Excision of Rudimentary Uterine Horn and Confined Morcellation

Jul 5, 2019 | 314 Views

Hussein Sabban, Togas Tulandi

This video demonstrates the excision of a uterine horn and the subsequent confined morcellation technique used for specimen extraction.

Inbag Contained Morcellation: The New Era in MIGS

Jul 5, 2019 | 288 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.

In Bag Morcellation

Jul 8, 2019 | 662 Views

Sukhbir Sony Singh

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

Laparoscopic Myomectomy in the 2nd Trimester of Pregnancy

Sep 26, 2019 | 356 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.

Manual Tissue Extraction: Approach to Vaginal Morcellation

Sep 27, 2019 | 471 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.

Intrauterine Morcellation at Laparoscopic Myomectomy

Sep 24, 2020 | 241 Views

Meghan O'Leary, Liane Belland

In this video, we present an approach to previously described suprapubic laparoscopic-assisted myomectomy that we feel mitigates some of the disadvantages of traditional myomectomy - increased operative time, increased blood loss and surgical expertise in laparoscopic suturing. Using footage from our own procedures of this kind, we propose a method by which a fibroid is just partially dissected free of the myometrium, is tagged with a unique suture and morcellated while still within the myometrium.

Laparoscopic Cervical Myomectomy with Pre-operative Uterine Artery Embolization and Concomitant Cerclage

Sep 24, 2020 | 120 Views

Vanille Simon, Marie-Eve Bergeron, Philippe Laberge, Sarah Maheux-Lacroix

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.