Cerrahi kongresi kongre biLİmsel programi ve biLDİRİ Özetleri

21 - 25 Şubat 2018
Wyndham Grand İstanbul Levent • İstanbul
MİNİMAL İNVAZİV JİNEKOLOJİK
CERRAHİ KONGRESİ
 www.minimalinvazivjinekolojikcerrahi.org
VS-50 
Laparoscopic Surgery of a Case with Deep Pelvic Endometriosis
Emine Karabuk
1
, Fathema Adel Alkhan
1
, Mehmet Murat Naki
1
, Bilgi Baca
2
, Mehmet Faruk Kose
1
1
Department of Obstetrics and Gynecology, Istanbul Acibadem Mehmet Aydinlar University 
Atakent Hospital
2
Department of General Surgery, Istanbul Acibadem Mehmet Aydinlar University Atakent 
Hospital
STUDY OBJECT: To describe our experience with laparoscopic management of deep pelvic 
endometriosis
PATIENT AND CASE PRESENTATION: She was 44 years old and had one ceserian section 
before. She has had clinically chronic pelvic pain, dysmenorrhea, dyspareunia, constipation 
and painful defecation since 2007. She has taken medication 2mg dienogest for a long 
time. In recent year her complaints has increased. In rectovainal examination, we noticed 
about a 2cm nodul at douglas. Any mass was not seen on the ultrasonography. And we 
aimed to explain the reason of her complaints by perfoming the diagnostic laparoscopy. By 
laparoscopy, we found multiple endometriotic nodules including the rectum in pelvic area. 
The treatment of severe deep pelvic endometriosis requires complete excision of all implants. So 
in this case we performed excision of deep endometriotic nodules of parametrial, uterovesical, 
rectovaginal and excision of endometriotic focus from rectum and rectum resection and end to 
end anastamosis by laparoscopic way.
 
Keywords: Endometriosis,pelvic pain, laparoscopy
 
 
 

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 www.minimalinvazivjinekolojikcerrahi.org
21 - 25 Şubat 2018
Wyndham Grand İstanbul Levent • İstanbul
MİNİMAL İNVAZİV JİNEKOLOJİK
CERRAHİ KONGRESİ
VS-51 
Laparoskopik pelvik lenf adenektomi benim tekniğim
Cihan Comba
Bakırköy Dr. Sadi Konuk EAH
Laparoskopik lenf adenektomi teknik: İnsizyona round ligament ile infundibulopelvik ligament 
arasından peritonun insizyonu ile başlanır. İnfundibulopelvik ligamente paralel insizyonu 
genişletiyoruz. Gözeli dokuyu lateral ve posteriora doğru iliopsoas kasına kadar diseke edilir. 
Genitofemoral, ilioinguinal sinirler korunur. Arteria iliak eksternanın lateral duvarına gelince 
kadar diseksiyon mediale genişletilir. Kaudalde sirkumflex iliak ven lateral sınırı yapar. Ardından 
eksternal iliak arter ve ven ile iliopsoas kası arasından paralel olarak obturator fossada obturator 
sinir bulununcaya kadar genişletilir. Oblitere umblikal arter medialde kalacak şekilde paravesikal ve 
üreter medialde kalacak şekilde pararektal fossalar açılır. İliopsoas kasından serbestlenen lenf nodu 
iliak eksternal arterin ön kısmından damara paralel keskin ve künt diseksiyonla ayrılır. Eksternal iliak 
ven duvarına dogru diseksiyon yapılır ve venin medialinden pubik kemiğe yakın taraftan obturator 
fossaysa doğru lenf nodu serbestlenir ve obturator sinir medialdende görülür ve sinir korunarak 
sinirden serbestlenir. Kaudalden başlanarak pelvik lenf nodları yekpare olarak çıkartılır. Endobag 
içinde batın dışına alınır.
 
Anahtar Kelimeler: Pelvik Lenf Adenektomi, Laparoskopi, Onkoloji
 
 

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21 - 25 Şubat 2018
Wyndham Grand İstanbul Levent • İstanbul
MİNİMAL İNVAZİV JİNEKOLOJİK
CERRAHİ KONGRESİ
 www.minimalinvazivjinekolojikcerrahi.org
VS-52 
Robotic Myomectomy; Removal of a Huge Fibroid
Ozguc Takmaz, Savas Gundogan, Esra Ozbasli, Suat Dede, Mete Gungor, Mehmet Murat Naki, 
Faruk Köse
Acibadem MAA University, Department of Obstetrics and Gynecology
OBJECTIVE: Video presentation of a huge myoma removed with robotic platform 
 
BACKGROUND: First robotic myomectomy was performed in 2004 by Advincula et al. Since that 
date, number of gynecologic robotic surgeries have been increased whole over the world. It has 
been revealed that fibroids which are larger than 8-10 cm is not appropriate for removal with 
minimally invasive gynecologic procedures in the literature. However, increasing numbers of 
endoscopic operations and requests from patients make surgeons enforce the borders. Here we 
present a huge fibroid which was removed with robotic platform.
 
SETTING: Acibadem MAA University, Department of Obstetrics and Gynecology
 
DESIGN: 38 year old patient with a 20x22cm fibroid was admitted to our clinic with endoscopic 
removal request. After a detailed information to the patient and having an informed consent, it 
has been decided to perform myomectomy operation via robotic platform. The operation was 
performed via da Vinci Xi platform (Intuitive Surgical, Inc., Sunnyvale, C), the patient card was docked 
centrally, three robotic arms and smoke evacuator (AirsealR SurgiQuest, Inc., CT, USA) were used. 
 
RESULTS: Operation time (skin to skin) was 205min., Docking time was 6min., Estimated blood 
loss (calculated with the difference between irrigation and suction) was 350cc, 2 transfusion had 
been made, first gas discharge was 13 hours after the surgery, Length of hospital stay was 2 days. 
No complication had been occured peri-operatively.
 
CONCLUSION: Huge fibroids can be removed by robotically.
 
Keywords: robotic myomectomy, huge fibroid, myoma
 
 
 

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