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Laparoscopic electrocauterization of polycystic ovaries: Prediction of the outcome
THURSDAY,
SEPTEMBER
7
and the salpingostomy group concerning the operation time (minutes; 34*12 vs. 57*20) and the rates of intraoperative tubal preservation (100% vs. 82%, OR: 0.00, CI; O.OO-0.253), operative reinterventions (0% vs. 5%, OR: 0.00, CI; 0.00-1.204) and final tubal preservation (100% vs. 77.5%, OR: 0.00, CI; 0.00-0.187). The rate of methotrexate therapies did not differ significantly (3.8% vs. 3.4%, respectively). Conclusions: Uncontrolled bleeding during salpingostomy causes a conversion to salpingectomy in a considerable part of patients with ectopic pregnancy where initially tubal preservation is intended. Hyperosmolar glucose solution seems to be a simpler procedure than salpingostomy and is superior to salpingostomy concerning tubal preservation in therapy of unruptured ectopic pregnancy with serum l3hCG levels < 2500 IUIL.
FC4.07.03 LAPAROSCOPIC TUBAL END-TO-END ANASTOMOSIS AFTER STERILIZATION L. Mettler and E. Lehman-Willenbrock, Dept. OBIGYN, University of Kiel, Kiel, Germany Objectives: Evaluation of 35 laparoscopic end-to-end anastomoses performed in sterilized females from 1996-99. Study Methods: Thirty-five patients underwent a laparoscopic tubal endto-end anastamosis using the isthmic-isthmic or isthmic-ampullary procedure. Results: In 35 patients a laparoscopic two-stitch end-to-end anastomosis was performed, the first stitch for the adaptation of the parametrium and the second for the adaptation of the muscularis mucosae. This procedure was performed over a catheter introduced transuterine through the working channel of a hysteroscope with a careful slice to slice resection of the tubal end. All patients showed a postoperative tubal patency with a pregnancy success rate of 61% after one year. Conclusions: Laparoscopic microsurgical tubal anastomosis is an alternative procedure to microsurgical tubal anastomosis by laparotomy in patients requesting tubal reversal and has replaced the laparotomy procedure.
FC4.07.04 LAPAROSCOPIC ELECTROCAUTERIZATION OF POLYCYSTIC OVARIES: PREDICTION OF THE OUTCOME H. M. Zakhira, S. Mostafa, S. Selim, S. Abullah, Dept. OBIGYN, Assiut University Hospitals, Assiut, Egypt Objectives: To detect the predictors of ovulation and pregnancy after laparoscopic electrocautery of polycystic ovaries (PCO). Study Methods: One hundred and fifty infertile women with PC0 syndrome who did not ovulate with clomiphene citrate were subjected to laparoscopic electrocauterization. Clinical, sonographic and biochemical assessment receded and followed the operation. Such variables were tested against the outcome: ovulation and pregnancy rates -using stepwise logistic regression analysis. Results: Galactorrhoea, menstrual pattern, LWFSH ratio, ovarian stroma appearance and hirsuitism were the predictors of ovulation. The same factors except menstrual pattern predicted the occurrence of pregnancy significantly. Conclusions: The estimated probability of outcome (ovulationpregnancy) could be determined by a regression equation including galactorrhoea, ovarian stroma appearance, hirsuitism and menstrual pattern.
FC4.07.05 LAPAROSCOPIC OVARIAN DRILLING OF POLYCYSTIC OVARIAN DISEASE (PCOD): COMPARISON BETWEEN ENDOCOAGULATION AND ELECTROCAUTERIZATION S.A. Abdullah (l), S.A. Mostafa (l), S.M. Selim (2), M.S. Zakhera (l), Faculty of Medicine, Assiut University, Assiut, Egypt. (1) Dept. OB/GYN (2) Dept. Physiology Objectives: To compare between two methods of laparoscopic ovarian drilling of polycystic ovaries (endocoagulation and electrocauterization) as regards postoperative menstrual cycle, ovulation and pregnancy rate and outcome.
33
Study Methods: 150 patients with clomiphene citrate resistant PCOD were recruited for this study. They were randomly allocated either to endocoagulation (70 patients0 or electrocauterization (80 patients). Results: Overall postoperative clinical outcome was as follows: Normal menstrual cyclicity was observed in 91.2% of patients, spontaneous ovulation was recorded in 70.3% of patients, increased to 80.4% after addition of clomiphene citrate (CC). The pregnancy rate was 99.3%, 81.3% were spontaneous. Abortion rate was 22.9%, 75% of them occurred in the first trimester. Postoperative regular menstrual cycle, ovulation rate and pregnancy rate were 88.4%, 78.3% and 48.5% vs. 93.7%, 82.3% and 50% for endocoagulation and electrocauterization, respectively. Conclusions: There is no significant difference between endocoagulation and electrocauterization as regards menstrual cyclicity, ovulation and pregnancy rate. Endocoagulation is effective as electrocauterization in management of CC resistant PCOD.
FC4.07.06 LAPAROSCOPIC OVARIAN ELECTROCAUTERY FOR MANAGEMENT OF POLYCYSTIC OVARIAN DISEASE A. Kriulani, N. Agarwal, D. Takkar, Dept. OBIGYN, All India Institute of Medical Sciences, New Delhi, India. Objectives: To evaluate the efficacy of laparoscopic ovarian electrocautery on ovulation and pregnancy rates in cases of polycystic ovarian disease, (PCOD) resistant to medical induction of ovulation. Study Methods: Forty eight anovulatory infertile subjects wit clinical endocrine and ultrasonographic characteristics of PCOD underwent laparoscopic electroagulation of ovarian surface using a triple puncture approach at operative laparoscopy. Bilateral ovarian drilling was done with an unipolar diathermy needle (Karl Stroz). Chromopertubation to confirm tubal patency was done in all the cases. Additional procedures like laparoscopic tuboplasty, endometrioma fulguration, adhesiolysis, hysteroscopic septum incision and hysteroscopic cannulation of fallopian tubes were done at the same sitting in 11 (22.9%) cases. Results: Forty three (89.55%) of PCOD patients ovulated spontaneously or following ovulation induction after the procedure. Pregnancies occurred in 31 out of 48 (64.5%) of patients. Total pregnancies reported in the serious were 38 in 31 patients as 7 patients conceived twice (n=6) and thrice (n=l) including 5 after abortion and 2 after term pregnancy and delivery. The miscarriage rate was 5.38(13%, no case of multiple pregnancy or ectopic pregnancy was reported. None of the cases had any intraoperative or postoperative complication related to the procedure. Conclusions: Laparoscopic ovarian, electocautery appears to be a useful, safe, easy to perform and cost effective alternative treatment for patients with polycystic ovarian disease resistant to medical induction of ovulation.
FC4.07.07 CHROMOPERTUBATION WITH FLEXIBLE CANNULA IN LAPAROSCOPIC EXAMINATION AND RECONSTRUCTIVE SURGERY TREATMENT FOR DISTAL TUBAL DISEASE A. Efimenco, M. Ivasi, L. Nacu, F. Bejan, Reproductive Medicine Centre “Gynesource,” Chisinau, Rep. Of Moldova. Objectives: The evaluation of an easy diagnostic technique and the identification of its advantages in treating distal tubal disease. Study Methods: 122 women who had laparoscopic surgery were included in this study. Chromepertubation consisted of two stages: Initially, about 20ml of saline solution was injected through the flexible can&a with the help a Foley type. Then the tubal reconstruction was carried out through the same can&a and 30.40ml Methylene blue solution was injected. The average age of the women was 27.8 years (19-39 years). The precondition for laparoscopic surgical treatment or all women was primary or secondary infertility of 2-17 years. Results: Before performing the laparoscopic surgery, all patients underwent transcervical cannulisation of the uterine cavity by means of floppy can&as of a Foley type. For 103 patients (84.4%) the can&a was inserted through the cervix without preliminary instrumental dilation. For 97 patients (79.5%) the intra-operative status of the identified Fallopian tubes corresponded to those on pre-operative stage appreciated by metrosalpingography.
SEPTEMBER
7
and the salpingostomy group concerning the operation time (minutes; 34*12 vs. 57*20) and the rates of intraoperative tubal preservation (100% vs. 82%, OR: 0.00, CI; O.OO-0.253), operative reinterventions (0% vs. 5%, OR: 0.00, CI; 0.00-1.204) and final tubal preservation (100% vs. 77.5%, OR: 0.00, CI; 0.00-0.187). The rate of methotrexate therapies did not differ significantly (3.8% vs. 3.4%, respectively). Conclusions: Uncontrolled bleeding during salpingostomy causes a conversion to salpingectomy in a considerable part of patients with ectopic pregnancy where initially tubal preservation is intended. Hyperosmolar glucose solution seems to be a simpler procedure than salpingostomy and is superior to salpingostomy concerning tubal preservation in therapy of unruptured ectopic pregnancy with serum l3hCG levels < 2500 IUIL.
FC4.07.03 LAPAROSCOPIC TUBAL END-TO-END ANASTOMOSIS AFTER STERILIZATION L. Mettler and E. Lehman-Willenbrock, Dept. OBIGYN, University of Kiel, Kiel, Germany Objectives: Evaluation of 35 laparoscopic end-to-end anastomoses performed in sterilized females from 1996-99. Study Methods: Thirty-five patients underwent a laparoscopic tubal endto-end anastamosis using the isthmic-isthmic or isthmic-ampullary procedure. Results: In 35 patients a laparoscopic two-stitch end-to-end anastomosis was performed, the first stitch for the adaptation of the parametrium and the second for the adaptation of the muscularis mucosae. This procedure was performed over a catheter introduced transuterine through the working channel of a hysteroscope with a careful slice to slice resection of the tubal end. All patients showed a postoperative tubal patency with a pregnancy success rate of 61% after one year. Conclusions: Laparoscopic microsurgical tubal anastomosis is an alternative procedure to microsurgical tubal anastomosis by laparotomy in patients requesting tubal reversal and has replaced the laparotomy procedure.
FC4.07.04 LAPAROSCOPIC ELECTROCAUTERIZATION OF POLYCYSTIC OVARIES: PREDICTION OF THE OUTCOME H. M. Zakhira, S. Mostafa, S. Selim, S. Abullah, Dept. OBIGYN, Assiut University Hospitals, Assiut, Egypt Objectives: To detect the predictors of ovulation and pregnancy after laparoscopic electrocautery of polycystic ovaries (PCO). Study Methods: One hundred and fifty infertile women with PC0 syndrome who did not ovulate with clomiphene citrate were subjected to laparoscopic electrocauterization. Clinical, sonographic and biochemical assessment receded and followed the operation. Such variables were tested against the outcome: ovulation and pregnancy rates -using stepwise logistic regression analysis. Results: Galactorrhoea, menstrual pattern, LWFSH ratio, ovarian stroma appearance and hirsuitism were the predictors of ovulation. The same factors except menstrual pattern predicted the occurrence of pregnancy significantly. Conclusions: The estimated probability of outcome (ovulationpregnancy) could be determined by a regression equation including galactorrhoea, ovarian stroma appearance, hirsuitism and menstrual pattern.
FC4.07.05 LAPAROSCOPIC OVARIAN DRILLING OF POLYCYSTIC OVARIAN DISEASE (PCOD): COMPARISON BETWEEN ENDOCOAGULATION AND ELECTROCAUTERIZATION S.A. Abdullah (l), S.A. Mostafa (l), S.M. Selim (2), M.S. Zakhera (l), Faculty of Medicine, Assiut University, Assiut, Egypt. (1) Dept. OB/GYN (2) Dept. Physiology Objectives: To compare between two methods of laparoscopic ovarian drilling of polycystic ovaries (endocoagulation and electrocauterization) as regards postoperative menstrual cycle, ovulation and pregnancy rate and outcome.
33
Study Methods: 150 patients with clomiphene citrate resistant PCOD were recruited for this study. They were randomly allocated either to endocoagulation (70 patients0 or electrocauterization (80 patients). Results: Overall postoperative clinical outcome was as follows: Normal menstrual cyclicity was observed in 91.2% of patients, spontaneous ovulation was recorded in 70.3% of patients, increased to 80.4% after addition of clomiphene citrate (CC). The pregnancy rate was 99.3%, 81.3% were spontaneous. Abortion rate was 22.9%, 75% of them occurred in the first trimester. Postoperative regular menstrual cycle, ovulation rate and pregnancy rate were 88.4%, 78.3% and 48.5% vs. 93.7%, 82.3% and 50% for endocoagulation and electrocauterization, respectively. Conclusions: There is no significant difference between endocoagulation and electrocauterization as regards menstrual cyclicity, ovulation and pregnancy rate. Endocoagulation is effective as electrocauterization in management of CC resistant PCOD.
FC4.07.06 LAPAROSCOPIC OVARIAN ELECTROCAUTERY FOR MANAGEMENT OF POLYCYSTIC OVARIAN DISEASE A. Kriulani, N. Agarwal, D. Takkar, Dept. OBIGYN, All India Institute of Medical Sciences, New Delhi, India. Objectives: To evaluate the efficacy of laparoscopic ovarian electrocautery on ovulation and pregnancy rates in cases of polycystic ovarian disease, (PCOD) resistant to medical induction of ovulation. Study Methods: Forty eight anovulatory infertile subjects wit clinical endocrine and ultrasonographic characteristics of PCOD underwent laparoscopic electroagulation of ovarian surface using a triple puncture approach at operative laparoscopy. Bilateral ovarian drilling was done with an unipolar diathermy needle (Karl Stroz). Chromopertubation to confirm tubal patency was done in all the cases. Additional procedures like laparoscopic tuboplasty, endometrioma fulguration, adhesiolysis, hysteroscopic septum incision and hysteroscopic cannulation of fallopian tubes were done at the same sitting in 11 (22.9%) cases. Results: Forty three (89.55%) of PCOD patients ovulated spontaneously or following ovulation induction after the procedure. Pregnancies occurred in 31 out of 48 (64.5%) of patients. Total pregnancies reported in the serious were 38 in 31 patients as 7 patients conceived twice (n=6) and thrice (n=l) including 5 after abortion and 2 after term pregnancy and delivery. The miscarriage rate was 5.38(13%, no case of multiple pregnancy or ectopic pregnancy was reported. None of the cases had any intraoperative or postoperative complication related to the procedure. Conclusions: Laparoscopic ovarian, electocautery appears to be a useful, safe, easy to perform and cost effective alternative treatment for patients with polycystic ovarian disease resistant to medical induction of ovulation.
FC4.07.07 CHROMOPERTUBATION WITH FLEXIBLE CANNULA IN LAPAROSCOPIC EXAMINATION AND RECONSTRUCTIVE SURGERY TREATMENT FOR DISTAL TUBAL DISEASE A. Efimenco, M. Ivasi, L. Nacu, F. Bejan, Reproductive Medicine Centre “Gynesource,” Chisinau, Rep. Of Moldova. Objectives: The evaluation of an easy diagnostic technique and the identification of its advantages in treating distal tubal disease. Study Methods: 122 women who had laparoscopic surgery were included in this study. Chromepertubation consisted of two stages: Initially, about 20ml of saline solution was injected through the flexible can&a with the help a Foley type. Then the tubal reconstruction was carried out through the same can&a and 30.40ml Methylene blue solution was injected. The average age of the women was 27.8 years (19-39 years). The precondition for laparoscopic surgical treatment or all women was primary or secondary infertility of 2-17 years. Results: Before performing the laparoscopic surgery, all patients underwent transcervical cannulisation of the uterine cavity by means of floppy can&as of a Foley type. For 103 patients (84.4%) the can&a was inserted through the cervix without preliminary instrumental dilation. For 97 patients (79.5%) the intra-operative status of the identified Fallopian tubes corresponded to those on pre-operative stage appreciated by metrosalpingography.