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Influence of Physical Exercise on Endometriosis Experimentally Induced in Rats
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253 601 Introduction of Fundamentals of Laparoscopic Surgery (FLS) Program in Obstetrics and Gynecology (Ob/Gyn) Residency Training Shields AA, Stampler KM. Obstetrics and Gynecology, Lankenau Hospital, Wynnewood, Pennsylvania Study Objective: The FLS program has been employed to teach and measure laparoscopic skills in standardized format for the last decade. While the American College of Surgeons has endorsed this training, it has not been universally adopted in ob/gyn training programs. A standardized training curriculum in laparoscopy is warranted within our specialty. We introduced the FLS program into our residency training with several goals in mind: to continue to validate the use of FLS in ob/gyn training, to enhance resident confidence in laparoscopy, and to test objective findings in the operative and simulator settings. Design: Observational. Setting: Community-based ob/gyn residency program. Patients: 13 residents were asked to participate with the pilot introduction of the program. 6 residents completed all required components. Intervention: The FLS online didactics were instituted at the beginning of the academic year 2014. Didactic testing, self-assessment questionnaires and FLS peg transfer and pattern cut tasks were objectively rated by unbiased observers in late June 2014. Final testing is scheduled for May/ June 2015. Measurements and Main Results: Participants rated their skills to be poor to moderate, with hours of simulation time ranging from 1 to 5, prior to testing. Average completion time for the peg transfer was 280 seconds and for pattern cut was 376 seconds, with no resident performing within FLS competency guidelines. Final testing data is pending. Conclusion: We hypothesize that both resident perception of skill and objective findings in task completion will increase with introduction of the FLS program. We will continue the need to validate this program for wide spread introduction in our specialty. In the next phase of our program, we plan to use objective findings to demonstrate improved operating room performance and plan to achieve program completion by all current residents.
602
Virtual Posters - Endometriosis
Perioperative Outcomes for Robotic-Assisted Excision of Severe Deep Infiltrating Endometriosis Barton-Smith P, Tan A. Obstetrics & Gynaecology, Singapore General Hospital, Singapore, Singapore Study Objective: Assess the perioperative outcomes for robot-assisted excision of deep infiltrating endometriosis (DIE). Design: A Prospective study of perioperative outcomes (March 2010 - April 2015). Data was collected prospectively in theatre and at a 6 week post operative check. Data were analysed using SPSS. Setting: 1 surgeon operating at 2 tertiary public centres for severe endometriosis (The Royal Surrey County Hospital UK and Singapore General Hospital). Patients: Women presenting to the department with pelvic pain, infertility or for other symptoms not related to endometriosis and diagnosed by transvaginal or transrectal ultrasound with deep infiltrating nodules and partial or complete obliteration of the cul-de-sac. Intervention: Counselling of options for treatment including conservative, medical or surgical including risks and benefits. For patients opting for
S167
surgery a 5 port robot-assisted excision of all visible lesions and endometriomas was carried out with the intention to shave bowel nodules when encountered. Measurements and Main Results: 95.7% had uterosacral DIE, 56.5% bowel, 15.2% ureteric and 2.2% bladder. Endometriomas were unilateral in 21.7% and bilateral in 30.4%. 97.6% of bowel-involved cases were treated by rectal shaving and 2.4 % by disc resection. Mean operating time was 190 minutes (range 105-475 minutes), mean EBL was 202 ml (range 5-3000 ml). There were 3 major intraoperative complications from bleeding > 1000 ml (3.5%). One case required suturing of bladder trauma. Three cases required prophylactic ureteric stenting. Hysterectomy and bilateral salpingo-oophorectomy were carried out in 29 cases. Conversion to open in 1 case (1.2%). Postoperatively there were no delayed complications involving bowel or ureters. Mean length of hospital stay was 1.9 days (range 1 - 4 days). Conclusion: Excision of DIE in severe cases is complex and carries a recognised significant rate of delayed major complications particularly to bowel and ureter. Robotics for severe DIE is a relatively new procedure and improves view, precision and ergonomics to potentially reduce this risk.
603 Influence of Physical Exercise on Endometriosis Experimentally Induced in Rats Rosa-e-Silva JC, Montenegro ML, Meola J, Zani AC, Ferriani RA. Gynecology and Obstetrics, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil Study Objective: Endometriosis is characterized by the growth of endometrial tissue outside the uterine cavity. Evidence has suggested the endometriosis symptoms result from a local inflammatory peritoneal reaction caused by ectopic endometrial implants undergo cyclic bleeding. On the other hand, regular physical exercise seems to have protective effects against diseases involving inflammatory processes as type 2 diabetes, colon and breast cancer. On this basis, it is possible the practice of physical exercise has beneficial effects in endometriosis. Therefore, the objective of the study was evaluated the possible antiinflammatory effect of physical exercise in endometriosis experimentally induced in rats. Design: Experimental animal study. Setting: Center of experimental surgery. Patients: Seventy female Wistar rats. Intervention: 70 female Wistar rats were divided in 7 groups with 10 animals each: Sedentary (no exercise), light exercise (once a week); moderate exercise (three times a week) and intense exercise (five times a week). Three groups performed physical exercise before endometriosis induction and the other three performed physical exercise after endometriosis induction. At the end of the experimental protocol, animals were sacrificed and the lesions excised for immunohistochemistry, gene expression and oxidative stress analysis. Measurements and Main Results: Fas gene levels were increased in groups that practice exercise after endometriosis induction suggesting greater cellular apoptosis. MMP9 and PCNA level seems decreased in all groups indicating reduction in proliferation, migration and differentiation of endometriotic tissue. Although with not significant results, immunohistochemistry analysis shows clear tendency of increase in fas protein levels in all study groups. As expected, the oxidative stress was reduced in all groups, confirming reduction of systemic oxidative stress levels during exercise practice. Conclusion: Our results showed at least in part practice of physical exercise could be beneficial in treatment of endometriosis.
602
Virtual Posters - Endometriosis
Perioperative Outcomes for Robotic-Assisted Excision of Severe Deep Infiltrating Endometriosis Barton-Smith P, Tan A. Obstetrics & Gynaecology, Singapore General Hospital, Singapore, Singapore Study Objective: Assess the perioperative outcomes for robot-assisted excision of deep infiltrating endometriosis (DIE). Design: A Prospective study of perioperative outcomes (March 2010 - April 2015). Data was collected prospectively in theatre and at a 6 week post operative check. Data were analysed using SPSS. Setting: 1 surgeon operating at 2 tertiary public centres for severe endometriosis (The Royal Surrey County Hospital UK and Singapore General Hospital). Patients: Women presenting to the department with pelvic pain, infertility or for other symptoms not related to endometriosis and diagnosed by transvaginal or transrectal ultrasound with deep infiltrating nodules and partial or complete obliteration of the cul-de-sac. Intervention: Counselling of options for treatment including conservative, medical or surgical including risks and benefits. For patients opting for
S167
surgery a 5 port robot-assisted excision of all visible lesions and endometriomas was carried out with the intention to shave bowel nodules when encountered. Measurements and Main Results: 95.7% had uterosacral DIE, 56.5% bowel, 15.2% ureteric and 2.2% bladder. Endometriomas were unilateral in 21.7% and bilateral in 30.4%. 97.6% of bowel-involved cases were treated by rectal shaving and 2.4 % by disc resection. Mean operating time was 190 minutes (range 105-475 minutes), mean EBL was 202 ml (range 5-3000 ml). There were 3 major intraoperative complications from bleeding > 1000 ml (3.5%). One case required suturing of bladder trauma. Three cases required prophylactic ureteric stenting. Hysterectomy and bilateral salpingo-oophorectomy were carried out in 29 cases. Conversion to open in 1 case (1.2%). Postoperatively there were no delayed complications involving bowel or ureters. Mean length of hospital stay was 1.9 days (range 1 - 4 days). Conclusion: Excision of DIE in severe cases is complex and carries a recognised significant rate of delayed major complications particularly to bowel and ureter. Robotics for severe DIE is a relatively new procedure and improves view, precision and ergonomics to potentially reduce this risk.
603 Influence of Physical Exercise on Endometriosis Experimentally Induced in Rats Rosa-e-Silva JC, Montenegro ML, Meola J, Zani AC, Ferriani RA. Gynecology and Obstetrics, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil Study Objective: Endometriosis is characterized by the growth of endometrial tissue outside the uterine cavity. Evidence has suggested the endometriosis symptoms result from a local inflammatory peritoneal reaction caused by ectopic endometrial implants undergo cyclic bleeding. On the other hand, regular physical exercise seems to have protective effects against diseases involving inflammatory processes as type 2 diabetes, colon and breast cancer. On this basis, it is possible the practice of physical exercise has beneficial effects in endometriosis. Therefore, the objective of the study was evaluated the possible antiinflammatory effect of physical exercise in endometriosis experimentally induced in rats. Design: Experimental animal study. Setting: Center of experimental surgery. Patients: Seventy female Wistar rats. Intervention: 70 female Wistar rats were divided in 7 groups with 10 animals each: Sedentary (no exercise), light exercise (once a week); moderate exercise (three times a week) and intense exercise (five times a week). Three groups performed physical exercise before endometriosis induction and the other three performed physical exercise after endometriosis induction. At the end of the experimental protocol, animals were sacrificed and the lesions excised for immunohistochemistry, gene expression and oxidative stress analysis. Measurements and Main Results: Fas gene levels were increased in groups that practice exercise after endometriosis induction suggesting greater cellular apoptosis. MMP9 and PCNA level seems decreased in all groups indicating reduction in proliferation, migration and differentiation of endometriotic tissue. Although with not significant results, immunohistochemistry analysis shows clear tendency of increase in fas protein levels in all study groups. As expected, the oxidative stress was reduced in all groups, confirming reduction of systemic oxidative stress levels during exercise practice. Conclusion: Our results showed at least in part practice of physical exercise could be beneficial in treatment of endometriosis.