technique to Reduce Blood Loss

Sep 27, 2019 | 206 Views

Fatemah Alhadhoud, Cici Zhu, Sukhbir Sony Singh

The objective of this video is to demonstrate a simple, temporary and reversible method for uterine artery occlusion at the time of laparoscopic myomectomy. A 42 yo G0 presented with a solitary, vascular uterine fibroid. her signs & symptoms were heavy menstrual bleeding, pressure symptoms and abdominal bloating.Because the patient desired fertility, laparoscopic myomectomy was done with intra-operative approaches to minimize blood loss; including reversible uterine artery occlusion using bulldog clamps, vasopressin, tranexamic acid and misoprostol.

Manual Tissue Extraction: Approach to Vaginal Morcellation

Sep 27, 2019 | 231 Views

Alysha Nensi, Jennifer Liu, Deborah Robertson

Vaginal morcellation is a manual tissue extraction technique used to remove large specimens following robotic, laparoscopic, or vaginal hysterectomy. This procedure allows the surgeon to offer minimally invasive options to select patient populations and circumvents the need for laparotomy for specimen extraction. In recent years, there have been concerns regarding morcellation and the potential for inadvertent dissemination of malignant tissue. However, with appropriate patient selection and thorough pre-operative evaluation, the risks are low, particularly when the specimen is morcellated vaginally. The objective of this video is to describe the technique and equipment required for vaginal morcellation following laparoscopic hysterectomy. The case is a 43-year-old G3P3 female with abnormal uterine bleeding due to a multi-fibroid uterus, who underwent a total laparoscopic hysterectomy, bilateral salpingectomy, cystoscopy and vaginal morcellation. In this video, we demonstrate a safe and effective vaginal morcellation technique performed with bisection of the uterus, sequential wedge resections and myomectomy.