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Fertility & Sterility® VIDEO ABSTRACT SESSION 1 gence of the 4K3D ORBEYE VOM has the potential to revolutionize MIM. In this video, we aimed to demonstrate a comparison of various visual parameters between the ORBEYE VOM and the SOM. We also conducted an V-01 10:00 AM Saturday, October 17, 2020 animal study to evaluate the surgical experience and efficacy of the VOM. METHODOLOGY: The depth of field, working distance, and operative NON-INVASIVE SELECTION OF SINGLE SPERM field were compared between the 4K3D OBYEYE VOM (Olympus/Sony) WITH HIGH DNA INTEGRITY FOR and the SOM. Four vasovasostomies (VVs) and four vasoepididymostomies 1 1 ICSI. Zhuoran Zhang, PhD, Changsheng Dai, MASc, (VEs) were performed on Wistar male adult rats using the 4K3D ORBEYE 1 2 Guanqiao Shan, MASc, Khaled Abdalla, MASc, VOM. Data on operating time to anastomotic completion and patency rates 2 2 Iryna Kuznyetsova, PhD, Clifford Lawrence Librach, MD, Keith Jarvi, were collected. 3 1 1 2 MD, Yu Sun, PhD University of Toronto, Toronto, ON, Canada; CReATe CONCLUSIONS: The 4K3D ORBEYE VOM provides high-end on- 3 Fertility Centre, Toronto, ON, Canada; University of Toronto, School of screen visualization, coupled with enhanced ergonomics and overall surgical Medicine, Toronto, ON, Canada. experience. The ORBEYE VOM has a depth of field three times greater than seen with the SOM at magnifications of x15 and lower, due to its higher im- OBJECTIVE: To develop a quantitative and non-invasive technique for se- age and video quality with quick zoom-in, auto-focus, and zero on-screen la- lecting single sperm with high DNA integrity for ICSI. tency capabilities. A larger operative field and a more comprehensive METHODOLOGY: In ICSI, embryologists qualitatively select sperm by working distance (200-550mm vs. 250mm) were also seen on the VOM. subjectively observing sperm motility and morphology. The DNA quality The ORBEYE VOM proved to be non-inferior to the SOM in fine anastomo- of the selected individual sperm is not known. We first tested the DNA quality ses, characteristic of MIM. The average operating time to complete an anas- of the sperm selected by embryologists following the WHO qualitative tomosis for VVs and VEs was 37 and 33 minutes, respectively, with superior criteria. Three embryologists selected sperm from the same sample and the patency rates for all procedures. This VOM possesses the potential to DNA integrity of the selected sperm was measured with comet assay on in- improve surgical safety and efficiency by reducing postural fatigue and eye dividual sperm. Indeed, the selected sperm had low DNA fragmentation < strain, which surgeons experience with the SOM. In addition, it can signifi- (p 0.01 compared to sample population). However, manual selection is cantly facilitate teamwork and teaching through its high-resolution screens highly subjective, and the results varied significantly among embryologists and zero-latency images. (p<0.01). In order to eliminate subjectivity, we have developed a software that automatically selects sperm using quantitative criteria. To establish the quantitative selection criteria, we first developed computer V-03 10:16 AM Saturday, October 17, 2020 vision algorithms to measure each individual sperm’s 9 motility (velocity, linearity etc.) and 9 morphology (head size etc.) parameters. The measure- FERTILITY-PRESERVING, SURGICAL MANAGE- ment is on live sperm without invasive staining. Then the same sperm was MENT OF A CESAREAN SCAR ECTOPIC transferred for DNA measurement using the comet assay. We have collected PREGNANCY. Christine Hur, MD, Miguel Luna Russo, a dataset of 440 individual sperm. For each sperm, its motility, morphology MD, Cara R. King, DO, MS. Cleveland Clinic, Cleveland, OH. and DNA fragmentation data were recorded. With the collected data, we then established our quantitative criteria. Our criteria were based on the WHO OBJECTIVE: The objective of this video is to highlight a fertility-preser- quantitative criteria, but we modified the morphology criteria using our ving surgical technique for the management of cesarean scar ectopic preg- data on live sperm without staining. For motility, considering that WHO cri- nancy. terion (VSLR25 mm/s) was defined for semen analysis instead of for ICSI METHODOLOGY: A video description of the surgical technique used to where PVP was used to slow down sperm motion, we scaled the motility cri- manage the cesarean scar ectopic pregnancy of a 28-year-old G6P4014 with terion by measuring sperm velocity change from semen to PVP. We trans- desires future fertility preservation. ferred 30 individual sperm from raw semen to ICSI medium supplemented CONCLUSIONS: This video highlights a surgical technique which allows with PVP, and the velocity of individual sperm decreased to almost the for the laparoscopic removal of a cesarean scar ectopic pregnancy with the same ratio (0.5). The new motility criterion was determined (VSLR13.5 concurrent repair of the uterine defect. It reviews strategies to restore normal mm/s). The quantitative criteria were first tested on our collected dataset anatomy, minimize blood loss and allow for healing in order to allow for and reduced the DNA fragmentation by 50%. future fertility. The quantitative criteria were built into our automated sperm selection software, and compared to manual qualitative sperm selection. From each new sample, both the software and three embryologists selected good sperm. V-04 10:24 AM Saturday, October 17, 2020 The software outperformed all three embryologists. Compared to the best RESOLUTION OF ABDOMINAL PAIN AFTER COIL embryologist, the software further reduced the DNA fragmentation by EMBOLIZATION OF VARICOCELE WITH ROBOTIC 30%. The software also showed smaller standard deviation and provided RESECTION OF GONADAL VEIN. more consistent selection results. Evaluation of ICSI outcomes using sperm Johnathan Doolittle, MD, Viraj Maniar, MD, Peter N. Dietrich, MD, selected by the software is underway. CONCLUSIONS: The developed automation technique is able to non-in- Jay I. Sandlow, MD, Scott Johnson, MD, Jagan K. Kansal, MD, MBA. vasively and quantitatively select single sperm with high DNA integrity Medical College of Wisconsin, Milwaukee, WI. without disturbing ICSI flow. Computer vision and quantitative selection OBJECTIVE: Chronic pain in the region of varicocele embolization is not improve the DNA quality of the selected sperm, and eliminate the subjec- well described and can be a challenging symptom for a urologist to manage. tivity in manual qualitative selection. Metallic coils from embolization are unable to be removed, leaving limited options for treatment after failing conservative measures. It is important to counsel patients of this potential complication when determining the best op- V-02 10:08 AM Saturday, October 17, 2020 tion for varicocele repair. To our knowledge, there are no reported cases of NEW ERA OF MALE INFERTILITY MICROSURGERY: gonadal vein excision for chronic abdominal pain after coil embolization. 4K3D ORBEYE VIDEO OPERATING METHODOLOGY: A 63-year-old male presented nine months after coil MICROSCOPY. Huixing Chen, M.D. Ph.D., embolization. His testicular pain resolved but he reported new left sided Russell P. Hayden, M.D., Omar Al Hussein Alawamlh, M.D., abdominal pain following coil embolization for a large left varicocele. After Peter N. Schlegel, M.D., Marc Goldstein, M.D., Philip S. Li, M.D. Center failing conservative measures including non-steroidal anti-inflammatory for Male Reproductive Medicine and Microsurgery, Weill Cornell Medicine, drugs, antibiotics and prednisone, he was referred to urology for further New York Presbyterian Hospital, New York, NY. workup and to discuss treatment options. On presentation, the patient re- ported pain on the left side of his abdomen consistent with the location to OBJECTIVE: Early adaptations of the 2-Dimensional (2D) video oper- gonadal vein. After extensive counseling that surgical removal may not alle- ating microscope (VOM) have shown to have better ergonomics, flexibility, viate his pain, robotic gonadal vein excision was offered, and the patient elec- and versatility compared to the standard operating microscope (SOM) in ted to proceed. The video illustrates the robotic excision of the left gonadal male infertility microsurgery (MIM). However, the low resolution, 2D vein. Coils were easily visualized through the wall of the vessel. While mild view, and depth of field were significant limitations. Therefore, the emer- edema of the surrounding tissue in the retroperitoneum was noted, extensive FERTILITY & STERILITYÒ e517 inflammation was not present, leading to an uncomplicated dissection. The V-07 10:44 AM Saturday, October 17, 2020 coil-containing gonadal vein was able to be excised in its entirety. The patient was discharged on post-operative day one with only non-steroidal pain med- SURGICAL REPAIR OF A CESAREAN SCAR DEFECT ications. Six weeks post operatively, the patient reported no complications, USING A VAGINAL APPROACH. Abigail C. Mancuso, 1 1 1 and almost complete resolution of his preoperative pain. MD, Erin Maetzold, MD, Joseph T. Kowalski, MD, 2 1 CONCLUSIONS: To our knowledge, this is the first case report demon- Bradley J. Van Voorhis, MD. University of Iowa Hospitals 2 strating the surgical removal of the gonadal vein for treatment of chronic and Clinics, Iowa City, IA; University of Iowa, Iowa City, IA. abdominal pain after varicocele embolization. After failing conservative measures, this may present another viable treatment option to address this OBJECTIVE: To discuss the signs and symptoms of a cesarean scar defect difficult complication in a select group of patients. and describe the techniques for the repair of a cesarean scar defect using a SUPPORT: None vaginal approach. METHODOLOGY: We demonstrate a case of a 32-year-old patient with a symptomatic cesarean scar defect desiring surgical repair. Repair of the ce- V-05 10:31 AM Saturday, October 17, 2020 sarean scar defect was successfully completed using a vaginal approach. CONCLUSIONS: There are several surgical approaches used for the A NOVEL ROBOTIC ENDOSCOPIC DEVICE USED repair of cesarean scar defect including hysteroscopic and laparoscopic FOR OPERATIVE HYSTEROSCOPY: ASHERMAN’S repair.
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