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CISH in Korea
Abstracts
endometriosis, with planned second-look laparoscopy 6 to 12 weeks later. Either Intergel, a hyaluronic acid gel, 300 ml, or lactated Ringer's solution 300 ml was administered as an intraperitoneal instillate at the completion of the initial surgery. At second-look laparoscopy, patients treated with Intergel had significantly fewer adhesions assessed at 24 anatomic sites throughout the peritoneal cavity compared with those who received lactated Ringer's solution. These included reduction of both de novo (26%, p = 0.001) and reformed adhesions (33.%, p <0.001). The extent (35%, p <0.001), severity (40%, p = 0.001), and AFS scores modified for 24 anatomic sites (51%, p = 0.001) were less in women who received Intergel. Reduction in adhesions was evident for all subgroups based on surgical procedure, use of sutures, and presence of endometriosis. There were no clinically significant differences between groups in laboratory values, hospital course, drug therapy, or adverse events. Conclusion. Intergel solution was safe and highly efficacious in reducing the frequency, extent, and severity of postoperative adhesions at 24 anatomic sites throughout the peritoneal cavity.
obtained at hysteroscopic endomyometrial resection guides the practitioner in further care.
90. Comparison of Results with Pathology in Endomyometrial Resection D Kim, CR Della Badia. Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
92. Post Treatment of the Endometrium to Improve Amenorrhea Rates after Cavaterm Endometrial Ablation B Kleinke-Gunk. Euro-Med Clinic, F/Jrth, Germany.
Objective. To assess the association of surgical pathology from hysteroscopic endomyometrial resection with patients' reports of symptom improvement and procedure satisfaction. Measurements and Main Results. Twenty-four patients underwent hysteroscopic endomyometrial resection for AUB. Pathologic review revealed adenomyosis (10 women), proliferative endometrium (6), leiomyomas (4), adenomyosis and leiomyoma (2), endometrial polyp (1), and stromal nodule (1). Survey of procedure satisfaction showed 63% of women to be very satisfied, 17% moderately satisfied, and 20% not satisfied. Survey of symptom improvement showed 46% cured, 29% acceptable improvement, and 25% no improvement in symptoms. In all patients reporting dissatisfaction or no improvement, pathology was adenomyosis. Conclusion. Adenomyosis is a risk factor associated with treatment failure, and histopathology of tissue
Objective. To describe postablation therapy by inserting a levonorgestrel-releasing intrauterine suppository. Measurements and Main Results. Eighteen women (average age 49 yrs, range 44-56 yrs) were receiving HRT but suffered from DUB that did not respond to alterations of hormone therapy. Treatment included diagnostic hysteroscopy to rule out intrauterine pathology, endometrial biopsy to exclude malignancy, thermal endometrial ablation with the Cavaterm, and insertion of a levonorgestrel-releasing intrauterine suppository immediately after endometrial ablation. By 15 months after treatment 16 patients had complete amenorrhea and 2 had spotting. All patients continued HRT, 11 of them receiving estrogen only. Conclusion. Posttreatment of the endometrium with a levonorgestrel-releasing intrauterine suppository seems to improve amenorrhea rates better than pretreatment with GnRH analogs. It has fewer side effects and provides safe contraception.
91. CISH in Korea DI-I Kim, YH Kim, DH Bae, Min Hur. Chung-Ang University Hospital, Seoul, Korea.
Objective. To evaluate the current status of CISH in Korea. Measurements" and Main Results. All 1000 hysterectomies were performed in the classic manner with grasping forceps, scissors, ligatures, and sutures. The most common indication was leiomyoma uteri. Mean uterine weight was 249.4 + 52.1 g. Average operating time was 176.1 + 55.1 minutes. Blood loss was 152 ___86 ml. Conclusion. Pelviscopic CISH is minimally invasive and organ-preserving surgery. Pelvic floor support is maintained and the ureters are not in danger. Coring out the cervix with the calibrated uterine resection tool may prevent development of cervical cancer. The procedure is often difficult, and surgeons must be taught to perform it in the controlled setting of a residency or a fellowship training program.
$26
endometriosis, with planned second-look laparoscopy 6 to 12 weeks later. Either Intergel, a hyaluronic acid gel, 300 ml, or lactated Ringer's solution 300 ml was administered as an intraperitoneal instillate at the completion of the initial surgery. At second-look laparoscopy, patients treated with Intergel had significantly fewer adhesions assessed at 24 anatomic sites throughout the peritoneal cavity compared with those who received lactated Ringer's solution. These included reduction of both de novo (26%, p = 0.001) and reformed adhesions (33.%, p <0.001). The extent (35%, p <0.001), severity (40%, p = 0.001), and AFS scores modified for 24 anatomic sites (51%, p = 0.001) were less in women who received Intergel. Reduction in adhesions was evident for all subgroups based on surgical procedure, use of sutures, and presence of endometriosis. There were no clinically significant differences between groups in laboratory values, hospital course, drug therapy, or adverse events. Conclusion. Intergel solution was safe and highly efficacious in reducing the frequency, extent, and severity of postoperative adhesions at 24 anatomic sites throughout the peritoneal cavity.
obtained at hysteroscopic endomyometrial resection guides the practitioner in further care.
90. Comparison of Results with Pathology in Endomyometrial Resection D Kim, CR Della Badia. Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
92. Post Treatment of the Endometrium to Improve Amenorrhea Rates after Cavaterm Endometrial Ablation B Kleinke-Gunk. Euro-Med Clinic, F/Jrth, Germany.
Objective. To assess the association of surgical pathology from hysteroscopic endomyometrial resection with patients' reports of symptom improvement and procedure satisfaction. Measurements and Main Results. Twenty-four patients underwent hysteroscopic endomyometrial resection for AUB. Pathologic review revealed adenomyosis (10 women), proliferative endometrium (6), leiomyomas (4), adenomyosis and leiomyoma (2), endometrial polyp (1), and stromal nodule (1). Survey of procedure satisfaction showed 63% of women to be very satisfied, 17% moderately satisfied, and 20% not satisfied. Survey of symptom improvement showed 46% cured, 29% acceptable improvement, and 25% no improvement in symptoms. In all patients reporting dissatisfaction or no improvement, pathology was adenomyosis. Conclusion. Adenomyosis is a risk factor associated with treatment failure, and histopathology of tissue
Objective. To describe postablation therapy by inserting a levonorgestrel-releasing intrauterine suppository. Measurements and Main Results. Eighteen women (average age 49 yrs, range 44-56 yrs) were receiving HRT but suffered from DUB that did not respond to alterations of hormone therapy. Treatment included diagnostic hysteroscopy to rule out intrauterine pathology, endometrial biopsy to exclude malignancy, thermal endometrial ablation with the Cavaterm, and insertion of a levonorgestrel-releasing intrauterine suppository immediately after endometrial ablation. By 15 months after treatment 16 patients had complete amenorrhea and 2 had spotting. All patients continued HRT, 11 of them receiving estrogen only. Conclusion. Posttreatment of the endometrium with a levonorgestrel-releasing intrauterine suppository seems to improve amenorrhea rates better than pretreatment with GnRH analogs. It has fewer side effects and provides safe contraception.
91. CISH in Korea DI-I Kim, YH Kim, DH Bae, Min Hur. Chung-Ang University Hospital, Seoul, Korea.
Objective. To evaluate the current status of CISH in Korea. Measurements" and Main Results. All 1000 hysterectomies were performed in the classic manner with grasping forceps, scissors, ligatures, and sutures. The most common indication was leiomyoma uteri. Mean uterine weight was 249.4 + 52.1 g. Average operating time was 176.1 + 55.1 minutes. Blood loss was 152 ___86 ml. Conclusion. Pelviscopic CISH is minimally invasive and organ-preserving surgery. Pelvic floor support is maintained and the ureters are not in danger. Coring out the cervix with the calibrated uterine resection tool may prevent development of cervical cancer. The procedure is often difficult, and surgeons must be taught to perform it in the controlled setting of a residency or a fellowship training program.
$26