This course provides strategies for expanding surgical candidates for minimally invasive hysterectomy.  Uterine size as well as extent of intrauterine and extrauterine disease influence the surgeons' decision about whether or not a patient is a candidate for a minimally invasive hysterectomy.  Using clinical vignettes and video presentations, this course will address common scenarios that make certain hysterectomies challenging.  We will focus on the presence of fibroids in atypical locations such as broad ligament or cervix, distortion of normal anatomical spaces due to pathology including endometriosis or prior infections, and very enlarged uteruses.  We will have an in-depth discussion of preoperative evaluation and surgical planning.  Videos will be used to illustrate specific surgical techniques for managing pathology that may traditionally preclude patients from being candidates for a minimally invasive approach including obliterated posterior cul-de-sac, inability to place a uterine manipulator, or contained extraction of uteruses larger than 20cm.

Learning Objectives: After attending this session, the participant will be able to: 1) Complete a preoperative evaluation to identify and circumnavigate factors contributing to increased surgical complexity; 2) Describe strategies for intraoperative management and extraction of enlarged uteruses; and 3) Employ strategies for intraoperative management of abnormal anatomy.

Presentations:
Welcome, Introduction and Course Overview
Chair: Katherine M. de Souza, MD
Washington University in St. Louis School of Medicine, Minimally Invasive Gynecologic Surgery, St. Louis, MO

Mapping the Course: Preoperative Evaluation
Cynthia Arvizo, MD, Weill Cornell Medicine, New York, NY

Navigating Cervical Pathology
Lindsey N. Valentine, MD, OB/GYN & Women’s Health Institute, Cleveland Clinic, Cleveland, OH

Wrangling the Very Large Uterus
Elise C. Bardawil, MD, Minimally Invasive Gynecologic Surgery, Washington University in St. Louis, St Louis, MO

A Path through Obliterated Normal Anatomy
Katherine M. de Souza, MD, Washington University in St. Louis School of Medicine, Saint Louis, MO

Discussion - Questions & Answers - All Faculty

Adjourn