Conclusion: Our technique is a simple, quick, reliable and safe method to
conrm the accurate insertion of the Veress needle.
310 Open Communications 17dLaparoscopy (4:50 PM d 4:55 PM) Combination VideoAssisted Thoracoscopic Surgery and Video Assisted Laparoscopic Surgery for Treatment of Endometriosis: A Multidisciplinary Approach Miller JM, 1 Paka C, 1 Beygui R, 2 Nezhat C. 1 1 Stanford University Hospital, Department of Obstetrics and Gynecology, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, California; 2 Stanford University Hospital, Department of Cardiothorasic Surgery, Stanford Cardiothorasic Surgery, Mountain View, California Study Objective: To report our institutions experience of systematically combining video assisted thoracoscopic surgery (VATS) and video assisted laparoscopic surgery (VALS) for the treatment of abdomino- pelvic, diaphragmatic and thoracic endometriosis. Design: Retrospective study. Setting: Tertiary referral center. Patients: Patients with signs and symptoms consistent with abdomino- pelvic, diaphragmatic and thoracic endometriosis. Intervention: All patients, who met criteria, underwent a combined VATS and VALS treatment of potential endometriosis from 1/2008 to 8/2012. Measurements and Main Results: Current data set includes 19 patients with the average age at time of surgical intervention being 37 years (25 - 60). All patients except one had an extensive history of dysmenorrhea and dyspareunia. Eighty-nine percent had complaints of catamenial chest pain and in 53% this was their only chest complaint. Catamenial pneumothorax was noted in 26%, shoulder pain in 21% and 16% had hemoptysis. Eighty- four percent of patients had undergone previous surgery for treatment of endometriosis. For those who underwent previous surgery for endometriosis, the average time to a combined, multidisciplinary surgical treatment was 10 years from initial surgical diagnosis of endometriosis. Only three out of the 19 cases had no previous diagnosis of endometriosis. Eighty-nine percent of the cases (17) had no major postoperative complications. There was one major thoracic complication and one major pelvic complication of a vaginal cuff hematoma occurring after a hysterectomy requiring two additional VALS and a blood transfusion. Conclusion: Clinical suspicion and preoperative assessment is crucial in the diagnosis of thoracic endometriosis and allows for a multidisciplinary preconsultation. Combination of VATS and VALS for treatment of endometriosis optimally addresses the pelvis, diaphragm and thoracic cavity in a single operation. This case series represents an opportunity to further evaluate extragenital manifestations of endometriosis and surgical treatment options in a multidisciplinary setting. 311 Video Session 9dHysteroscopy (3:20 PM d 3:26 PM) Outpatient Resection of Fibroid: A Patients View Penketh R, Bruen E, Groves L, Hill S, Patwardhen A, Lindsay P, Grifths A. Obstetrics and Gynaecology, Cardiff and Vale University Health Board, Cardiff, Wales, United Kingdom Following the award of a Health Foundation Shine 2010 grant the team started resection of broids and polyps in the outpatient clinic (ofce). Over 350 resections have been attempted with over 90% success and less than 2% failure of resection Eight or 10 mm Storz monopolar resectoscope (gravity fed glycine, maximum 9L, minimal decit). Contemporaneous pain scores averaged 3.5/10, and independent evaluation of patient experience was extremely positive. Comparative cost analysis reveals savings of 650 ($1000) compared with general anaesthetic in theatre and over 270 ($400) compared to disposable bipolar instrumentation. Tissue weights are available in 268specimens and 70 of these (26%) weighed over 2 grammes, regarded as the upper limit for removal in outpatients (ofce). During the resection of a particularly large broid (29G) the patient produced her iphone and captured unique footage of the procedure and environment. 312 Video Session 9dHysteroscopy (3:27 PM d 3:33 PM) The Diverse Hysteroscopic Appearance in Cases of Retained Products of Conception Smorgick N, Barel O, Vaknin Z, Halperin R, Pansky M. Obstetrics and Gynecology, Assaf Harofe Medical Center, Tel Aviv University, Beer Yaakov, Israel Retained products of conception (RPOC), also called residual throphoblastic tissue, may occur after any type of delivery or pregnancy termination. Hysteroscopy is considered the gold standard for the diagnosis of RPOC. From our experience, different types of RPOC have different hysteroscopic appearance. The purpose of this video is to describe the hysteroscopic ndings in cases of RPOC and the hysteroscopic approach used to treat these cases. 313 Video Session 9dHysteroscopy (3:34 PM d 3:42 PM) Management of AUB in a Bicornuate Uterus: Endometrial Ablation in a Complex Medical Patient Chudnoff SG, Levie M, Lieberman E. Obstetrics & Gynecology and Womens Health, Monteore Medical Center / Albert Einstein College of Medicine, Bronx, New York The management of abnormal uterine bleeding (AUB) is routine in many gynecologic practices, however, certain medical considerations may create difculty in its management. We present a case of a patient with a history of peripartum cardiomyopathy, hypertention, a bicornuate uterus, and who has Essure coils in-situ who has failed other managements for her AUB or was not a candidate for those managements. We managed the patient by performing an endometrial ablation with the hydrothermal ablation system. We demonstrate our approach for dealing with uterine anomalies with this technique. The patient tolerated the procedure well and reported ammenorrhea at 6 months post-procedure. 314 Video Session 9dHysteroscopy (3:43 PM d 3:51 PM) Fertility Sparing (Minimally Invasive) Treatment of Arteriovenous Malformation of the Uterus with Mullerian Anomaly Khan Z, 1 Woodrum DA, 2 Jensen JR. 1 1 Department of Obstetrics & Gynecology, Division of Reproductive Endocrinology & Infertility, Mayo Clinic, Rochester, Minnesota; 2 Department of Rdiology, Division of Vascular & Interventional Radiology, Mayo Clinic, Rochester, Minnesota Arteriovenous malformation of the uterus is a rare condition that may be congenital or acquired. While hysterectomy is the denitive therapy, uterine artery embolization appears to be an effective uterine sparing option. More than 85 cases of embolization of uterine arteriovenous malformation have been reported. Restoration of normal menstrual cycles and successful pregnancies have been reported in 2 cases. We present the case of a 24 year old G1P0010 patient who was diagnosed with a septate uterus and a heterogenous mass in the uterus. MR and ultrasonographic imaging suggested presence of an arteriovenous malformation in the uterus. The patient underwent a bilateral uterine artery embolization where the arteriovenous malformation in the uterus was targeted. Following resolution of the vascular lesion a hysteroscopic septoplasty was performed without any complications. The patient recovered from the procedure and is currently pregnant in her second trimester. S98 Abstracts / Journal of Minimally Invasive Gynecology 20 (2013) S95S132