Abstract:

Neurophysiological investigations and neurosurgical procedures of the sacral plexus are not especially well developed, because the sacral plexus is difficult to access. Awareness that sacral radiculopathies may exist is still lacking and the incidence of these pathologies is widely underestimated. Since the recent introduction of laparoscopy in the field of pelvic nerves, the situation has changed considerably: laparoscopy not only permits a precise morphological and functional exploration of the entire sacral plexus, but also offers new therapeutic options: In lesions to the sacral nerve roots by compression, infiltration, or surgical damages, the laparoscopy offers an adequate access for micro-neurosurgical procedures; whereas in neurogenic pathologies or situations of failure of neurosurgical treatments, the technique of laparoscopic implantation of a neuroprosthesis - the LION procedure - permits the neuromodulation of all sacral nerve roots in different combination with only one electrode for simultaneous control of pelvic/lower limb pain and pelvic visceral dysfunctions. Regarding the dramatically increased incidence of sacral radiculopathies, especially secondary to pelvic prolaps surgeries by blind mesh-material implantation, this field of pathologies has to come in the focus of medical interests. Also, physicians involved in pelvic pathologies/surgeries have to be trained in clinical neuropelveology.

Authors:

Prof. Dr. med. Marc Possover, M.D., Ph.D., Director of Department for Surgical Gynecology & Neuropelveology, Hirslanden Clinic, Zürich, Switzerland

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Abstract:

This was a prospective study of postmenopausal women who underwent a computerized tomography (CT) examination of the abdomen and pelvis. We evaluated the location of the aortic bifurcation and transverse colon relative to the umbilicus at midline axis. Of 66 women, 24 were of normal weight, 23 were classified as overweight, and 19 as obese. The ages of the women in all groups were comparable. In the normal weight and overweight women, the mean location of the umbilicus was 0.6 cm ± 0.4 cm and 0.4 cm ± 0.3 cm cranial to the aortic bifurcation, respectively, and in obese women its mean location was 1.4 cm ± 0.5 cm caudal to the aortic bifurcation. In approximately half of the normal weight and overweight women, the umbilicus was located cranial to the aortic bifurcation, and in 62.2% of obese women it was located caudal to the aortic bifurcation. Compared to those with normal weight (0.3 cm ± 1.1 cm), the distance between umbilicus and transverse colon was greater in overweight (4.5 cm ± 1.2 cm) and obese women (7.1 cm ± 0.7 cm). In approximately one third of the normal weight women and over half of the overweight women, the umbilicus was located caudal to the transverse colon. In contrast, the umbilicus in 84.2% of the obese women was located caudal to transverse colon. There was a linear correlation between the distance of umbilicus and transverse colon distance and body mass index (BMI; r = 0.54, p < 0.0001). Regardless of the BMI, there was a wide variability whether the umbilicus was cranial or caudal to the aortic bifurcation or transverse colon. Similar to that in reproductive-aged women, in postmenopausal women the location of the aortic bifurcation and transverse colon varies. Proper insertion of the Veress needle and trocar is more important than a particular angle of insertion.

Authors:

Ayman Al-Talib, M.D., Research Fellow in Minimally Invasive Surgery, Department of Obstetrics and Gynecology, McGill University, Fawaz Alharbi, M.D., Resident, Department of Radiology, McGill University, David Valenti, M.D., Assistant Professor of Radiology, Department of Radiology, McGill University, Togas Tulandi, M.D., M.H.C.M., Professor of Obstetrics and Gynecology, Milton Leong Chair in Reproductive Medicine, Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada

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Abstract:

During the total laparoscopic hysterectomy (TLH) operation, small changes in the uterine and vaginal cuff position, provided by an adequate manipulator, may optimize the attack angles to the vulnerable structures involved during the procedure and facilitate their dissection. The uterine manipulators are effective because they raise the uterus when moving it from one place to another, leaving the fixing elements on tension. The Lopez-Zepeda uterine manipulator exposes all the anatomic structures involved in TLH, especially those in the vulnerable areas. It avoids dissection and mobilization of the bladder and therefore its innervation. It takes the ureter away from the risky area by 4 cm. to 5 cm. decreasing the injury risk. Finally, thanks to its anteflexion and anteversion movement, it puts the posterior culdotomy area further away from the ureter, the rectum and the sigmoid colon.

Authors:

M.A. López-Zepeda, M.D., Chair Professor, Instituto de Endoscopía Ginecológica S.C., Guadalajara, Jalisco, México, F. Ortiz Morgan, M.D., Diploma Course Program Coordinator, Associated "D" Professor, Coordinación Universitaria of the Hospital Civil de Culiacán, Universidad Autónoma de Sinaloa, Culiacán, Sinaloa, México., Harry Reich, M.D., F.A.C.O.G., Emeritus Staff, Wilkes-Barre General Hospital, Wilkes-Barre, PA

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Abstract:

One of the treatments of malignancy of low genital tract is local pelvic radiation. However, in premenopausal it is associated with premature ovarian failure. Ovarian transposition is a technique to avoid radiation damage to the ovaries. The authors report robotic-assisted ovarian transposition in a 39-year-old woman with stage II-b cervical cancer. The ovaries were transposed to the ipsilateral paracolic gutter and secured to the anterior-lateral peritoneum using a disposable fixation device.

Authors:

Ismail Al-Badawi, M.D., Consultant Gynecologic Oncology & Minimal Invasive Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, Murad Al-Aker, M.D., Assistant Consultant Obstetrics & Gynecology , King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, Togas Tulandi M.D., M.H.C.M., Professor of Obstetrics and Gynecology, and Milton Leong Chair in Reproductive Medicine, McGill University, Montreal, QC, Canada

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