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Gynecology

Find all the surgical interventions, lectures, experts opinions, debates, webinars and operative techniques per specialty.
Complete cytoreductive surgery (CRS) and HIPEC using a minimally invasive approach with NOTES extraction for peritoneal carcinomatosis from primary ovarian cancer
This is the case of a 60-year old woman who sought medical advice for constipation and increased abdominal perimeter in October 2016. The abdominal CT-scan suggested a peritoneal carcinomatosis of ovarian origin along with an ascites.
The PET-scan did not show any other lesions. CA125 levels were high (1265 U/mL). The biopsy was positive and immunohistochemistry (IHC) showed a high-grade ovarian peritoneal serous carcinoma (CK7: (+), CK20: (-), WTI: (+), P53: (+), PAX8: (+), CA125: (+), RE: (+)). The diagnosis of a FIGO stage IIIc peritoneal carcinomatosis of ovarian origin was established. The patient was treated with neoadjuvant chemotherapy (Carboplatin-Paclitaxel- Bevacizumab, 4 cycles).
The patient showed a favorable clinical response with ascites disappearance. The radiological imaging also showed the disappearance of peritoneal implants. Only a 3cm right parauterine mass persisted and a biochemical response was noted with CA125 decrease (32 U/mL). A radical cytoreductive surgery is decided upon using a minimally invasive intraperitoneal hyperthermia chemotherapy. A complete cytoreduction (CC0) was performed after tumor load determination with a Peritoneal Cancer Index (PCI) of 4. It showed a greater pelvic affectation and a minimal involvement of the greater omentum. We performed a hysterectomy, a double adnexectomy, and a bilateral pelvic and parietal peritonectomy. Complete omentectomy with a gastro-omental arcade preservation, round ligament resection, bilateral iliac lymphadenectomy, and appendectomy were performed. The surgical specimens were extracted through the vagina. The patient underwent an intraoperative hyperthermic intraperitoneal chemotherapy (42ºC) with Paclitaxel (60mg/m2). Postoperative outcomes were uneventful.
A Arjona-Sánchez, S Rufian Pena, D Garcilazo Arismendi, A Cosano Alvarez, A Moreno Navas, JM Sanchez Hidalgo, FJ Briceño Delgado
Surgical intervention
1 year ago
5671 views
398 likes
0 comments
32:37
Complete cytoreductive surgery (CRS) and HIPEC using a minimally invasive approach with NOTES extraction for peritoneal carcinomatosis from primary ovarian cancer
This is the case of a 60-year old woman who sought medical advice for constipation and increased abdominal perimeter in October 2016. The abdominal CT-scan suggested a peritoneal carcinomatosis of ovarian origin along with an ascites.
The PET-scan did not show any other lesions. CA125 levels were high (1265 U/mL). The biopsy was positive and immunohistochemistry (IHC) showed a high-grade ovarian peritoneal serous carcinoma (CK7: (+), CK20: (-), WTI: (+), P53: (+), PAX8: (+), CA125: (+), RE: (+)). The diagnosis of a FIGO stage IIIc peritoneal carcinomatosis of ovarian origin was established. The patient was treated with neoadjuvant chemotherapy (Carboplatin-Paclitaxel- Bevacizumab, 4 cycles).
The patient showed a favorable clinical response with ascites disappearance. The radiological imaging also showed the disappearance of peritoneal implants. Only a 3cm right parauterine mass persisted and a biochemical response was noted with CA125 decrease (32 U/mL). A radical cytoreductive surgery is decided upon using a minimally invasive intraperitoneal hyperthermia chemotherapy. A complete cytoreduction (CC0) was performed after tumor load determination with a Peritoneal Cancer Index (PCI) of 4. It showed a greater pelvic affectation and a minimal involvement of the greater omentum. We performed a hysterectomy, a double adnexectomy, and a bilateral pelvic and parietal peritonectomy. Complete omentectomy with a gastro-omental arcade preservation, round ligament resection, bilateral iliac lymphadenectomy, and appendectomy were performed. The surgical specimens were extracted through the vagina. The patient underwent an intraoperative hyperthermic intraperitoneal chemotherapy (42ºC) with Paclitaxel (60mg/m2). Postoperative outcomes were uneventful.
Role of laparoscopy in treating ovarian cancer
Borderline ovarian tumors (BOTs) represent about 10 to 20% of all ovarian malignancies and differ from invasive ovarian cancers (IOCs) by many characters. The standard management of BOT is peritoneal washing cytology, hysterectomy, bilateral salpingo-oophorectomy, omentectomy, complete peritoneal resection of macroscopic lesions; in case of mucinous BOTs, appendectomy should be performed. Because BOTs are often diagnosed at an earlier stage, in younger women and have a better prognosis and a higher survival rate than IOCs, fertility-sparing surgery is one of the options to preserve a childbearing capacity. However, conservative surgery is still controversial.
So far, postoperative chemotherapy, radiotherapy, and hormone therapy are not recommended. BOTs are characteristically difficult to diagnose using preoperative radiological methods, exhibit inconsistencies in expression of tumor markers, and are often inaccurately identified using frozen sections. In these slides, Dr. Marco Puga will discuss the controversial issues of BOTs and will present the management of BOTs.
M Puga
Lecture
2 years ago
2607 views
167 likes
0 comments
31:15
Role of laparoscopy in treating ovarian cancer
Borderline ovarian tumors (BOTs) represent about 10 to 20% of all ovarian malignancies and differ from invasive ovarian cancers (IOCs) by many characters. The standard management of BOT is peritoneal washing cytology, hysterectomy, bilateral salpingo-oophorectomy, omentectomy, complete peritoneal resection of macroscopic lesions; in case of mucinous BOTs, appendectomy should be performed. Because BOTs are often diagnosed at an earlier stage, in younger women and have a better prognosis and a higher survival rate than IOCs, fertility-sparing surgery is one of the options to preserve a childbearing capacity. However, conservative surgery is still controversial.
So far, postoperative chemotherapy, radiotherapy, and hormone therapy are not recommended. BOTs are characteristically difficult to diagnose using preoperative radiological methods, exhibit inconsistencies in expression of tumor markers, and are often inaccurately identified using frozen sections. In these slides, Dr. Marco Puga will discuss the controversial issues of BOTs and will present the management of BOTs.
Combining VATS and laparoscopic approach in the resection of ovarian carcinoma metastasis
This is the case of a 64-year-old woman with a history of hysterectomy and left adnexectomy. In 2012, a vaginal ultrasound revealed a right ovarian mass diagnosed as a right ovarian cancer. In December 2012, she underwent a right adnexectomy with pelvic, lumbo-aortic lymphadenectomy and omentectomy. Final pathological staging of the ovarian cystadenocarcinoma was pT3cpN1Mx (IIIC). She completed 6 cycles of adjuvant chemotherapy with carboplatin and paclitaxel. During the follow-up exam, the patient remained symptom-free and presented with a stable perihepatic lesion. In 2015, two new lesions were found on CT-scan: one in the anterior mediastinum (14mm) and another in the abdominal diaphragm in contact with a liver segment VIII (19mm). In addition, CA 125 raised from 19 to 50kU/L. PET-scan only evidenced these two new lesions (SUV= 10). Taking into account the patient’s excellent performance status, long disease-free survival, stability of lesions, with CT-scans performed with a 3-month interval, and the possibility of video-assisted surgery, it was decided to use VATS and laparoscopy to remove the lesions. Final pathological findings showed ovarian cystadenocarcinoma metastases in 2 lesions (R0). The third perihepatic lesion was a cyst. The patient was discharged on postoperative day 4.
F Cabral, JA Pereira, P Calvinho, P Amado, R Maio
Surgical intervention
2 years ago
2704 views
91 likes
0 comments
11:33
Combining VATS and laparoscopic approach in the resection of ovarian carcinoma metastasis
This is the case of a 64-year-old woman with a history of hysterectomy and left adnexectomy. In 2012, a vaginal ultrasound revealed a right ovarian mass diagnosed as a right ovarian cancer. In December 2012, she underwent a right adnexectomy with pelvic, lumbo-aortic lymphadenectomy and omentectomy. Final pathological staging of the ovarian cystadenocarcinoma was pT3cpN1Mx (IIIC). She completed 6 cycles of adjuvant chemotherapy with carboplatin and paclitaxel. During the follow-up exam, the patient remained symptom-free and presented with a stable perihepatic lesion. In 2015, two new lesions were found on CT-scan: one in the anterior mediastinum (14mm) and another in the abdominal diaphragm in contact with a liver segment VIII (19mm). In addition, CA 125 raised from 19 to 50kU/L. PET-scan only evidenced these two new lesions (SUV= 10). Taking into account the patient’s excellent performance status, long disease-free survival, stability of lesions, with CT-scans performed with a 3-month interval, and the possibility of video-assisted surgery, it was decided to use VATS and laparoscopy to remove the lesions. Final pathological findings showed ovarian cystadenocarcinoma metastases in 2 lesions (R0). The third perihepatic lesion was a cyst. The patient was discharged on postoperative day 4.
Laparoscopic retroperitoneal access to ovarian cysts fixed by severe pelvic adhesions: a case report
Left cystectomy or left adnexectomy can be difficult in cases of frozen pelvis, with an adnexa entirely covered with the sigmoid colon and stuck to the pelvic sidewall.
This video clearly demonstrates the advantages of the left retroperitoneal access to the adnexa, limiting the risks of injury of the ureter and the perforation of the sigmoid colon. The different steps of the operation are as follows: 1) Lysis of adhesions between the sigmoid colon and the left pelvic sidewall to visualize the tube. 2) Division of adhesions between the sigmoid colon and the uterus to visualize the left ovary. 3) Left retroperitoneal access to the ovary with a longitudinal incision of the peritoneum, laterally. 4) Division of the utero-ovarian pedicle. 5) Retroperitoneal dissection of the ureter to completely release the ovary from the ureter. 6) Lysis of the upper surface of the ovary from the sigmoid colon.
JB Dubuisson, J Dubuisson
Surgical intervention
2 years ago
5352 views
297 likes
0 comments
08:20
Laparoscopic retroperitoneal access to ovarian cysts fixed by severe pelvic adhesions: a case report
Left cystectomy or left adnexectomy can be difficult in cases of frozen pelvis, with an adnexa entirely covered with the sigmoid colon and stuck to the pelvic sidewall.
This video clearly demonstrates the advantages of the left retroperitoneal access to the adnexa, limiting the risks of injury of the ureter and the perforation of the sigmoid colon. The different steps of the operation are as follows: 1) Lysis of adhesions between the sigmoid colon and the left pelvic sidewall to visualize the tube. 2) Division of adhesions between the sigmoid colon and the uterus to visualize the left ovary. 3) Left retroperitoneal access to the ovary with a longitudinal incision of the peritoneum, laterally. 4) Division of the utero-ovarian pedicle. 5) Retroperitoneal dissection of the ureter to completely release the ovary from the ureter. 6) Lysis of the upper surface of the ovary from the sigmoid colon.
Laparoscopic oophorectomy for solid ovarian mass
We present the case of a 28-year-old woman with no relevant previous surgical or medical history. The patient was addressed for the removal of a right ovarian mass. She presented with dysmenorrhea and occasional dyspareunia. There were no other symptoms. Her physical examination showed a right adnexal mass to the vaginal touch. Preoperative work-up included a pelvic ultrasound, which showed a tumor apparently originating from the right ovary, of solid homogeneous appearance. MRI confirmed the presence of the solid mass, measuring approximately 6cm. No other pathological findings were present in the rest of the abdominal cavity. Tumor markers were negative. The patient had not completed childbearing and desired a conservative surgical approach. The different aspects of the surgical management were explained, including the possibility of performing an oophorectomy if no healthy ovarian tissue could be identified.
A Wattiez, C Redondo Guisasola, M Puga, R Fernandes, J Alves
Surgical intervention
5 years ago
5161 views
83 likes
1 comment
08:33
Laparoscopic oophorectomy for solid ovarian mass
We present the case of a 28-year-old woman with no relevant previous surgical or medical history. The patient was addressed for the removal of a right ovarian mass. She presented with dysmenorrhea and occasional dyspareunia. There were no other symptoms. Her physical examination showed a right adnexal mass to the vaginal touch. Preoperative work-up included a pelvic ultrasound, which showed a tumor apparently originating from the right ovary, of solid homogeneous appearance. MRI confirmed the presence of the solid mass, measuring approximately 6cm. No other pathological findings were present in the rest of the abdominal cavity. Tumor markers were negative. The patient had not completed childbearing and desired a conservative surgical approach. The different aspects of the surgical management were explained, including the possibility of performing an oophorectomy if no healthy ovarian tissue could be identified.
Transumbilical single incision laparoscopic left ovariectomy
Background: Transumbilical single incision laparoscopy has been reported to be a feasible and safe procedure to treat gynecologic diseases. This video presents a left ovariectomy performed in a patient with a symptomatic giant ovarian cyst.

Clinical case: A 56-year-old female with a body mass index of 20.5 kg/m2, was consulted for abdominal pain localized in the left iliac fossa. Preoperative work-up showed a left ovarian cyst of 12cm in diameter. The cyst appeared to be round, with smooth walls, homogenic liquid, and without intracystic proliferations. The procedure was performed using an 11mm reusable port for a 10mm, 30-degree standard length scope, and curved reusable instruments according to Dapri (Karl Storz Endoskope). The specimen was extracted through the umbilicus in a custom-made plastic bag.

Results: No conversion to open surgery nor additional ports were necessary. The laparoscopy lasted 37 minutes and the final umbilical incision length was 15mm. Pathological data revealed a serous cystadenoma. The patient was discharged on postoperative day 1. At 7-month follow-up, no late complications were found and the patient was asymptomatic.

Conclusions: Transumbilical single incision laparoscopy is beneficial for gynecologic diseases and this technique allow for a final scar of minimal size. The cost of the procedure is similar to that of multi-port laparoscopy.
G Dapri, M Degueldre
Surgical intervention
6 years ago
2846 views
33 likes
1 comment
03:46
Transumbilical single incision laparoscopic left ovariectomy
Background: Transumbilical single incision laparoscopy has been reported to be a feasible and safe procedure to treat gynecologic diseases. This video presents a left ovariectomy performed in a patient with a symptomatic giant ovarian cyst.

Clinical case: A 56-year-old female with a body mass index of 20.5 kg/m2, was consulted for abdominal pain localized in the left iliac fossa. Preoperative work-up showed a left ovarian cyst of 12cm in diameter. The cyst appeared to be round, with smooth walls, homogenic liquid, and without intracystic proliferations. The procedure was performed using an 11mm reusable port for a 10mm, 30-degree standard length scope, and curved reusable instruments according to Dapri (Karl Storz Endoskope). The specimen was extracted through the umbilicus in a custom-made plastic bag.

Results: No conversion to open surgery nor additional ports were necessary. The laparoscopy lasted 37 minutes and the final umbilical incision length was 15mm. Pathological data revealed a serous cystadenoma. The patient was discharged on postoperative day 1. At 7-month follow-up, no late complications were found and the patient was asymptomatic.

Conclusions: Transumbilical single incision laparoscopy is beneficial for gynecologic diseases and this technique allow for a final scar of minimal size. The cost of the procedure is similar to that of multi-port laparoscopy.
Laparoscopic oophoropexy
This is the case of a 25-year-old woman with a previous history of right ovarian torsion that necessitates removal of that ovary. The patient expressed concern regarding fertility and possible torsion of the left ovary in the future.
During laparoscopy, an elongated utero-ovarian ligament was noticed. Decision was made to proceed with oophoropexy to decrease the chance of ovarian torsion in the future.
The video demonstrates the back load technique of the needle introduced through the 5mm port incision to achieve optimal cosmetic results.
The needle was passed through the left utero-ovarian ligament. Plication started from the ovarian end towards the uterine end. Extracorporeal knot was tied.
Interceed™ was used to minimize the risk of subsequent adhesions.
M Milad, N Latif, I Moy
Surgical intervention
6 years ago
7666 views
204 likes
0 comments
03:05
Laparoscopic oophoropexy
This is the case of a 25-year-old woman with a previous history of right ovarian torsion that necessitates removal of that ovary. The patient expressed concern regarding fertility and possible torsion of the left ovary in the future.
During laparoscopy, an elongated utero-ovarian ligament was noticed. Decision was made to proceed with oophoropexy to decrease the chance of ovarian torsion in the future.
The video demonstrates the back load technique of the needle introduced through the 5mm port incision to achieve optimal cosmetic results.
The needle was passed through the left utero-ovarian ligament. Plication started from the ovarian end towards the uterine end. Extracorporeal knot was tied.
Interceed™ was used to minimize the risk of subsequent adhesions.