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Endometrial ablation and the postablation tubal sterilization syndrome
Abstracts
was treated by observation. Length of procedure and fluid volume were also assessed. Conclusion. Fertiloscopy is an efficient, accurate, well-tolerated procedure that will have a place in evaluation of pelvic pathology.
fect compromise? 2. Hands-on training: is there any difference among synthetic, animal, and human models? Can models be replaced by virtual reality training? 3. Clinical training: is telesurgery: sense or nonsense? Is the "expert-at-your-side" training: just wishful thinking? Conclusion. Finding answers to these questions could help achieving global consensus on this topic.
238. Patient Acceptance of Diagnostic Hysteroscopy without Anesthesia E Valli, E Zupi, D Marconi, M Sbracia, B De Vivo, G Lanzi, B Szabolcs, C Romanini. University of Rome Tor Vergata, Rome, Italy.
240. Endometrial Ablation and the Postablation Tubal Sterilization Syndrome B Van Voorhis, A Mall, G Shirk. University of Iowa College of Medicine, Iowa City, Iowa.
Objective. To establish patient acceptance of outpatient hysteroscopy without anesthesia. Measurements and Main Results. Hysteroscopy was performed in 670 consecutive women (mean age 48.9 _+ 13.5 yrs) with the Hamou 1 and CO2 distention of the uterine cavity without anesthesia. In 56 patients (8.3%) the examination was impossible because of intemal stenosis or vagal reaction; they were eliminated from data analysis. After the procedure, patients were asked to answer two questions: was the pain was more or less than expected?, and would they have a repeat hysteroscopy without anesthesia again, or with local or general anesthesia? Patients were asked to indicate pain level on a VAS from 0 to 10 (0 = no pain, 10 = worst pain). Data were correlated with difficulty of the examination. It was easy in 68.6%, more difficult in 22.4%, and difficult in 8.9% of patients. The mean VAS pain score was 3.76 + 2 (range 0-9, median 4). Patients older than 65 years experienced higher pain level (4.9 _+ 2.3) than younger patients (3.5 + 2.12, p <0.05). Women with easy examination had significantly less pain (3.13 _+ 1.77) than those with difficult examination (5.14 _+ 2.12, p <0.01), and calm patients described less pain (3.31 _+2.12) than excited and anxious ones (4.35 + 2.15, p <0.05). Except women with impossible examinations, most preferred to repeat the examination as it had been performed. Conclusion. Hysteroscopy can be performed without anesthesia in most patients.
Objective. To determine the frequency of postablation tubal sterilization syndrome (PATSS) and risk factors for additional gynecologic surgery after endometrial ablation. Measurements and Main Results. We identified 100 consecutive women undergoing rollerball endometrial ablation and sent them questionnaires regarding posttreatment symptoms and need for subsequent surgery. Possible risk factors for failed ablation including a history of tubal ligation (TL) were determined by chart review and questionnaire. Seventy-two women (mean age 41 yrs; average follow-up 50 mo, range 15-96 mo) retumed the questionnaire. Of these, 75% were satisfied with the outcome and 84% reported amenorrhea or decreased menses. Among 47 women with a previous TL, 2 (8%) reported new or worse pain, 13 (28%) had additional gynecologic surgery including hysterectomy (9) or other pelvic surgery (4), and 3 (6%) had pathologically confirmed PATSS. Among 25 women with no previous TL, 2 (8%) reported new or worse pain and 2 (8%) had subsequent surgery. Survival analysis curves suggested a trend toward increased postablation surgical procedures among women who had a previous TL. Conclusion. The frequency of PATSS was between 6% (pathologically confirmed) and 15% (pathology or new symptoms). Previous TL may be a risk factor for surgery after ablation.
239. How to Find Consensus Regarding Teaching
Hysterocopy in the New Millennium YRM Van Belle. St. Jansziekenhuis, Brussels, Belgium.
241. A New Transcervical Sterilization Procedure 1T Vancaillie, 2DR Stewart, 3jG Garza Leal. 1Royal Hospital for Women, Randwick, Australia; 2Adiana, Inc., Redwood City, California; 3Hospital Universitario, Monterrey, Mexico.
Objective. To question existing techniques for hysteroscopic training. Measurements and Main Results. Three questions are raised. 1. Theoretical training: which is better, computer screen or blackboard? Is the CD-ROM the per-
Objective. To describe a new method to achieve permanent fallopian tube occlusion. $72
was treated by observation. Length of procedure and fluid volume were also assessed. Conclusion. Fertiloscopy is an efficient, accurate, well-tolerated procedure that will have a place in evaluation of pelvic pathology.
fect compromise? 2. Hands-on training: is there any difference among synthetic, animal, and human models? Can models be replaced by virtual reality training? 3. Clinical training: is telesurgery: sense or nonsense? Is the "expert-at-your-side" training: just wishful thinking? Conclusion. Finding answers to these questions could help achieving global consensus on this topic.
238. Patient Acceptance of Diagnostic Hysteroscopy without Anesthesia E Valli, E Zupi, D Marconi, M Sbracia, B De Vivo, G Lanzi, B Szabolcs, C Romanini. University of Rome Tor Vergata, Rome, Italy.
240. Endometrial Ablation and the Postablation Tubal Sterilization Syndrome B Van Voorhis, A Mall, G Shirk. University of Iowa College of Medicine, Iowa City, Iowa.
Objective. To establish patient acceptance of outpatient hysteroscopy without anesthesia. Measurements and Main Results. Hysteroscopy was performed in 670 consecutive women (mean age 48.9 _+ 13.5 yrs) with the Hamou 1 and CO2 distention of the uterine cavity without anesthesia. In 56 patients (8.3%) the examination was impossible because of intemal stenosis or vagal reaction; they were eliminated from data analysis. After the procedure, patients were asked to answer two questions: was the pain was more or less than expected?, and would they have a repeat hysteroscopy without anesthesia again, or with local or general anesthesia? Patients were asked to indicate pain level on a VAS from 0 to 10 (0 = no pain, 10 = worst pain). Data were correlated with difficulty of the examination. It was easy in 68.6%, more difficult in 22.4%, and difficult in 8.9% of patients. The mean VAS pain score was 3.76 + 2 (range 0-9, median 4). Patients older than 65 years experienced higher pain level (4.9 _+ 2.3) than younger patients (3.5 + 2.12, p <0.05). Women with easy examination had significantly less pain (3.13 _+ 1.77) than those with difficult examination (5.14 _+ 2.12, p <0.01), and calm patients described less pain (3.31 _+2.12) than excited and anxious ones (4.35 + 2.15, p <0.05). Except women with impossible examinations, most preferred to repeat the examination as it had been performed. Conclusion. Hysteroscopy can be performed without anesthesia in most patients.
Objective. To determine the frequency of postablation tubal sterilization syndrome (PATSS) and risk factors for additional gynecologic surgery after endometrial ablation. Measurements and Main Results. We identified 100 consecutive women undergoing rollerball endometrial ablation and sent them questionnaires regarding posttreatment symptoms and need for subsequent surgery. Possible risk factors for failed ablation including a history of tubal ligation (TL) were determined by chart review and questionnaire. Seventy-two women (mean age 41 yrs; average follow-up 50 mo, range 15-96 mo) retumed the questionnaire. Of these, 75% were satisfied with the outcome and 84% reported amenorrhea or decreased menses. Among 47 women with a previous TL, 2 (8%) reported new or worse pain, 13 (28%) had additional gynecologic surgery including hysterectomy (9) or other pelvic surgery (4), and 3 (6%) had pathologically confirmed PATSS. Among 25 women with no previous TL, 2 (8%) reported new or worse pain and 2 (8%) had subsequent surgery. Survival analysis curves suggested a trend toward increased postablation surgical procedures among women who had a previous TL. Conclusion. The frequency of PATSS was between 6% (pathologically confirmed) and 15% (pathology or new symptoms). Previous TL may be a risk factor for surgery after ablation.
239. How to Find Consensus Regarding Teaching
Hysterocopy in the New Millennium YRM Van Belle. St. Jansziekenhuis, Brussels, Belgium.
241. A New Transcervical Sterilization Procedure 1T Vancaillie, 2DR Stewart, 3jG Garza Leal. 1Royal Hospital for Women, Randwick, Australia; 2Adiana, Inc., Redwood City, California; 3Hospital Universitario, Monterrey, Mexico.
Objective. To question existing techniques for hysteroscopic training. Measurements and Main Results. Three questions are raised. 1. Theoretical training: which is better, computer screen or blackboard? Is the CD-ROM the per-
Objective. To describe a new method to achieve permanent fallopian tube occlusion. $72