8718 Novel Use of Viscera Retainer for Safer Resection of Posterior Fibroids during Laparoscopic Myomectomy

Abstract

<h3>Study Objective</h3> To demonstrate a novel use of an abdominal viscera retainer for improving safe access to the posterior aspect of the uterus during laparoscopic myomectomy. <h3>Design</h3> Surgical film. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> Patient with a large 7 × 7cm subserosal and intramural fibroid at the posterior aspect of the uterine body and fundus. <h3>Interventions</h3> A viscera retainer is a device widely used by surgeons to retain omentum and protect underlying bowel during fascial closure of laparotomy cases. The device has been used to improve speed of closure while significantly reducing the risk of unintended needle punctures. During this laparoscopic myomectomy case, we used an umbilical port for the camera, left and right lower quadrant ports, and a midline suprapubic mini-laparotomy incision using a mini GelPoint. We used a medium sized viscera retainer, measuring approximately 6 × 9 inches. The retainer is able to be easily rolled for placement in the pelvis through the mini GelPoint. Once in the abdomen, the retainer can be positioned into the posterior cul-de-sac overtop of any underlying bowel. The weighted center spine helps to keep the device in place and prevents bowel from inadvertently moving into the surgical field. <h3>Measurements and Main Results</h3> The viscera retainer was able to be used as an intra-abdominal retraction device and physical protective barrier for the bowel during laparoscopic myomectomy, specifically during enucleation of the fibroid and suturing of the hysterotomy. <h3>Conclusion</h3> This unique use of a device typically reserved for laparotomy improved surgeon's access to the posterior aspect of the uterus for dissection and enucleation of posterior fibroids during laparoscopic myomectomy.