Abstracts of the 26th Annual Congress of the European Society for Gynaecological Endoscopy (ESGE) 18th – 21st October 2017 Sueno Belek – Antalya – Turkey SELECTED ABSTRACTS FOR ORAL AND VIDEO PRESENTATION (45) ES26-0017 Best Selected Abstracts 1 HALON (Hysterectomy by trans-abdominal laparoscopy or transvaginal NOTES): a randomized controlled trial Jan Baekelandt1, Jan Bosteels2, Steven Weyers3, Ben Mol4 1Imelda Hospital, Department of Gynaecological Oncology and Endoscopy, Bonheiden, Belgium 2Cochrane Belgium, CEBAM the Centre for Evidence-based Medicine, Leuven, Belgium 3University Hospital Gent, Universitaire Vrouwenkliniek, Gent, Belgium 4The University of Adelaide, The Robinson Institute- School of Paediatrics and Reproductive Health, Adelaide, Australia Background The HALON trial is a randomized controlled, single center, single-blinded, parallel-group, non-inferiority, efficacy study (ClinicalTrials.gov: NCT02631837). The objective is to compare transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) Hysterectomy and Total Laparoscopic Hysterectomy (TLH) for the successful removal of the uterus for benign gynecological pathology. We studied women with a benign indication for hysterectomy aged 18-70. Women with a history of rectal surgery, rectovaginal endometriosis, malignancy, history of PID, active lower genital tract infection, virgo or pregnancy were not eligible. Methods After written informed consent, women were randomly allocated to vNOTES Hysterectomy or TLH by using a computer generated randomization list. All procedures were performed by a surgeon equally skilled in performing both techniques, who was not blinded to the treatment allocation. Participants, nursing staff and outcome assessors were blinded by mock incisions. Pre- and postoperative treatment was provided by staff blinded for the allocated intervention using a standardized protocol, identical for both techniques. Primary outcome was successful removal of uterus with the intended approach without conversion to another approach. Secondary outcomes were proportion of women discharged on the same day, based on their own preference, postoperative pain scores between day 1-7 and total use of analgesics, postoperative infection, per- or postoperative complications according to Clavien-Dindo classification; hospital readmissions, surgery duration, dyspareunia, sexual wellbeing and direct costs up to 6 weeks. Results All 70 patients were successfully operated with the intended approach (35 vNOTES; 35 TLH) without conversion to another approach. The discharge rate on the day of the surgery was 28/35 (80%) in the vNOTES group versus 17/35 (48.5%) in the TLH group (RR:1.6, 95% CI:1.1-2.4). Data collection on secondary outcomes is ongoing, and will be available in October 2017. Conclusions In women scheduled for hysterectomy, vNOTES is a promising procedure that can reduce morbidity, duration in hospital stay and costs. ES26-0019 Best Selected Abstracts 1 The sacrospinal ligament: a subject of reflection Marta Maria Kemp1, Sandrine Campagne-Loiseau1, Benoît Rabischong1, Nicolas Bourdel1, Michel Canis1, Revaz Botchorishvili1 1CHU Estaing Clermont Ferrand, Department of Obstetrics- Gynecology and Reproductive Medicine, Clermont Ferrand, France Background The sacrospinal ligament fixation is a wide used technique for vaginal vault prolapse surgery. We aim to show the sacrospinal ligament and the surrounding structures from the laparoscopic point of view. Methods An extended dissection of the Latzko, Okabayashi and/or Retzius space(s) was performed towards the pelvic floor aiming the sacrospinal ligament in patients undergoing laparoscopic promontofixation for genital prolapse. The recorded videos from the surgeries were reviewed and selected to highlight in the images the sacrospinal ligament and it’s surrounding structures and anatomic repairs. Results The laparoscopic view puts in evidence the highly variable structure of the sacrospinal ligament, not only the noble vessels and nerves close to it, but important differences in its constitution sometimes represented by a large and firm ligament and sometimes by only a few fragile ligamentary fibers. Conclusions This visual experience brings a few reflections to mind: 1- the different presentations of the sacrospinal ligament, sometimes large and firm, sometimes thin and fragile, raise doubts concerning the indications of the sacrospinal fixation technique: is it a reliable structure to carry the weight of the abdominal and pelvic organs for every patient?; 2- can the vaginal approach assure a safe procedure regarding the surrounding structures in every patient? Or the main reason for choosing this technique is related to convenience; 3- because the learning process for the recognition of pelvic ligaments are fundamentally based on palpation of structures that, as a rule, the students and residents are not accustomed to see, is there a more effective anatomic teaching and learning process of this compartment? http://player.vimeo.com/video/213847271?autoplay=1 ES26-0126 Best Selected Abstracts 1 Laparoscopic and robotic techniques for bleeding control and vascular repair Masaaki Andou1 1Kurashiki Medical Center, Gynecology, Kurashiki-shi, Japan Background To demonstrate laparoscopic vascular injury repair techniques to prevent conversion to open surgery. Methods: We have performed approximately 1100 laparoscopic or robotic retroperitoneal lymphadenectomies including para-aortic and pelvic dissection since 1998. Of these cases, 28 required vessel repair for inadvertent injury. 5 of these cases are presented. Methods Case 1- The right external iliac artery was injured by cutting current during robotic pelvic lymphadenectomy for cervical cancer. We used laparoscopic vascular clamps to temporarily control bleeding and robotically repaired the area with 4.0 interrupted proline suture. Case 2- The left external iliac artery was injured by cutting current during laparoscopic pelvic lymphadenectomy stage of a radical trachelectomy for cervical cancer. The hole was repaired the same as Case 1, but laparoscopically. Case 3- An avulsion injury to the left external iliac vein occurred during pelvic lymphadenectomy for endometrial cancer. Temporary bleeding control was achieved with atraumatic forceps. The repair was managed with one 5.0 proline Z-suture. Case 4- An avulsion injury to the left renal vein occurred during left-sided para-aortic dissection for endometrial cancer. We used a hemoclip for temporary bleeding control and one 4.0 proline Z-suture for repair. Case 5- The IVC was injured with a vessel sealer during right-sided para-aortic lymphadenectomy for endometrial cancer. Vascular tape wasn’t effective so pressure on the bleeding point was required to control bleeding. After finding the bleeding point, suturing of the hole was performed with 4.0 proline continuous suture. Results All 28 cases required temporary bleeding control with vascular clamps, atraumatic forceps, vascular tape and/ or pressure application with sponge. All cases were administered with high molecular heparin and holes closed successfully without conversions to laparotomy. No blood transfusions were required. Conclusions Being prepared for possible vascular injuries and understanding how to control bleeding is vital for successful same session, conversion-free repair. http://player.vimeo.com/video/219373396?autoplay=1 ES26-0142 Best Selected Abstracts 1 Retropubic fibroma: a rare tumor entity causing lower urinary tract obstruction Chung-Hsien Sun1 1Lucina Women & Children Hospital, Ob/Gyn, Kaohsiung City, Taiwan Background Retropubic isolated tumor causing lower urinary tract obstruction is very rare in young women. In this video, we will present a 31 y/o female, with the problems of voiding difficulty and several episodes of acute urine retention. She was referred to us by urologist. Imaging study revealed a well-margin large retropubic tumor, occupying the Lt 2/3 Retzius space and entire left paravagina space, in close contact with left obturator internus muscle, obturator bundle, pubic bone, left ureter, vagina, urethra, and bladder. Methods Laparoscopic surgery was performed. Port setup: umbilical port with 2 trocars, and additional two 5mm trocars over left and right lower quadrant. Energy source: Olympus PK, and Ethicon Harmonic Ace. Results Tumor was successfully excised laparoscopically, after careful dissection of the important retropubic and retroperitoneal sidewall structures. (obturator internus muscle, obturator nerve and vessels, urethra, left ureter, and bladder). Estimated blood loss was 25 cc. Final pathology: fibroma, without malignancy. Conclusions Large retropubic fibroma causing lower urinary tract obstruction is very rare. Laparoscopic excision is feasible and safe. http://player.vimeo.com/video/219416257?autoplay=1 ES26-0303 Best Selected Abstracts 1 Impact of laparoscopic sacropexy on quality of life and sexuality in high-aged population. A prospective study Ralf Joukhadar1, Erich Solomayer2, Sascha Baum3, Daniel Herr1, Achim Woeckel1 1University Hospital Wuerzburg Germany, Gynecological department, Wuerzburg, Germany 2University Hospital Homburg Germany, Gynecological Department, Homburg-Saar, Germany 3University Hospital Luebeck Germany, Gynecological Department, Luebeck, Germany Background Pelvic organ prolapse (POP) has a very high prevalence, especially in the aging population, with an estimated lifetime risk of over 30%. Patients with POP suffer significant negative impact on quality of life,