S44 Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S1–S44 Design: Retrospective medical chart review. Setting: Large academic medical institution. Patients: Thirty three women who underwent laparoscopic repair of bladder and/or bowel wall using barbed suture between January 2009 and July 2013. Measurements and Main Results: There were a total of 9 (27.2%) cystotomies, 7 (21.2%) enterotomies, 4 (12.1%) bladder deserolizations and 13 (39.4%) bowel deserolizations. Of all 33 injuries, 17 (55.5%) were intentional in the setting of bladder or bowel endometriosis nodule excision, while 16 (48.5%) were accidental and occurred at the time of lysis of adhesions.13 (92.9%) out of 14 bladder injuries were at the dome and one (7.1%) at the trigone. 15 out of 20 (75%) bowel injuries were rectal, 3 (15%) on the colon and 2 (10%) on the small intestine. Cystotomies ranged from 1 to 5 and enterotomies from 1.5 to 6 centimeters in length. 12 (75%) full thickness bladder or bowel wall defects were repaired using 2 layers of barbed suture while 4 (25%) were repaired using a layer of barbed suture and a layer of a running or interrupted smooth delayed absorbable suture. All bladder or bowel deserolizations were repaired using a single layer of barbed suture. Duration of follow up ranged from 1 to 15 months. At the 4 week postoperative visit, one patient complained of transient urinary urgency and another of urinary retention. Only one patient developed longstanding constipation secondary to a mild rectal stricture which was diagnosed 11 month postoperatively. Conclusion: Barbed suture provides adequate tension-free bladder and bowel repair. As we have so far not encountered any major complications, the use of barbed suture for the repair of bladder or bowel defects seems feasible and safe. 148 Open Communications 7 - Laparoscopy (4:14 PM - 4:19 PM) Impact of Prolonged Laparoscopy: A Retrospective Review of Laparoscopic Hysterectomy in Two Teaching Institutions McHugh K, Daggy J, Haas D, Hathaway J. Department of Obstetrics and Gynecology, Indiana University, Indianapolis, Indiana Study Objective: To evaluate the effect of prolonged laparoscopy on surgical outcomes among patients who underwent laparoscopic hysterectomy. Design: Retrospective chart review. Setting: Two urban academic institutions. Patients: 370 laparoscopic hysterectomies by 26 attending surgeons performed for benign indications from January 2010 to December 2012 were analyzed. 302 cases were analyzed after excluding conversion to open or missing operative times. Measurements and Main Results: Primary variables evaluated were procedure duration and minor and major perioperative complications. Among non-converted cases, Laparoscopic Assisted Vaginal Hysterectomy (LAVH) was the most common procedure (182/302, 60%), while the remainder were Laparoscopic Supracervical Hysterectomy (LSH, 73/302, 24%) and Total Laparoscopic Hysterectomy (TLH, 47/302, 16%). Most common indications included leiomyomata (170/302, 56%) and menorrhagia (143/302, 47%). At least one postoperative complication occurred in 11% (34/302) of our patients, most commonly transfusion (9/ 302, 3%), and ileus (6/302, 2%). After adjusting for age and uterine weight, we found that a 30-minute increase in operative time was associated with a 30% increase in the odds of having a postoperative complication (OR 1.32, 95% C.I. 1.04-1.67). Above 3 hours, a complication occurred in 17.1% (95% CI = [11.3%, 24.4%]) of patients, compared to only 6.2% (95% CI = [3%, 11.1%]) of patients with surgery time at or below 3 hours. We found no association between route of hysterectomy and postoperative complication rate (p-value = .238). Eighteen percent (67/370) of all cases were converted to open. Conversion rate among all patients (N = 370) significantly differed between hysterectomy type (p-value = .001). LSH was the highest (23/97, 24%) followed by LAVH (43/225, 19%) and TLH (1/48, 2%). Conclusion: Longer operative time is an independent contributor to postoperative complications with a higher rate of complication above 3 hours. This potentially mitigates the benefits of laparoscopy in terms of lower postoperative morbidity. 149 Open Communications 7 - Laparoscopy (4:20 PM - 4:25 PM) A Randomized Blinded Trial of Single Port Kit Usage in Gynecologic Laparoscopy Moon H-S, Inamdar R. The Women Cancer Center, Ewha Womans’ University Hospital, Seoul, Korea Study Objective: To determine which single port kit is most convenient in gynecologic laparoscopy. Design: Prospective, randomized, blinded clinical trial using Octoport, Gelpoint, and homemade glove port. Setting: Ewha Womans’ University Hospital. Patients: Women undergoing gynecologic surgery using single port laparoscopic technique were enrolled and followed postoperatively for 1month. Intervention: Patients were randomly assigned to use either single port kits in operating room. Laparoscopic adnexal surgery was done through umbilical one wound. The variables such as scar incision size, operating time, adnexal size, and pain score, and healing scar were measured. Measurements and Main Results: 117 patients were eligible for analysis, all procedures included adnexal operation. Mean operative time was not different among 3 groups but if adnexal size was larger than 6cm, operative time by glove port group was longer than those by Gelpoint and Octoport groups. Regardless of single port kit usage, incision size, and healing scar was not different. Hospital stay was shorter in glove port group than those by Gelpoint and Octoport groups and was different between endometrioitic groups and nonendometriotic group. Conclusion: The clinical outcomes by single port gynecologic laparoscopy were not different according to single port kits. 150 Open Communications 7 - Laparoscopy (4:26 PM - 4:31 PM) Laparoscopic Morcellation Versus Abdominal Hysterectomy for Presumed Uterine Leiomyomata: A Decision Analysis Siedhoff MT, Wheeler SB, Rutstein S, Geller EJ, Doll KM, Wu JM, ClarkePearson DL. Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Study Objective: To compare the risks associated with laparoscopic hysterectomy (LH) with morcellation to total abdominal hysterectomy (TAH) for an enlarged uterus presumably due to leiomyomata. Design: Decision analytic model with 5-year time horizon. Setting: Women with an enlarged uterus. Patients: Hypothetical cohort of 100,000 women undergoing hysterectomy in the United States. Intervention: LH with morcellation versus TAH. Measurements and Main Results: For each strategy, we included the risks of transfusion, abdominal wound infection, vaginal cuff dehiscence, venous thromboembolism, incisional hernia, procedure-related mortality, and mortality due to leiomyosarcoma (LMS). The probabilities for these events were based on the published literature. Our model predicted more deaths from LMS with LH plus morcellation than TAH (129 vs 106 per 100,000), but more procedure-related deaths with TAH (32 vs 12), and thus a similar mortality overall. While LH had a higher risk of vaginal cuff dehiscence (640 vs 290), TAH had higher rates of transfusion (4700 vs 2400), wound infection (6300 vs 1500), incisional hernia (8800 vs 710), and venous thromboembolism (840 vs 690) compared to LH. In a one-way deterministic sensitivity analysis, our results were relatively robust to varying the rates of LMS, 5-year LMS-related deaths, and hysterectomy-associated deaths across predefined ranges in the published literature. Conclusion: In our decision analysis, we found similar rates of overall mortality due to LH with morcellation and TAH for women with an enlarged uterus presumably due to leiomyomata. While LH was associated with a higher risk of vaginal cuff dehiscence, TAH was associated with higher risks of transfusion, wound infection, incisional hernia and venous thromboembolism.