1885 Robotic-Assisted Hysterectomy and Bilateral Salpingo-Oophorectomy with Uterine Artery Ligation in a Case of Tubo-Ovarian Abscess with Severe Pelvic Adhesion

Abstract

Video Objective Surgeries for tubo-ovarian abscess (TOA) may be very challenging due to severe adhesions from the abscess to the surrounding inflamed tissue. Treatment was often limited to drainage of the abscess due to the difficulty of more extensive surgery. This video demonstrates successful robotic-assisted total hysterectomy with bilateral salpingo-oophorectomy and uterine artery ligation with adhesiolysis for treatment of a case with tubo-ovarian abscess. Techniques of visualizing surgical anatomy and localizing the uterine artery will also be demonstrated. Setting A 41 year-old G3P2SA1 female patient presented to our out-patient clinic with lower abdominal pain with fever for 1 month. She had undergone cesarean delivery twice 17 and 18 years ago with no other significant gynecologic history. On pelvic examination, lifting tenderness with moderate odorous discharge was noted. Transvaginal ultrasound showed bialteral adnexal mass, measuring 5 × 2 cm and 5 × 3 cm. She was then admitted to our department under the tentative diagnosis of tubo-ovarian abscess. Interventions Robotic-assisted total hysterectomy with bilateral salpingo-oophorectomy, uterine artery ligation and adhesiolysis was performed on the second day of hospitalization. Conclusion Total hysterectomy with bilateral salpingo-oophorectomy may be feasible in the treatment of tubo-ovarian abscess by using robotic-assisted instruments. Due to the greater precision, better visualization, and higher dexterity of robotic-assisted surgeries.