- Email: [email protected]
Anterior Resection of a Rectal Endometriotic Nodule
Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S1eS51 2
Wayne State University School of Medicine, Detroit, MI; Obstetrics and Gynecology, Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany; 3Fundacion IVI, Instituto Universitario IVI, Valencia University, Valencia, Spain; 4Omrix Biopharmaceuticals Ltd., Israel; 5 Synechion Inc., Dallas, TX Study Objective: Postoperative adhesions frequently develop after surgery. We report the results of a phase II study to evaluate adhesion development after bilateral ovarian surgery, with and without application of AdhexilÔ, a Fibrin sealant acting as an absorbable barrier for adhesion prevention and reduction. Design: Prospective, controlled, randomized, reviewer blinded study. Setting: Multi-institutional trial. Patients: Women with bilateral ovarian disease. Intervention: Patients were assessed for incidence, extent and severity of ovarian adhesions at the 1st look laparoscopy (1LL) followed by standard surgical procedure (adhesiolysis, biopsy etc.). At the end of surgery ovaries were randomized for application of ADHEXILÔ or left untreated, allowing each patient to serve as her own control. A 2nd look laparoscopy (2LL) was performed 6(4) weeks later to assess adhesions incidence, extent and severity. All surgeries were recorded on a DVD and then assessed by an independent reviewer, blinded to treatment side and procedure. Measurements and Main Results: 17 patients were enrolled; 16 completed the study (1 refused 2LL). An apparent improvement in adhesion incidence was found in the treated ovaries, with 50% (8/16) of adhesion free ovaries in the ADHEXILÔ group, versus 31% (5/16) of adhesion free control ovaries. Substantial improvement in the mean AFS score in the ADHEXILÔ treated group from 1LL (6.4 6.8) to 2LL (4.6 6.9) was observed, whereas worsening of adhesions was observed on the control side from 1LL, (5.6 5.1) to 2LL (7.1 6.9). No AEs or SAEs considered to be related to the study product were reported. Conclusion: A clear trend of efficacy for AdhexilÔ reducing the incidence, severity and extend of adhesions in laparoscopic gynecology surgery involving the ovaries, despite the small sample size. The use of AdhexilÔ appears safe; further exploration of its efficacy in preventing/reducing post surgical adhesions is warranted.
53a
Open Communications 3dReproductive Issues (1:04 PM d 1:09 PM)
Diagnosis and Surgery for Malformations of Uterus and Vagina with Use of Endoscopic Approaches Adamyan LV, Makiyan ZN, Bobkova MV, Yarotskaya EL, Tkachenko ER, Stepanian A. Scientific Center for Obstetrics, Gynecology and Perinatology, Moscow, Russian Federation Study Objective: Improvement of diagnosis and results of treatment of malformations of uterus and vagina. Design: Analysis of 1460 cases of malformations managed by conventional or endoscopic surgical approaches. Setting: Department of Operative Gynecology of the Scientific Center for Obst., Gyn. & Perinatology. Patients: In 259 cases of vaginal and uterine aplasia, 40 of vaginal aplasia and functional uterus, 211 of uterine septum, 142 of rudimentary uterine horn, 7 cases of bicornuate uterus malformations laparoscopy and hysteroscopy were used for diagnosis and correction of malformation. Interventions and Main Results: Simultaneous performance of laparoscopy and hysteroscopy was crucial for final precise diagnosis of malformation. In 30 cases of vaginal aplasia with functional uterus laparoscopic hysterectomy was performed, while in 10 analogous cases the uterus was preserved by creation of utero-perineal tunnel to provide menstrual outflow. Resectoscopy was used either alone for management of uterine septum, or together with laparoscopy for correction of bicornuate uterus by combined endoscopic metroplasty, resulting in complete restoration of endometrium and full-term pregnancy and natural delivery in 125 (59.0%) for uterine septum and in 71,4% pregnancy rate with cesarean section for bicornuate uterus. Rudimentary horns were removed by laparoscopy also used for lysis of pelvic adhesions and remove endometriotic lesions. In all patients with vaginal and uterine
S17
aplasia a neovagina was created from pelvic peritoneum by laparoscopically assisted transperineal approach, resulting in satisfactory neovagina capacity and normal epithelium morphology. Conclusions: Laparoscopy and hysteroscopy are necessary for final correct diagnosis of malformations of uterus and vagina. In asymmetric anomalies laparoscopy provides minimally invasive approach both for radical and reconstructive surgery. Hysteroresectoscopy is the method of choice for correction of uterine septum, and the important step of combined hysterolaparoscopic metroplasty.
54
Video Session 2dEndometriosis 1 (12:05 PM d 12:13 PM)
Anterior Resection of a Rectal Endometriotic Nodule Miranda-Mendoza I, Nassif J, Ferreira H, Baulon E, Wattiez A. Obstetrics and Gynecology, IRCAD/EITS, Strasbourg, France Study Objective: Deeply infiltrating endometriosis includes rectovaginal lesions that might greatly alter the quality of life (dysmenorrhea, dispareunia, dyschezia, rectorragy). The indications for colorectal resection are controversial because of the risk of complications. We present a video showing our technique of an anterior rectal endometriotic nodule resection with a circular stapler in a patient with catamenial dyschezia. For the anterior rectal resection we used circular stapler (DST SeriesÔ EEAÔ of 31 mm, Autosuture Ò). This device places a circular, double staggered row of titanium staples and resects the excess tissue, creating a circular anastomosis. The instrument is activated by squeezing the handle firmly as far as it will go. A study analysing the circular stapler approach is ongoing. Primary results show lower operative time, blood loss and complications. This technique of discoid bowel resection may allow us to have less invasive treatment with better outcomes.
55
Video Session 2dEndometriosis 1 (12:14 PM d 12:22 PM)
Excisional Surgery for Deeply Infiltrating Endometriosis with Culde-Sac Obliteration Deura I, Miki M, Hada T, Ohta Y, Takaki Y, Kanao H, Andou M. Gynecology, Kurashiki Medical Center, Kurashiki, Okayama, Japan Study Objective: We will show our systematic procedures of excisional surgery for deeply infiltrating endometriosis with cul-de-sac obliteration. Patients: Sixty one patients who underwent conservative excisonal surgery for deeply infiltrating endometriosis with cul-de-sac obliteration at Kurashiki Medical Center from April 2006 to March 2008. Materials and Methods: Our video presentation demonstrates how to open the obliterated cul-de-sac safely and excise deep endometriotic lesions completely. Results: Pain was significantly reduced from 7.4 (Visual analog scale) prior to surgery to 2.8 after. Mean operative time was 85 minutes. Mean blood loss was 156 ml. There was no blood transfusion. Fifteen cases required rectal repair due to intra-operative injury. There were no severe complications. Conclusion: Our systematic procedures are safe and effective for completely excising endometrioic lesions while preventing injury to adjacent organs, which may clear hurdles related to endometriosis and adhesion.
56
Video Session 2dEndometriosis 1 (12:23 PM d 12:31 PM)
Laparoscopic-Transvaginal Technique for Rectosigmoid Resection in Patients with Endometriosis Litta PS,1 Cocco A,1 Saccardi C,1 Cosmi E,1 Baldan N,2 Ancona E.2 1 Clinic of Obstetrics and Gynecology, University of Padova, School of Medicine, Padova, Italy; 2Department of Surgery, University of Padova, School of Medicine, Padova, Italy Study Objective: We report a case of young woman with dyspareunia, dischetia and chronic pelvic pain. An NMR revealed a solid node of 3 cm in the rectal-vaginal septum protruding in the rectal lumen confirmed by
Wayne State University School of Medicine, Detroit, MI; Obstetrics and Gynecology, Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany; 3Fundacion IVI, Instituto Universitario IVI, Valencia University, Valencia, Spain; 4Omrix Biopharmaceuticals Ltd., Israel; 5 Synechion Inc., Dallas, TX Study Objective: Postoperative adhesions frequently develop after surgery. We report the results of a phase II study to evaluate adhesion development after bilateral ovarian surgery, with and without application of AdhexilÔ, a Fibrin sealant acting as an absorbable barrier for adhesion prevention and reduction. Design: Prospective, controlled, randomized, reviewer blinded study. Setting: Multi-institutional trial. Patients: Women with bilateral ovarian disease. Intervention: Patients were assessed for incidence, extent and severity of ovarian adhesions at the 1st look laparoscopy (1LL) followed by standard surgical procedure (adhesiolysis, biopsy etc.). At the end of surgery ovaries were randomized for application of ADHEXILÔ or left untreated, allowing each patient to serve as her own control. A 2nd look laparoscopy (2LL) was performed 6(4) weeks later to assess adhesions incidence, extent and severity. All surgeries were recorded on a DVD and then assessed by an independent reviewer, blinded to treatment side and procedure. Measurements and Main Results: 17 patients were enrolled; 16 completed the study (1 refused 2LL). An apparent improvement in adhesion incidence was found in the treated ovaries, with 50% (8/16) of adhesion free ovaries in the ADHEXILÔ group, versus 31% (5/16) of adhesion free control ovaries. Substantial improvement in the mean AFS score in the ADHEXILÔ treated group from 1LL (6.4 6.8) to 2LL (4.6 6.9) was observed, whereas worsening of adhesions was observed on the control side from 1LL, (5.6 5.1) to 2LL (7.1 6.9). No AEs or SAEs considered to be related to the study product were reported. Conclusion: A clear trend of efficacy for AdhexilÔ reducing the incidence, severity and extend of adhesions in laparoscopic gynecology surgery involving the ovaries, despite the small sample size. The use of AdhexilÔ appears safe; further exploration of its efficacy in preventing/reducing post surgical adhesions is warranted.
53a
Open Communications 3dReproductive Issues (1:04 PM d 1:09 PM)
Diagnosis and Surgery for Malformations of Uterus and Vagina with Use of Endoscopic Approaches Adamyan LV, Makiyan ZN, Bobkova MV, Yarotskaya EL, Tkachenko ER, Stepanian A. Scientific Center for Obstetrics, Gynecology and Perinatology, Moscow, Russian Federation Study Objective: Improvement of diagnosis and results of treatment of malformations of uterus and vagina. Design: Analysis of 1460 cases of malformations managed by conventional or endoscopic surgical approaches. Setting: Department of Operative Gynecology of the Scientific Center for Obst., Gyn. & Perinatology. Patients: In 259 cases of vaginal and uterine aplasia, 40 of vaginal aplasia and functional uterus, 211 of uterine septum, 142 of rudimentary uterine horn, 7 cases of bicornuate uterus malformations laparoscopy and hysteroscopy were used for diagnosis and correction of malformation. Interventions and Main Results: Simultaneous performance of laparoscopy and hysteroscopy was crucial for final precise diagnosis of malformation. In 30 cases of vaginal aplasia with functional uterus laparoscopic hysterectomy was performed, while in 10 analogous cases the uterus was preserved by creation of utero-perineal tunnel to provide menstrual outflow. Resectoscopy was used either alone for management of uterine septum, or together with laparoscopy for correction of bicornuate uterus by combined endoscopic metroplasty, resulting in complete restoration of endometrium and full-term pregnancy and natural delivery in 125 (59.0%) for uterine septum and in 71,4% pregnancy rate with cesarean section for bicornuate uterus. Rudimentary horns were removed by laparoscopy also used for lysis of pelvic adhesions and remove endometriotic lesions. In all patients with vaginal and uterine
S17
aplasia a neovagina was created from pelvic peritoneum by laparoscopically assisted transperineal approach, resulting in satisfactory neovagina capacity and normal epithelium morphology. Conclusions: Laparoscopy and hysteroscopy are necessary for final correct diagnosis of malformations of uterus and vagina. In asymmetric anomalies laparoscopy provides minimally invasive approach both for radical and reconstructive surgery. Hysteroresectoscopy is the method of choice for correction of uterine septum, and the important step of combined hysterolaparoscopic metroplasty.
54
Video Session 2dEndometriosis 1 (12:05 PM d 12:13 PM)
Anterior Resection of a Rectal Endometriotic Nodule Miranda-Mendoza I, Nassif J, Ferreira H, Baulon E, Wattiez A. Obstetrics and Gynecology, IRCAD/EITS, Strasbourg, France Study Objective: Deeply infiltrating endometriosis includes rectovaginal lesions that might greatly alter the quality of life (dysmenorrhea, dispareunia, dyschezia, rectorragy). The indications for colorectal resection are controversial because of the risk of complications. We present a video showing our technique of an anterior rectal endometriotic nodule resection with a circular stapler in a patient with catamenial dyschezia. For the anterior rectal resection we used circular stapler (DST SeriesÔ EEAÔ of 31 mm, Autosuture Ò). This device places a circular, double staggered row of titanium staples and resects the excess tissue, creating a circular anastomosis. The instrument is activated by squeezing the handle firmly as far as it will go. A study analysing the circular stapler approach is ongoing. Primary results show lower operative time, blood loss and complications. This technique of discoid bowel resection may allow us to have less invasive treatment with better outcomes.
55
Video Session 2dEndometriosis 1 (12:14 PM d 12:22 PM)
Excisional Surgery for Deeply Infiltrating Endometriosis with Culde-Sac Obliteration Deura I, Miki M, Hada T, Ohta Y, Takaki Y, Kanao H, Andou M. Gynecology, Kurashiki Medical Center, Kurashiki, Okayama, Japan Study Objective: We will show our systematic procedures of excisional surgery for deeply infiltrating endometriosis with cul-de-sac obliteration. Patients: Sixty one patients who underwent conservative excisonal surgery for deeply infiltrating endometriosis with cul-de-sac obliteration at Kurashiki Medical Center from April 2006 to March 2008. Materials and Methods: Our video presentation demonstrates how to open the obliterated cul-de-sac safely and excise deep endometriotic lesions completely. Results: Pain was significantly reduced from 7.4 (Visual analog scale) prior to surgery to 2.8 after. Mean operative time was 85 minutes. Mean blood loss was 156 ml. There was no blood transfusion. Fifteen cases required rectal repair due to intra-operative injury. There were no severe complications. Conclusion: Our systematic procedures are safe and effective for completely excising endometrioic lesions while preventing injury to adjacent organs, which may clear hurdles related to endometriosis and adhesion.
56
Video Session 2dEndometriosis 1 (12:23 PM d 12:31 PM)
Laparoscopic-Transvaginal Technique for Rectosigmoid Resection in Patients with Endometriosis Litta PS,1 Cocco A,1 Saccardi C,1 Cosmi E,1 Baldan N,2 Ancona E.2 1 Clinic of Obstetrics and Gynecology, University of Padova, School of Medicine, Padova, Italy; 2Department of Surgery, University of Padova, School of Medicine, Padova, Italy Study Objective: We report a case of young woman with dyspareunia, dischetia and chronic pelvic pain. An NMR revealed a solid node of 3 cm in the rectal-vaginal septum protruding in the rectal lumen confirmed by