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Fernanda ASENCIO

São Luiz Hospital
São Paulo, Brazil
MD
1721 likes
59147 views
2 comments
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Strategy for laparoscopic total hysterectomy and bilateral salpingectomy in case of large uterus
This video demonstrates the case of a 46-year-old patient presented with menorrhagia and anemia.
Clinical examination revealed a large mass almost reaching the level of the umbilicus.
The uterus appeared much bigger than usual on MRI, with a large myoma coming out of the pelvis.
It was decided to perform total laparoscopic hysterectomy combined with bilateral salpingectomy.
This video demonstrates the appropriate strategy to safely perform total laparoscopic hysterectomy in case of large uterus, showing the appropriate surgical steps and providing safety tips. The specimen weighed more than 1kg.
A Wattiez, F Asencio, J Faria, I Argay, L Schwartz
Surgical intervention
3 years ago
8518 views
303 likes
0 comments
25:01
Strategy for laparoscopic total hysterectomy and bilateral salpingectomy in case of large uterus
This video demonstrates the case of a 46-year-old patient presented with menorrhagia and anemia.
Clinical examination revealed a large mass almost reaching the level of the umbilicus.
The uterus appeared much bigger than usual on MRI, with a large myoma coming out of the pelvis.
It was decided to perform total laparoscopic hysterectomy combined with bilateral salpingectomy.
This video demonstrates the appropriate strategy to safely perform total laparoscopic hysterectomy in case of large uterus, showing the appropriate surgical steps and providing safety tips. The specimen weighed more than 1kg.
Anterior and posterior laparoscopic mesh removal due to pelvic pain, subtotal hysterectomy, mesh replacement, and Burch procedure
This is the case of a 69-year-old woman presenting with pelvic pain after laparoscopic sacrocolpopexy. The patient has a history of one vaginal birth, laparoscopic sacrocolpopexy with uterine preservation combined with a transobturator tape (TOT) sling procedure performed in 2013.
The following symptoms appeared after surgery: invalidating pelvic pain, especially in an upright position, severe terminal constipation, worsening of a previously mild stress urinary incontinence.
On clinical examination, a high rectocele (grade 2/3), a cystocele, and elective pain at the level of the TOT sling were observed. MRI revealed a perineal inflammation between the anterior aspect of the vagina and the urethra, at the level of the lower third of the urethra. A fibrotic area can be noted at the level of the rectovaginal space.
Her TOT sling was partially resected in January 2014.
Cystoscopy ruled out the presence of mesh erosion. Hysteroscopy was normal.
Endometrial biopsy demonstrated an atrophic endometrium.
In this surgery, the anterior and posterior meshes are removed. A subtotal hysterectomy combined with the replacement of meshes were performed, followed by a Burch procedure.
A Wattiez, I Argay, F Asencio, J Faria, L Schwartz
Surgical intervention
3 years ago
1741 views
63 likes
1 comment
33:56
Anterior and posterior laparoscopic mesh removal due to pelvic pain, subtotal hysterectomy, mesh replacement, and Burch procedure
This is the case of a 69-year-old woman presenting with pelvic pain after laparoscopic sacrocolpopexy. The patient has a history of one vaginal birth, laparoscopic sacrocolpopexy with uterine preservation combined with a transobturator tape (TOT) sling procedure performed in 2013.
The following symptoms appeared after surgery: invalidating pelvic pain, especially in an upright position, severe terminal constipation, worsening of a previously mild stress urinary incontinence.
On clinical examination, a high rectocele (grade 2/3), a cystocele, and elective pain at the level of the TOT sling were observed. MRI revealed a perineal inflammation between the anterior aspect of the vagina and the urethra, at the level of the lower third of the urethra. A fibrotic area can be noted at the level of the rectovaginal space.
Her TOT sling was partially resected in January 2014.
Cystoscopy ruled out the presence of mesh erosion. Hysteroscopy was normal.
Endometrial biopsy demonstrated an atrophic endometrium.
In this surgery, the anterior and posterior meshes are removed. A subtotal hysterectomy combined with the replacement of meshes were performed, followed by a Burch procedure.
Laparoscopic colposacropexy for the treatment of an apical defect in a patient with previous total hysterectomy
We present the case of a 69-year-old patient who suffered from an elytrocele. Previously, she had undergone a total hysterectomy with anterior and posterior colpoperineoplasty due to the presence of a grade 2 cystocele, without urinary incontinence. The management of genital prolapse requires a thorough knowledge of the anatomy and physiology of the female pelvic floor. This video outlines the main steps to follow for the repair of an apical defect with no true rectocele or cystocele. It also offers a very good insight of the specific issues to be considered when performing dissection and mesh fixation in specific situations, such as distortion of the normal anatomy due to the scarring process from a previous surgery and obesity. This surgery was performed and streamed live.
A Wattiez, C Redondo Guisasola, M Puga, F Asencio
Surgical intervention
5 years ago
4333 views
77 likes
0 comments
18:00
Laparoscopic colposacropexy for the treatment of an apical defect in a patient with previous total hysterectomy
We present the case of a 69-year-old patient who suffered from an elytrocele. Previously, she had undergone a total hysterectomy with anterior and posterior colpoperineoplasty due to the presence of a grade 2 cystocele, without urinary incontinence. The management of genital prolapse requires a thorough knowledge of the anatomy and physiology of the female pelvic floor. This video outlines the main steps to follow for the repair of an apical defect with no true rectocele or cystocele. It also offers a very good insight of the specific issues to be considered when performing dissection and mesh fixation in specific situations, such as distortion of the normal anatomy due to the scarring process from a previous surgery and obesity. This surgery was performed and streamed live.