En Bloc Resection of Deep Infiltrating Endometriosis with a Novel Tissue Extraction and Anastomotic

Jul 8, 2019 | 191 Views

Brigid Nee, Sarah Mah

This video demonstrates the use of natural orifice vaginal extraction for the completion of a laparoscopic bowel resection in the setting of deep infiltrating endometriosis.

Novel Management of Ureteral Endometriosis

Jul 8, 2019 | 208 Views

W. Al-Shayeji, Brian Blew, Hisham Khalil, Hassan Shenassa, Sukhbir Sony Singh

This video demonstrates a unique approach to the management of ureteral endometriosis.

Approach to the Obliterated Cul-De-Sac

Jul 8, 2019 | 414 Views

Devon Evans, Michael Suen, Vincent della Zazzera, Sukhbir Sony Singh

This video describes a laparoscopic approach to the obliterated cul-de-sac in the setting of endometriosis

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 | 295 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.

Resection of the Complete Uterine Septum

Sep 28, 2019 | 270 Views

Geoffrey Zeni, Andrew Zakhari, Ari Sanders, Lisa Allen

The surgical correction of a complete uterine and cervical septum. 1. Overview of the background, clinical presentation and relevant pre-operative planning.2. An illustration and instruction for surgical correction.3. Discussion of the post-operative care and long-term outcomes.