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Recovery of ovarian function after laparoscopic enucleation of a cyst
August 2002, Vol. 9, No. 3 Supplement TheJournal of the American Association of Gynecologic Laparoscopists
tubal patency in 20% (p <0.05). In those with secondary infertility, respective figures were 66.6% and 33.3% (p <0.05). Pregnancy rates were 40% (p <0.05) and 83.3% (p <0.001), respectively. Continuing pregnancy rates were 75% (p <0.001) and 40% (p <0.05), respectively. Conclusion. Bee venom is effective treatment of proximal tubal obstruction, with satisfactory tubal patency and pregnancy rates. It is cost effective, with no complications.
ine posterior wall. The adhesion was removed with contact Nd:YAG laser and a 2-cm mass was excised. Histologic examination showed endometriosis. All symptoms were resolved after this operation. Conclusion. Combined laparoscopic-vaginal approach to dissect an endometriotic lesion is in our opinion the treatment of choice for this unusual location of ectopic endometrium.
13. Recovery of Ovarian Function after Laparoscopic Enucleation of a Cyst
11. Laparoscopic Pegasys for Treatment of Tubal Pregnancy
1M Barbieri, 2M Busacca, 1B Bottani, 1B Agnoli, 1R Granese, 1M Candiani. 111Clinica L. Mangiagalli, Milan, Italy; 2Clinica Macedonio Melloni, Milan, Italy.
AFM Ali, S Shaker, WM Hamed. Faculty of Pharmacy and National Research Center, Heliopolis, Cairo, Egypt.
Objective. To evaluate the functional activity of the ovary after laparoscopic cyst enucleation. Measurements and Main Results. Twenty women (age range 1 8 4 0 yrs) with a monolateral, persistent ovarian cyst larger than 4 cm underwent laparoscopic enucleation of the cyst. All patients had TVUS postoperatively on the tenth day of the cycle (9-11 days) to verify the presence of a dominant follicle, and on the twenty-first day of the cycle (19-22 days) to verify the presence of a luteinized follicle; serum progesterone was measured during midluteal phase. These procedures were repeated after three cycles. Eighteen (90%) patients had a normal ovulatory cycle at first TVS: 7 (38%) had normal ovulation in the enucleated ovary and 11 (62%) in the contralateral ovary. After three cycles all 20 patients had a normal ovulatory cycle: 9 (45%) in the treated ovary and 11 (55%) in the contralateral ovary. After nine cycles data were identical to those in controls. Conclusion. Ovaries in which cyst laparoscopic enucleation was performed recovered almost normal activity after three periods.
Objective. To evaluate the feasibility of laparoscopic intratubal injection of Pegasys (intefferon-c~2a 180 pg/0.5 ml) as a new modality for treatment of undisturbed tubal pregnancy. Measurements and Main Results. Five women diagnosed with undisturbed tubal pregnancy by TVS and serum B-hCG, and not exceeding 4 cm, were enrolled. One ampule of Pegasys was injected directly into the site of the gestation laparoscopically. Follow-up consisted of serial measurements of B-hCG. All patients were treated successfully with minimal side effects (nausea and vomiting 2, headache 5, runny nose 3, leg cramps 3, backache 2). Conclusion. Pegasys injection for treatment of undisturbed tubal pregnancy in carefully selected women has a high success rate and minimal side effects, but is costly.
12. Laparoscopic-Assisted Vaginal Management of Rectovaginal Endometriotic Nodule Y Asakawa, M Morita, S Watanabe, I Uchiide, M Nakakuma, H Kubo. First Department of Obstetrics and Gynecology, Toho University School of Medicine, Tokyo, Japan.
14. Cosmetic Tubectomy VR Benadikar. Ichalkaranji, Maharashtra, India.
Objective. To compare a simple, inexpensive modification of abdominal tubectomy with laparoscopic tubectomy. Measurements and Main Results. In 850 women modified abdominal tubectomy was performed between second and fifth days postpartum. Of these, 670 cases were done under general and 180 under local anesthesia. A 1-cm incision was made in the lower abdomen, about 2 inches below the uterine ftmdus. The
Objective. To describe laparoscopic excision of deep endometriosis on the uterosacral ligament. Measurement and Main Results. A 33-year-old woman had a history of severe dysmenorrhea, dyspareunia, and pain on defecation. Speculum examination showed an endometriosis lesion on the left posterior fomix. The CA 125 level was 20.0 U/ml. A mass with tendemess was palpated in the left uterosacral ligament. Laparoscopy revealed the rectum adhered to the uter-
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tubal patency in 20% (p <0.05). In those with secondary infertility, respective figures were 66.6% and 33.3% (p <0.05). Pregnancy rates were 40% (p <0.05) and 83.3% (p <0.001), respectively. Continuing pregnancy rates were 75% (p <0.001) and 40% (p <0.05), respectively. Conclusion. Bee venom is effective treatment of proximal tubal obstruction, with satisfactory tubal patency and pregnancy rates. It is cost effective, with no complications.
ine posterior wall. The adhesion was removed with contact Nd:YAG laser and a 2-cm mass was excised. Histologic examination showed endometriosis. All symptoms were resolved after this operation. Conclusion. Combined laparoscopic-vaginal approach to dissect an endometriotic lesion is in our opinion the treatment of choice for this unusual location of ectopic endometrium.
13. Recovery of Ovarian Function after Laparoscopic Enucleation of a Cyst
11. Laparoscopic Pegasys for Treatment of Tubal Pregnancy
1M Barbieri, 2M Busacca, 1B Bottani, 1B Agnoli, 1R Granese, 1M Candiani. 111Clinica L. Mangiagalli, Milan, Italy; 2Clinica Macedonio Melloni, Milan, Italy.
AFM Ali, S Shaker, WM Hamed. Faculty of Pharmacy and National Research Center, Heliopolis, Cairo, Egypt.
Objective. To evaluate the functional activity of the ovary after laparoscopic cyst enucleation. Measurements and Main Results. Twenty women (age range 1 8 4 0 yrs) with a monolateral, persistent ovarian cyst larger than 4 cm underwent laparoscopic enucleation of the cyst. All patients had TVUS postoperatively on the tenth day of the cycle (9-11 days) to verify the presence of a dominant follicle, and on the twenty-first day of the cycle (19-22 days) to verify the presence of a luteinized follicle; serum progesterone was measured during midluteal phase. These procedures were repeated after three cycles. Eighteen (90%) patients had a normal ovulatory cycle at first TVS: 7 (38%) had normal ovulation in the enucleated ovary and 11 (62%) in the contralateral ovary. After three cycles all 20 patients had a normal ovulatory cycle: 9 (45%) in the treated ovary and 11 (55%) in the contralateral ovary. After nine cycles data were identical to those in controls. Conclusion. Ovaries in which cyst laparoscopic enucleation was performed recovered almost normal activity after three periods.
Objective. To evaluate the feasibility of laparoscopic intratubal injection of Pegasys (intefferon-c~2a 180 pg/0.5 ml) as a new modality for treatment of undisturbed tubal pregnancy. Measurements and Main Results. Five women diagnosed with undisturbed tubal pregnancy by TVS and serum B-hCG, and not exceeding 4 cm, were enrolled. One ampule of Pegasys was injected directly into the site of the gestation laparoscopically. Follow-up consisted of serial measurements of B-hCG. All patients were treated successfully with minimal side effects (nausea and vomiting 2, headache 5, runny nose 3, leg cramps 3, backache 2). Conclusion. Pegasys injection for treatment of undisturbed tubal pregnancy in carefully selected women has a high success rate and minimal side effects, but is costly.
12. Laparoscopic-Assisted Vaginal Management of Rectovaginal Endometriotic Nodule Y Asakawa, M Morita, S Watanabe, I Uchiide, M Nakakuma, H Kubo. First Department of Obstetrics and Gynecology, Toho University School of Medicine, Tokyo, Japan.
14. Cosmetic Tubectomy VR Benadikar. Ichalkaranji, Maharashtra, India.
Objective. To compare a simple, inexpensive modification of abdominal tubectomy with laparoscopic tubectomy. Measurements and Main Results. In 850 women modified abdominal tubectomy was performed between second and fifth days postpartum. Of these, 670 cases were done under general and 180 under local anesthesia. A 1-cm incision was made in the lower abdomen, about 2 inches below the uterine ftmdus. The
Objective. To describe laparoscopic excision of deep endometriosis on the uterosacral ligament. Measurement and Main Results. A 33-year-old woman had a history of severe dysmenorrhea, dyspareunia, and pain on defecation. Speculum examination showed an endometriosis lesion on the left posterior fomix. The CA 125 level was 20.0 U/ml. A mass with tendemess was palpated in the left uterosacral ligament. Laparoscopy revealed the rectum adhered to the uter-
$5