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

Jul 8, 2019 | 294 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.

Two Methods for Vaginal Vault Suspension at Total Laparoscopic Hysterectomy

Jul 8, 2019 | 1556 Views

Michael Chaikof, Ari Sanders, May Alarab, Colleen McDermott, Mara Sobel

This video outlines two approaches to the suspension of the vaginal vault following total laparoscopic hysterectomy.

Surgical Repair of Uterovaginal Septums and Other Müllerian Anomalies

Sep 26, 2019 | 403 Views

Daniel Horspool, Nicholas Leyland, Sarah Scattolon

This video offers a brief overview of mullerian anomaly repair focusing specifically on uterine and vaginal septums. The septate uterus (ASRM Class V) is both the most common uterine anomaly and the most likely to be associated with adverse pregnancy outcomes. Women with septate uteri are at an increased risk for many reproductive complications including spontaneous abortion and preterm delivery. To reduce the risk of reproductive complications, surgical repair through hysteroscopic resection of the uterine septum can be performed. This video highlights the five essential steps to surgical repair: preoperative imaging, preoperative preparation, diagnostic hysteroscopy, hysteroscopic septoplasty and postoperative treatment. This video also demonstrates the repair of a vaginal septum, which often accompany uterine anomalies.Operative hysteroscopy offers a minimally invasive approach to repairing uterine septums. With appropriate preoperative planning and an organized, stepwise operative technique, a normal uterine cavity can be safely restored and reproductive outcomes improved.

Laparoscopic Hysterectomy with Cervicovaginal Agenesis

Sep 26, 2019 | 318 Views

Rupinder Dhaliwal, Liane Belland

We present a laparoscopic surgical approach for hysterectomy in Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome with cervicovaginal agenesis. Laparoscopic approaches for removal of uterine remnants have been published with only reports of laparotomy described for hysterectomy with cervicovaginal agenesis. We discuss the diagnosis, management considerations and preoperative planning for definitive surgical treatment of a patient with MRKH with cervicovaginal agenesis presenting initially with hematometra and pain. We show that laparoscopic hysterectomy is a viable and safe option in patients with cervicovaginal agenesis. The importance of preoperative imaging to rule out associated anomalies and assist in surgical planning is stressed. We highlight necessary alterations in surgical technique to overcome the lack of traction, identify potential anomalous vasculature and ultimately maintain hemostasis, clear delineation of surgical anatomy, and avoid injury. Tissue extraction through laparoscopic in bag morcellation is performed thus avoiding mini laparotomy altogether.