Apr 15, 2019 | 325 Views
This video presents the multidisciplinary preoperative, intraoperative, and postoperative management of invasive placentation at a single institution. It also outlines the surgical steps taken to safely perform this procedure.
Jul 5, 2019 | 229 Views
This video outlines the management options for cesarean scar ectopic pregnancies and highlights a case of laparoscopic surgical management.
Sep 26, 2019 | 243 Views
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.
Sep 26, 2019 | 226 Views
Adnexal torsion is a common gynecological pathology representing 2.7% of all gynecological emergencies. The management of adnexal torsion presents a unique challenge when encountered in advanced pregnancy. This challenge is further complicated by a paucity of literature discussing management approaches and outcomes in pregnancy. The objective of this video is to review the risk factors, perioperative planning and management of adnexal torsion in advanced gestation. The stepwise minimally invasive approach consists of identification of the anatomy, determination of accessory port placement, detorsion of the adenexa, and finally removal of the specimen. This surgical approach will be demonstrated by a case of adnexal torsion in pregnancy with a focus on pearls to utilize and pitfalls to avoid. Furthermore, general tips for laparoscopic surgery in pregnancy will be covered and demonstrated in the video.
Sep 27, 2019 | 209 Views
Uterine anomalies contribute to impaired fertility, especially pregnancy loss and preterm birth. Dysmorphic uteri is a newly defined class of uterine anomalies characterized by a T-shaped cavity and hypertrophic lateral walls. Pilot studies indicate surgical correction of dysmorphic uteri may improve fertility outcomes.We show three cases of hysteroscopic metroplasty to expand dysmorphic uteri in patients with recurrent pregnancy loss. In two cases, the dysmorphic uteri were initially misdiagnosed as normal on two-dimensional ultrasound, suggesting the anomaly may be underdiagnosed. Relaxing incisions were made along the lateral and anteroposterior walls using a Collins knife. Follow-up hysteroscopic lysis of adhesions were performed as an outpatient. Follow-up three-dimensional ultrasound demonstrated expansion and normalization of the uterine cavity. Dysmorphic uteri are an under-recognized cause of impaired fertility and surgical management may improve fertility outcomes. These cases demonstrate the importance of accurate diagnosis to facilitate appropriate treatment options.
Sep 24, 2020 | 65 Views
The purpose of this educational video is to provide an overview of the guidelines and indications for laparoscopy in pregnancy. We will review preoperative, intraoperative and postoperative considerations for laparoscopy in this patient population. Although historically contraindicated in pregnancy, laparoscopy is now the preferred treatment approach to surgical conditions in pregnancy and is considered safe in all trimesters. In this video, we review topics such as patient positioning, recommendations for venous thromboembolism prophylaxis and appropriate monitoring for preterm labor. We also review and demonstrate options for safe laparoscopic port entry and surgical techniques to aid with visualization. We aim to provide a thorough approach to laparoscopy in this unique patient population.
Sep 24, 2020 | 59 Views
The patient was a 29-year-old G1P0 female presenting with a live 11-week extrauterine pregnancy. Radiologic work-up with both pelvic ultrasound and MRI could not fully ascertain diagnosis. Differential diagnosis included tubal ectopic, horn pregnancy of a bicornuate uterus, interstitial pregnancy, and broad ligament pregnancy. Given this was a wanted pregnancy, intra-sac potassium chloride was not administered pre-operatively and the patient was consented for a diagnostic laparoscopy and possible removal of ectopic pregnancy. Laparoscopy revealed a large left rudimentary horn pregnancy. Our video demonstrates a stepwise approach for the excision of such pregnancies including isolation of the ureter retroperitoneally, bladder dissection, use of peritoneal landmarks to ensure safe transection of the fibrous band, and use of hemostatic techniques such as vasopressin and advanced bipolar devices. In addition, we demonstrate a simple technique for oophoropexy where we stabilize a hypermobile ovary to the round ligament pedicle using a laparoscopic ligature device.
Sep 24, 2020 | 95 Views
The purpose of this educational video is to provide a brief overview of interstitial ectopic pregnancy, describe a rare case of a recurrent interstitial ectopic pregnancy after previous ipsilateral cornuectomy and demonstrate a minimally invasive surgical approach to management. We describe the case of a 38 year old G5P2 woman who presented with imaging concerning for a left interstitial ectopic pregnancy. She had previously undergone a left salpingectomy and left uterine wedge resection for separate pregnancies making the case complex and clinically fascinating. While recurrent interstitial ectopic pregnancy does pose a high risk to patients, it can be safely managed with a minimally invasive surgical approach when techniques focused on surgical planning, blood conservation, vigilant post operative care and extensive patient counseling are implemented
Sep 24, 2020 | 49 Views
Adnexal torsion in the third trimester of pregnancy is rare but associated with significant risk of maternal and fetal morbidity if left untreated. Laparoscopy is considered the preferred surgical approach for treatment of adnexal torsion but has not been described beyond 34 weeks’ gestation. Here we illustrate a case of right adnexal torsion in the setting of a known ovarian cyst successfully treated with laparoscopic detorsion and cystectomy at 35+5 weeks gestational age. Pre-operative consultations, port placement, surgical steps and post-operative monitoring with the help of a multidisciplinary team are presented.
Sep 24, 2020 | 57 Views
This video reviews the surgical management of adnexal torsion in early and late pregnancy. We discuss imaging and diagnosis, and present an approach focusing on the preoperative, intraoperative, and postoperative considerations.
Sep 24, 2020 | 130 Views
Management of interstitial ectopic pregnancy has traditionally been performed via cornual wedge resection. We present a minimally invasive approach using a four step process: (1) identify the location of the interstitial pregnancy, (2) utilize hemostatic measures such as vasopressin, vessel occlusion, or tranexamic acid, (3) create a circumferential linear incision over the specimen leaving a tissue pedicle, and (4) complete a double layer running closure for re-approximation and hemostasis.