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Adhesion Formation Following Laparoscopic Myomectomy
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S152–S177 Intraoperative and short-term outcomes of the 2 study groups Outcomes
LM(n=155)
LAM(n=52)
P value
Hb change (mg/dl) Estimated blood loss (ml) Transfusion, n (%) Operation time (min) Hospitalization days Complications, n (%) Postoperative analgesics, n (%)
1.81.0 215.0185.5 6 (3.9) 135.051.8 4.02.6 1 2.141.3
2.21.2 353.3262.8 9 (17.3) 110.331.6 4.40.8 2 2.351.5
0.035 \0.001 0.003 \0.001 NS NS NS
LM, Laparoscopic Myomectomy; LAM, Laparoscopically assisted myomectomy; NS, Non significant. Conclusion: It is difficult to conclude which operation of the two is superior to another. However, preoperatve careful evaluation of the size, number, and location of myomas is necessary to decrease operation time and bleeding and to avert conversion. 529 Outcomes of Single-Port and Two-Port Laparoscopic Hysterectomy and Adenxal Surgery Park J-Y, Kim J-J, Joo W-D, Yoo H-J, Kim D-Y, Kim J-H, Kim Y-M, Kim Y-T, Nam J-H. Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea Study Objective: The aim of this study was to estimate the feasibility, safety and surgical outomes of single-port and two-port laparoscopic hysterectomy and adnexal surgery. Design: Retrospective analysis. Setting: Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. Patients: A total of 387 patients who required hysterectomy or adnexal surgery due to benign gynecologic disease. Intervention: Single-port or two port laparoscopic hysterectomy or adnexal surgery. Measurements and Main Results: In single-port hysterectomy group (n=50), the mean uterine weight, operating time, estimated blood loss (EBL), and postoperative hospital stay were 225 gm (range, 61-490 gm), 132 min (range, 70-244 min), 99 mL (range, 10-300 mL), and 2 days (range, 1-4 days) respectively. Transfusion was required in two patients and perioperative complications occurred in 2 patients (1 bowel injury and 1 bladder injury). In single-port adnexal surgery group (n=41), the mean size of ovarian tumor, operating time, estimated blood loss (EBL), and postoperative hospital stay were 6 cm (range, 2-15 cm), 95 min (range, 59-183 min), 76 mL (range, 10-200 mL), and 2 days (range, 1-4 days) respectively. There was no perioperative transfusion requirement and complication. In two-port hysterectomy group (n=153), the mean uterine weight, operating time, estimated blood loss (EBL), and postoperative hospital stay were 293 gm (range, 49-1220 gm), 115 min (range, 61-258 min), 142 mL (range, 20-500 mL), and 2.8 days (range, 1-8 days) respectively. In two-port adnexal surgery group (n=143), the mean size of ovarian tumor, operating time, estimated blood loss (EBL), and postoperative hospital stay were 5.7 cm (range, 2-20 cm), 86 min (range, 41-261 min), 81 mL (range, 10-300 mL), and 2.4 days (range, 1-7 days) respectively. Conclusion: Single-port and two-port laparoscopic hysterectomy and adenxal surgery were feasible and safe alternatives to conventional three or four port laparoscopic surgery in selected patients.
S153
Design: Prospective study including 63 women who underwent laparoscopic myomectomy between 2003 and 2005. Setting: Tertiary private referral center of Gynecologic Laparoscopic Surgery Lefkos Stavros Hospital, Athens, Greece. Patients: Sixty three women (aged 26 to 46 years) who underwent laparoscopic myomectomy. Intervention: All patients had a second look laparoscopy within 2-6 months of the first operation to assess the presence, severity and extent of adhesions. Measurements and Main Results: The factors analysed included fibroid size and position, number of fibroids removed, duration of surgery and blood loss. The statistical analysis was performed using the SigmaStat 2.03 statistical software. Thirtythree women (52.5%) developed post operative adhesions. The median number of fibroids removed per patient was 2 (min:1–max:4) with a median size of 4cm (min:2cm– max:8cm). Neither the size nor the number of the fibroids removed per patient were significantly related to the presence or severity of adhesions. Of the 111 fibroids removed, 38.7% were anterior, 51.4% posterior and 9.9% fundal. Adhesions were formed in 59.6% (36.8% dense - 22.8% filmy) following removal of posterior fibroids compared with 54.6% (27.3% dense - 27.3% filmy) after removal of fundal fibroids and 48.8% (25.6% dense - 23.2% filmy) after removal of anterior fibroids; these differences were not significant. The adhesion formation was significantly affected by both the duration (p=0.028) and blood loss during the first procedure (p=0.019). However, these factors did not affect the severity of adhesions. Conclusion: Although laparoscopic surgery is considered less adhesiogenic, over 50% of patients developed post operative adhesions. The most significant factors in our study were duration and blood loss. Posterior myomectomies seemed to cause more adhesions, but the difference was not significant.
531 Recurrence of Myomas after Myomectomy in Women Pretreated with GnRH Agonists Pugh CJ,1 Schmitz AL,2 Mensinger J.3 1OB/GYN, University of Tennessee Medical Group, Memphis, Tennessee; 2OB/GYN, The Reading Hospital and Medical Center, West Reading, Pennsylvania; 3Drexel University, College of Nursing and Health Professions, M.S. 503, Philadelphia, Pennsylvania Study Objective: To assess the association of gonadotropin-releasing hormone agonist (GnRHa) therapy with the recurrence of myomas. A secondary analysis of fertility rates was also performed in treated and untreated women prior to myomectomy. Design: A multi-centered, retrospective, case-control. Setting: One tertiary care center and two community hospitals. Patients: 200 women between the ages of 19 and 44 years of age with either subserosal or intramural myomas who underwent laparotomy or laparoscopic myomectomy. Patients were followed from 6 to 240 months for recurrence of myomas and pregnancy. Intervention: 75 women received GnRH prior to myomectomy. Measurements and Main Results: Rate of myoma recurrence and fertility rates post myomectomy were measured. These were compared for use and or non-use of GnRH and for laparoscopy vs. laparotomy. Overall, a recurrence rate of 44.5% was observed in both groups. Those treated with GnRH agonists had a 38.7% recurrence rate, while those not pretreated had a recurrence rate of 48% (c2=1.65, p=.199). Recurrence of Myomas
530
Recurrence
Yes
No
Adhesion Formation Following Laparoscopic Myomectomy Pistofidis GA, Myrillas KP, Bardis NS, Balinakos PM, Filippidis MS. Gynecologic Endoscopic Syrgery, Lefkos Stavros Hospital of Athens, Athens, Attica, Greece
Direct to Surgery (%) GnRH agonist pretreatment (%) Total recurrence (%)
60 (48) 29 (39) 111 (44)
65 (52) 46 (61) 89 (56)
Study Objective: To investigate factors that affect adhesion formation following laparoscopic myomectomy.
Table 1 demonstrates the differences in incidence of recurrence between patient pre-treated with GnRH agonist and those that went directly to myomectomy. Total rate of recurrence is also shown.
LM(n=155)
LAM(n=52)
P value
Hb change (mg/dl) Estimated blood loss (ml) Transfusion, n (%) Operation time (min) Hospitalization days Complications, n (%) Postoperative analgesics, n (%)
1.81.0 215.0185.5 6 (3.9) 135.051.8 4.02.6 1 2.141.3
2.21.2 353.3262.8 9 (17.3) 110.331.6 4.40.8 2 2.351.5
0.035 \0.001 0.003 \0.001 NS NS NS
LM, Laparoscopic Myomectomy; LAM, Laparoscopically assisted myomectomy; NS, Non significant. Conclusion: It is difficult to conclude which operation of the two is superior to another. However, preoperatve careful evaluation of the size, number, and location of myomas is necessary to decrease operation time and bleeding and to avert conversion. 529 Outcomes of Single-Port and Two-Port Laparoscopic Hysterectomy and Adenxal Surgery Park J-Y, Kim J-J, Joo W-D, Yoo H-J, Kim D-Y, Kim J-H, Kim Y-M, Kim Y-T, Nam J-H. Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea Study Objective: The aim of this study was to estimate the feasibility, safety and surgical outomes of single-port and two-port laparoscopic hysterectomy and adnexal surgery. Design: Retrospective analysis. Setting: Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. Patients: A total of 387 patients who required hysterectomy or adnexal surgery due to benign gynecologic disease. Intervention: Single-port or two port laparoscopic hysterectomy or adnexal surgery. Measurements and Main Results: In single-port hysterectomy group (n=50), the mean uterine weight, operating time, estimated blood loss (EBL), and postoperative hospital stay were 225 gm (range, 61-490 gm), 132 min (range, 70-244 min), 99 mL (range, 10-300 mL), and 2 days (range, 1-4 days) respectively. Transfusion was required in two patients and perioperative complications occurred in 2 patients (1 bowel injury and 1 bladder injury). In single-port adnexal surgery group (n=41), the mean size of ovarian tumor, operating time, estimated blood loss (EBL), and postoperative hospital stay were 6 cm (range, 2-15 cm), 95 min (range, 59-183 min), 76 mL (range, 10-200 mL), and 2 days (range, 1-4 days) respectively. There was no perioperative transfusion requirement and complication. In two-port hysterectomy group (n=153), the mean uterine weight, operating time, estimated blood loss (EBL), and postoperative hospital stay were 293 gm (range, 49-1220 gm), 115 min (range, 61-258 min), 142 mL (range, 20-500 mL), and 2.8 days (range, 1-8 days) respectively. In two-port adnexal surgery group (n=143), the mean size of ovarian tumor, operating time, estimated blood loss (EBL), and postoperative hospital stay were 5.7 cm (range, 2-20 cm), 86 min (range, 41-261 min), 81 mL (range, 10-300 mL), and 2.4 days (range, 1-7 days) respectively. Conclusion: Single-port and two-port laparoscopic hysterectomy and adenxal surgery were feasible and safe alternatives to conventional three or four port laparoscopic surgery in selected patients.
S153
Design: Prospective study including 63 women who underwent laparoscopic myomectomy between 2003 and 2005. Setting: Tertiary private referral center of Gynecologic Laparoscopic Surgery Lefkos Stavros Hospital, Athens, Greece. Patients: Sixty three women (aged 26 to 46 years) who underwent laparoscopic myomectomy. Intervention: All patients had a second look laparoscopy within 2-6 months of the first operation to assess the presence, severity and extent of adhesions. Measurements and Main Results: The factors analysed included fibroid size and position, number of fibroids removed, duration of surgery and blood loss. The statistical analysis was performed using the SigmaStat 2.03 statistical software. Thirtythree women (52.5%) developed post operative adhesions. The median number of fibroids removed per patient was 2 (min:1–max:4) with a median size of 4cm (min:2cm– max:8cm). Neither the size nor the number of the fibroids removed per patient were significantly related to the presence or severity of adhesions. Of the 111 fibroids removed, 38.7% were anterior, 51.4% posterior and 9.9% fundal. Adhesions were formed in 59.6% (36.8% dense - 22.8% filmy) following removal of posterior fibroids compared with 54.6% (27.3% dense - 27.3% filmy) after removal of fundal fibroids and 48.8% (25.6% dense - 23.2% filmy) after removal of anterior fibroids; these differences were not significant. The adhesion formation was significantly affected by both the duration (p=0.028) and blood loss during the first procedure (p=0.019). However, these factors did not affect the severity of adhesions. Conclusion: Although laparoscopic surgery is considered less adhesiogenic, over 50% of patients developed post operative adhesions. The most significant factors in our study were duration and blood loss. Posterior myomectomies seemed to cause more adhesions, but the difference was not significant.
531 Recurrence of Myomas after Myomectomy in Women Pretreated with GnRH Agonists Pugh CJ,1 Schmitz AL,2 Mensinger J.3 1OB/GYN, University of Tennessee Medical Group, Memphis, Tennessee; 2OB/GYN, The Reading Hospital and Medical Center, West Reading, Pennsylvania; 3Drexel University, College of Nursing and Health Professions, M.S. 503, Philadelphia, Pennsylvania Study Objective: To assess the association of gonadotropin-releasing hormone agonist (GnRHa) therapy with the recurrence of myomas. A secondary analysis of fertility rates was also performed in treated and untreated women prior to myomectomy. Design: A multi-centered, retrospective, case-control. Setting: One tertiary care center and two community hospitals. Patients: 200 women between the ages of 19 and 44 years of age with either subserosal or intramural myomas who underwent laparotomy or laparoscopic myomectomy. Patients were followed from 6 to 240 months for recurrence of myomas and pregnancy. Intervention: 75 women received GnRH prior to myomectomy. Measurements and Main Results: Rate of myoma recurrence and fertility rates post myomectomy were measured. These were compared for use and or non-use of GnRH and for laparoscopy vs. laparotomy. Overall, a recurrence rate of 44.5% was observed in both groups. Those treated with GnRH agonists had a 38.7% recurrence rate, while those not pretreated had a recurrence rate of 48% (c2=1.65, p=.199). Recurrence of Myomas
530
Recurrence
Yes
No
Adhesion Formation Following Laparoscopic Myomectomy Pistofidis GA, Myrillas KP, Bardis NS, Balinakos PM, Filippidis MS. Gynecologic Endoscopic Syrgery, Lefkos Stavros Hospital of Athens, Athens, Attica, Greece
Direct to Surgery (%) GnRH agonist pretreatment (%) Total recurrence (%)
60 (48) 29 (39) 111 (44)
65 (52) 46 (61) 89 (56)
Study Objective: To investigate factors that affect adhesion formation following laparoscopic myomectomy.
Table 1 demonstrates the differences in incidence of recurrence between patient pre-treated with GnRH agonist and those that went directly to myomectomy. Total rate of recurrence is also shown.