Laparoscopic Uterine Cerclage: A 10 Year Experience at a Tertiary Referral Centre

Laparoscopic Uterine Cerclage: A 10 Year Experience at a Tertiary Referral Centre

Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97 BMI. RALH was associated with a longer total operative time (mean 132 minutes) t...

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Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97 BMI. RALH was associated with a longer total operative time (mean 132 minutes) than TLH (mean 107 minutes). There were no intra-operative complications and no conversions to laparotomy. Three minor post-operative complications occurred in each group. The average length of stay was significantly higher in the TLH group (1.78 days vs 1.26 days) than the RALH group. Six patients (15.4%) in the RALH group were discharged on the day of surgery. Majority of cases of RALH reported <20mL EBL compared with average of 78mL for TLH, a statistically significant difference. Conclusion: The establishment of a robotic gynecological surgery program at our institution is safe and feasible. Complication rate and blood loss are low and patient recovery is excellent. Length of stay is reduced, and same-day discharge is achievable, allowing significant reductions in health care costs. Open Communications 19: Robotics (2:00 PM − 3:00 PM) 2:49 PM Retroperitoneal Approach to Laparoscopic Hysterectomy in Patient with Complete Uterus Didelphys Radtke SJ*. Obstetrics and Gynecology, Texas Tech University Health and Science Center, El Paso, TX *Corresponding author. Video Objective: Demonstrate how a retroperitoneal dissection can facilitate hysterectomy in cases of uterine anomalies Setting: University affiliated hospital Interventions: 55 year old patient presented with severe abnormal uterine bleeding and dysmenorrhea. Imaging was suspicious for a M€ullerian anomaly. A laparoscopic hysterectomy was planned. On entry into the abdomen, complete uterine didelphys was noticed. Using a retroperitoneal dissection we were able to identify all critical structures and maintain adequate hemostasis during the case, resulting in a satisfactory outcome for the patient. Conclusion: Developing the retroperitoneal space is paramount in order to successfully perform surgery in a uterus with distorted anatomy Open Communications 20: Laparoscopy (2:00 PM − 3:00 PM) 2:00 PM Laparoscopic Uterine Cerclage: A 10 Year Experience at a Tertiary Referral Centre Ma K,* Lim K, Majumder K, Edi-Osagie E. Gynaecology, Manchester Foundation Trust, Manchester, United Kingdom *Corresponding author. Study Objective: To determine the safety and efficacy of all cases of laparoscopic uterine cerclage performed in a tertiary referral center in the last 10 years. Design: Retrospective Cohort Study. Setting: Tertiary referral center and university teaching hospital. Patients or Participants: All patients who underwent laparoscopic uterine cerclage from March 2010 to March 2019. Interventions: Laparoscopic insertion of uterine cerclage. Measurements and Main Results: A total of 14 cases were identified. 14/ 14 patients presented with a history of recurrent pregnancy loss or extreme premature labor (below 26 weeks). Indication included further mid-trimester loss or extreme premature labor despite elective cervical cerclage (8/ 14), failed rescue cerclage (3/14) and a short cervix on ultrasound or failure to insert cervical cerclage (3/14). No intra-operative complications were noted. Mean operating time was 98 minutes (Range 68-124). No post-operative complications or readmissions were noted. Of the 12 patients who underwent surgery greater than 12 months ago, there were 12

S75 spontaneous conceptions (11/12 patients), 1 miscarriage and 11 livebirths after 37 weeks gestation by elective or emergency caesarean section. In the patient who suffered a miscarriage a surgical evacuation was carried out without complication. Conclusion: Laparoscopic uterine cerclage remains a novel technique with a strict inclusion criteria requiring regular surveillance and audit of outcomes. This has limited the number of cases performed and there are currently no robust randomized control trials comparing management options for women with recurrent pregnancy loss after cervical cerclage. Despite the small numbers our results indicate that this technique has a good safety profile and outcomes in livebirths rates >34 weeks are good. Our results supports expansion of this service at a regional level through multi-disciplinary assessment to enable this technique can becoming established practice.

Open Communications 20: Laparoscopy (2:00 PM − 3:00 PM) 2:07 PM Laparoscopic Specimen Containment Using a Large Isolation Bag Putman JG,* Biest SW. Obstetrics and Gynecology, Washington University In St. Louis/Barnes-Jewish Hospital, St. Louis, MO *Corresponding author. Video Objective: To demonstrate laparoscopic specimen containment for extraction using a large isolation bag inserted through the vagina. Setting: A 41-year-old G2P2 who presented with an enlarged 18 weeks size myomatous uterus desiring definitive surgical management. Interventions: Specimen placement into a large containment bag introduced into the abdomen through the vagina after total laparoscopic hysterectomy with bilateral salpingectomy. Conclusion: This video demonstrates a viable method of tissue containment for large specimens. This method allows for safe extraction and morcellation of contained specimens when required and appropriate. Open Communications 20: Laparoscopy (2:00 PM−3:00 PM) 2:14 PM The Inspire Comparative Cost Study: One-Year Medical Resource Utilization, and Payer Cost Analysis Associated with Hysterectomy and Myomectomy Compared to Sonography-Guided Transcervical Ablation for the Treatment Of Uterine Fibroids Brooks E,1 Mihalov LS,2 Delvadia D,*,3 Hudgens JL,4 Mama ST,5 Makai GE,6 Yuen M,1 Little C,1 Zambelli-Weiner A,1 Levine DJ7. 1TTi Health Research & Economics, Westminster, MD; 2Gynecology, Virginia Mason Medical Center, Seattle, WA; 3Drexel University College of Medicine, Philadelphia, PA; 4Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA; 5Ob/Gyn, Cooper Medical School of Rowan University, Camden, NJ; 6Obstetrics and Gynecology, Christiana Care Health Systems, Newark, DE; 7Gynecology Minimally Invasive Surgery, Mercy Clinical Minimally Invasive Gynecology, St. Louis, MO *Corresponding author. Study Objective: The INSPIRE study compared health care resource utilization (HCRU) and payor costs associated with transcervical radiofrequency (RF) ablation, hysterectomy, and myomectomy. Design: Data for transcervical RF ablation were derived from a prospective, multicenter, single-arm clinical trial (the SONATA trial); data for hysterectomy and myomectomy arms were derived from the Truven Health MarketScan Commercial Claims Database. Setting: 6 clinical sites in the US.