Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S90S108

subtotal hysterectomy and compare them to similar cases published in the

literature.
Conclusion: Careful attention must be paid at the end of every procedure to
be sure to have removed all pieces of morcellated specimen, especially
between the bowel. Pieces of tissue may remain in the trocar and leaved
in the canal after trocar removal. If malignancy is expected morcellation
should be avoided.

323

Video Session 9dLaparoscopic Management of

Endometriosis and Pelvic Pain
(3:20 PM d 3:28 PM)

Laparoscopic Partial Cystectomy for Bladder Endometriosis

Scarella AC, Villarroel CQ, Jesam CG, Sovino HS. Instituto de
Investigaciones Materno Infantil., School of Medicine, Univeridad de
Chile, Santiago, Region Metropolitana, Chile
Bladder endometriosis is a rare pathological entity that must be suspected in
patients suffering of deep infiltrating endometriosis specially when is
associated to dysuria, increased micturition frequency, suprapubical pain
and menuria. Bladder ultrasound is the first approach to identify this
pathology that can be confirmed by pelvic MRI. Intravenous pyelography
must be used to exclude the ureteral involvement. Laparoscopic partial
cystectomy performed for bladder endometriosis in selected patients
requires advanced laparoscopic skills including pelvic dissection, suturing
and intracorporeal knot tying. Cystoscopic skills to assess the extent of
the endometriosis involvement in the blabber and to place ureteral stents.
We report a 41-year-old referred by a general gynecologist of deep
infiltrating bladder nodule that compromises the bladder wall and
mucosa. We observed a complete improvement and no recurrence of
urinary symptoms after 6-month period.

324

Video Session 9dLaparoscopic Management of

Endometriosis and Pelvic Pain
(3:29 PM d 3:37 PM)

Laparoscopic Ureteroneocystostomy for the Treatment of Ureteral

Endometriosis
Bautzer CRD,2 Podgaec S,1 Machado MT,2 Averbach M,2 Abrao MS.1
1
Ginecology, School of Medicine University of Sao Paulo, Sao Paulo,
Brazil; 2Sirio Libanes Hospital, Sao Paulo, Brazil
Deep infiltrating endometriosis (DIE) can affect pelvic organs, including the
ureters bilaterally, which may lead to stenosis and obstruction. If DIE
infiltrates the ureteral muscularis, ureterolysis is often uneffective and
a complete ressection is necessary. We reported the case of a 36-year-old
female, with diagnosis of DIE infiltrating the distal left ureter, previously
submitted to ureterolysis and with recidive lesion and stenosis. We
performed a complete laparoscopic ureteroneocystostomy, with Psoashitch ureteral reimplantation and submucosal non-refluxing techinique
and with double J stent associated. The patient had an hospital stay of 2
days, without any leakage from the reimplantation site. The Foley
catheter was withdraw after seven days. After 2 months, the double J was
withdrawn, and after 2 months, MRI showed discrete dilation of the
ureter and pelvis and an cintilographic study showed the absence of
ureteral obstruction, with a complete washout after furosemide.

325

Video Session 9dLaparoscopic Management of

Endometriosis and Pelvic Pain
(3:38 PM d 3:46 PM)

S97

of coils. Surgery was performed as follows: at pelvic inspection was found

one end of the micro device that had perforated the right Fallopian tube
without opening the peritoneum of the broad ligament, even if the women
complained pain in the left iliac fossa. The resection of the Fallopian tube
was performed with harmonic scalpel in cranio-caudal direction. Near the
tubal isthmus resection was done through the perimetrium and
myometrium until the opening of the endometrial cavity, acting around
the axis of the micro device and removing the Fallopian tube including
interstitial tubal tract. Uterine scars were sutured bilaterally by single
intracorporeal stitches in the myometrial layer for each side.
326

Video Session 9dLaparoscopic Management of

Endometriosis and Pelvic Pain
(3:47 PM d 3:55 PM)

Laparoscopic Treatment of a Case of Cystic Adenomyosis of the

Lower Uterine Wall
Pistofidis G, Koukoura OG, Bardis NS, Filippidis M. Tertiary Referral
Center of Gynecologic Laparoscopy, Hospital, Greece, Lefkos Stavros
Hospital, Athens, Greece
Cystic adenomyosis is a rare entity which primarily affects adolescents and
young women. We present a case of cystic adenomyosis which was located
in the lower anterior uterine segment. The patient was a 31 year-old woman
who presented with severe dysmenorrhea and pelvic pain. A transvaginal
scan revealed a cystic lesion of 3.7 cm at the lower uterine wall. The
patient opted for laparoscopic excision of the lesion. During laparoscopy,
the site of the incision was guided exclusively on the basis of a previous
ultrasound scan. The anterior uterine wall was incised and the content of
the cystic lesion drained. The base of the cyst was in close contact to the
endometrial cavity which was entered during the operation. The patient
made a good recovery and was discharged the following day. A
diagnostic hysteroscopy has been planned for two months after the
operation.

327

Video Session 9dLaparoscopic Management of

Endometriosis and Pelvic Pain
(3:56 PM d 4:04 PM)

Robotic Resection of Ureteral Endometriosis

Reddy J,1 Frick AC,1 Stein RJ,2 Paraiso MFR,1 Falcone T.1 1Obstetrics,
Gynecology and Womens Health Institute, Cleveland Clinic, Cleveland,
Ohio; 2Glickman Urological and Kidney Institute, Cleveland Clinic,
Cleveland, Ohio
Deeply infiltrating endometriosis describes a specific, infiltrative form of the
disease that may involve the uterosacral ligaments, rectovaginal septum,
bowel, or lower urinary tract. In recent case series of women with deeply
infiltrative endometriosis, the lower urinary tract was affected in 0.3-6%
of cases. Endometriosis most commonly involves the bladder, followed
by the ureters, kidneys and then the urethra. Although the incidence of
ureteral endometriosis is rare, progressive compression and obstruction
can compromise renal function potentially leading to renal failure. The
objectives of our video are to review the signs and symptoms of lower
urinary tract endometriosis, specifically focusing on the ureter and to
demonstrate our surgical technique for performing a robotic
ureteroneocystostomy using a Boari Flap.
328

Video Session 9dLaparoscopic Management of

Endometriosis and Pelvic Pain
(4:05 PM d 4:12 PM)

Laparoscopic Removal of Essure Microdevice

Litta PS, Saccardi C, Conte L, Cela V, Florio P. Department of
Gynecological Sciences and Human Reproduction, University of Padua,
Padua, Italy

Robotic-Assisted RSO with Pelvic Sidewall Dissection for

Endometriosis and Pelvic Abscess
Gallo TN, Laser M. OB/GYN, Yale New Haven Health/Bridgeport
Hospital, Bridgeport, Connecticut

We report the case of a woman subjected to laparoscopic removal of Essure

micro device for chronic pelvic pain arising few months after the placement

To show the feasibility of robotically-assisted pelvic sidewall dissection for

significant endometriosis and pelvic abscess. Methods: The Da Vinci S