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Safety and Efficiency of Bipolar Electrocoagulation for Total Laparoscopic Hysterectomy
S46
Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159
the pelvis and lower abdomen are considered to be the ‘‘secondary Mu¨llerian system’’ due to their embryological resemblance to the Mu¨llerian ducts. They have the ability to convert into uterine tissue under hormonal influences. The ‘‘uterus like mass’’ may be the end-stage of transition from ovarian stromal cells or peritoneal endometriosis into smooth muscle cells due to local metaplasia or a remnant of a congenital Mu¨llerian fusion defect. We present two distinct cases of a uterus-like mass.
173
Video Session 7dEndometriosis II (12:02 PM d 12:08 PM)
Dissection of Endometriosis from Cul-de-Sac and Pelvic Sidewall Using Ultrasonic Energy Santomauro AG,1 Ferzandi TR.2 1Obstetrics and Gynecology, Bridgeport Hospital, Bridgeport, Connecticut; 2Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, Massachusetts This video shows the dissection of severe endometriosis of the cul-de-sac and pelvic sidewall in a patient with long-standing pelvic pain. The use of Autosonix by Covidien is demonstrated here, which uses ultrasonic energy. The advantage of this is that vascular adhesions are lysed at a low setting, while avascular or filmy adhesions can be lysed at high power producing a more rapid dissection. This energy can also be used close to intricate structures because of minimal lateral thermal spread when compared to monopolar current.
174
Video Session 7dEndometriosis II (12:09 PM d 12:17 PM)
Laparoscopic Treatment of Ureteral Endometriosis Kaufman Y,1,2 Alturki H,1 Lam A.1 1Centre for Advanced Reproductive Endosurgery, Australia; 2The Lady Davis Carmel Medical Center Affiliated to the Medical School of the Technion Institute of Technology, Haifa, Israel Approximately 2% of women with endometriosis have involvement of the urinary tract. In 15% of these cases the ureter is involved. Ureteral disease is usually unilateral, more commonly on the left side and in the distal third of the ureter. Extrinsic disease occurs in 80% of cases and involves the outer layers of the ureter up to the submucosa. Intrinsic disease involves the submucosa and the uroepithelium. Preoperative diagnosis of urinary tract endometriosis may often be a challenge. Symptoms are often vague and non-specific and the severity of symptoms correlates poorly with the degree of ureteral obstruction. Silent obstruction can cause loss of renal function and therefore a preoperative high index of suspicion for ureteral involvement should be maintained with all patients diagnosed with endometriosis. We present 2 cases of urinary tract endometriosis.
175
Video Session 7dEndometriosis II (12:18 PM d 12:25 PM)
Minimally Invasive Ureteric Reimplantation in Severe Endometriosis Galletto D, Cavalli N, Tanaka MT, Mendes JB Jr, Tanaka AS, Cavalli LO, Pacagnan EF. Obstetrics and Gynecology, Genesis Hospital, Cascavel, Parana, Brazil To demonstrate the feasibility of ureteric reimplantation after excision of severe endometriosis in the ureter using an entirely minimally invasive technique. Material and Method: A 37-year-old woman with intense pelvic pain had previous hysterectomy and several surgeries for endometriosis. Imaging exams showed obstruction of right ureter and a 5 cm mass in the projection of iliac arteries, ureter and bladder. Results:Operation time was 7 hours, blood loss 220 ml, 1 week hospital stay. The authors demonstrate operation over the bladder, ureter and vagina. Reimplantation of the ureter was performed by the Gregoir technique. Conclusion: The minimally invasive approach is technically feasible and may afford great benefits to
patients who would otherwise undergo open surgery with greater discomfort and prolonged hospitalization.
176
Video Session 7dEndometriosis II (12:26 PM d 12:32 PM)
Neutral Argon Plasma in Laparoscopic Management of Endometriosis Nezhat CH, Morozov V. Atlanta Center for Special Minimally Invasive Surgery & Reproductive Medicine, Atlanta, Georgia In this video, we demonstrate the use of a Neutral Argon Plasma system utilitzed on High Temperature/High Flow/Forced mode to laparoscopically vaporize and excise pelvic endometriosis. Specimens were sent to pathology for the identification of residual disease after use of Neutral Argon Plasma. No residual endometriosis was identified at the base of the vaporized and excised lesions. Thermal spread was limited to less than 1 mm depth. No complications were observed. A Neutral Argon Plasma device can be used safely and efficiently to laparoscopically treat endometriosis, especially superficial implants. Minimal thermal spread and the absence of flow of electrical current through the body makes its use especially appealing.
177
Open Communication Session 5dHysterectomy (2:30 PM d 2:35 PM)
Endocervical Coring at Laparoscopic Supracervical Hysterectomy Removes a Majority of Endocervical Glands Makai GEH, Rosenblatt PL, Kamat BR, DiSciullo AJ. Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, Massachusetts Study Objective: Endocervical coring during hysterectomy, a previously described technique, removes a central cylinder of tissue from the cervix. While this maneuver may have other benefits, removing this tissue may reduce cyclic vaginal bleeding and subsequent development of cervical neoplasia. In this pilot study we aimed to evaluate the amount and type of tissue removed during endocervical coring at laparoscopic supracervical hysterectomy with transcervical morcellation (LSH/TCM). Removal of all or a majority of active endocervical tissue would provide pathologic evidence in support of the safety and efficacy of supracervical hysterectomy. Design: After obtaining IRB approval, eighteen patients who had undergone LSH/TCM between January and April 2008 were retrospectively enrolled in the study. Endocervical core specimens had been collected using either the WISAP serrated-edge (hand-driven) morcellator, Gynecare (electronic) morcellator, CURT or CISH instruments. Choice and size of device depended on availability and provider preference. Patients with malignancy or history of abnormal cervical cytology were excluded from the study. Specimens were prepared in a manner similar to cervical cone biopsy and evaluated by a single pathologist for consistency. Data regarding squamous, endocervical, and endometrial tissue was collected and recorded. Measurements and Main Results: Main outcome measures were removal of the entire transformation zone (in 3/18 cases), radial margins clear of endocervical glands (in 14/18 cases) and radial margins free of endometrial glands (in 18/18 cases). Statistical evaluation to compare tissue removed by each device was impossible due to small sample size. Conclusion: A majority of endocervical and endometrial glands is removed at the time of endocervical coring with these devices. However, the transformation zone is not completely removed. Larger numbers of cases with each device are needed to determine a preferential method. Removing this endocervical tissue may reduce cyclic bleeding and risk of cervical neoplasia. Further studies are needed to test these hypotheses. 178
Open Communication Session 5dHysterectomy (2:36 PM d 2:41 PM)
Safety and Efficiency of Bipolar Electrocoagulation for Total Laparoscopic Hysterectomy Song J, Hsu CD. Obstetrics and Gynecology, Nassau University Medical Center/Affiliated with State Univeristy of New York, Stonybrook University School of Medicine, East Meadow, New York
Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159 Study Objective: The purpose of this study was to evaluate whether bipolar electro-coagulation of the uterine arteries and infundibulo-pelvic ligaments can be used in an procedure to secure main blood vessels of uterus when total hysterectomy and bilateral oophorectomy is carried out by laparoscopy. Design: A case control study was carried out in patients who underwent total laparoscopic hysterectomy and bilateral oophorectomy for six-month period. Setting: All patients were from Nassau University Medical Center and New York Hospital Queens. Patients were managed and followed up in inpatient and outpatient care. Patients: Thirty patients (group 1) were selected randomly for surgical management due to uterine myoma, adenomyosis, pelvic pain, extensive endometriosis. Control group (group 2) includes thirty patients who had same surgery by using ligature. Demographics were analysed between two groups showing no difference statistically. Intervention: Uterine artery was coagulated by bipolar electrocoagulator and separated from the uterine side wall by scissors. Similar procedure was performed for ovarian artery. Endoloop tie or clip was not applied to the arterial pedicle after confirming hemostasis under water examination. Measurements and Main Results: The duration of operation, amount of bleeding, decrease in homoglobin, intra and post operative complications were analyzed and compared with control group. The average duration of operation was 119.2 min and 121.8 min in Groups 1 and 2, respectively (pO0.05). The average amount of bleeding was 169.8 ml and 172.4 ml in Groups 1 and 2, respectively (pO0.05). Hemoglobin decreased in average by 0.85 g/100 ml and 0.91 g/100 ml in Groups 1 and 2, respectively (pO 0.05). No intra and post operative complication was noted in both groups. Conclusion: These results demonstrate that bipolar electrocoagulation of uterine and ovarian arterial pedicles is safe and efficient method for advanced laparoscopic surgery like total laparoscopic hysterctomy and bilateral oophorectomy.
179
Open Communication Session 5dHysterectomy (2:42 PM d 2:47 PM)
Laparoscopic Hysterectomy on an Out-Patient Basis: One Year’s Experience in an Urban HMO Setting Kivnick S, Yera RE. Obstetrics and Gynecology, Kaiser-Permanente, West Los Angeles, Los Angeles, California Study Objective: To describe our experience with outpatient laparoscopic hysterectomy for a range of indications. Design: Retrospective case reveiw of all hysterectomies attempted laparoscopically in 2007 at Kaiser Permanente, West Los Angeles. Setting: Kaiser Permanente is a large HMO in California and other states. K-P, West LA is a community hospital in an urban setting, caring for 170,000 members. All operations in this series were performed by the 19 staff physicians in the obstetrics and gynecology department. Patients: All women on with hysterectomies attempted laparoscopically in 2007. Intervention: Laparoscopic supracervical hysterectomy or total laparoscopic hysterectomy (with or without bilateral salpingoophorectomy). Measurements and Main Results: Of the 326 hysterectomies in 2007, 271 (83%) were attempted laparoscopically. 268 (99%) were completed laparoscopically: 202 (75%) LSH and 66 (25%) TLH. 3 cases were converted to TAH. 260 cases (92%) were completed as outpatients. 8 patients were discharged the next day for social reasons. 3 of the outpatients were re-admitted for complications (2 for ileus; 1 cuff cellulitis). Mean age: 47.2 7.6 years. Mean BMI 29.7 6.1 kg/m2. Mean operative time: 114.8 47.3 minutes. Median uterine weight: 373 grams (range 15e2495 g). Mean estimated blood loss: 50 ml (range 10e500 ml). Surgical indications: fibroids 190 (69.6%); abnormal uterine bleeding 31 (11.4%); pain 14 (5.1%); endometrial cancer 11 (3.7%); ovarian cancer risk 7(2.6%); cervical dysplasia 5 (1.8%); endometrial hyperplasia 4 (1.5%); cervical cancer 1 (.4%); other 9 (3.3%). There were no differences in demographic or surgical characteristics between the outpatient and inpatient groups.
S47
Conclusion: Laparoscopic hysterectomy can be performed on an outpatient basis in a community hospital with low rates of complications and re-admissions. A small percentage of patients will insist on overnight hospitalization. The outpatient approach is suitable even for patients with very large, myomatous uteri and selected patients with endometrial cancer.
180
Open Communication Session 5dHysterectomy (2:48 PM d 2:53 PM)
Incidence, Risk Factors, Indications and Complication Rates of Cesarean Hysterectomy Cordoba M,1 Diamond MP,2 Bahado-Singh RO,3 Awonuga AO,2 Dbouk T,1 Kumar S,1 Imudia AN.1 1Obstetrics and Gynecology, Wayne State University/Detroit Medical Center, Detroit, Michigan; 2Division of Reproductive Endocrinology and Infertility, Wayne State University/ Detroit Medical Center, Detroit, Michigan; 3Division of Maternal Fetal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan Study Objective: To establish the incidence, risk factors, indications, and complication rates associated with cesarean hysterectomy (CH) in our institution in the last seventeen years. Design: This is a retrospective cohort study of 158 women who had cesarean hysterectomy in three different hospitals of Detroit Medical Center between January 1991 and December 2007. Following institutional research board approval, data were obtained from patients’ medical records and analyzed using SPSS 11.5 program in order to determine our institution CH experience. Setting: Tertiary Institutions in Metropolitan Detroit. Patients: Obstetrics patients attending 3 hospitals of Detroit Medical Hospital. Measurements and Main Results: During the study period, 45,599 cesarean deliveries were performed, 158 (0.35%) of them were CHs; of these 90.7% were performed emergently while 9.3% were planned because of pre-existing neoplasm in one of the reproductive organs. Overall, more African Americans had CH than Caucasians (73.5% vs. 26.5%). The two most common risk factors associated with CH were previous cesarean section (73.5%) and total placenta previa (34.6%). Bleeding problems during or after cesarean delivery, placenta accreta/ percreta, and uterine atony were the leading indications of CH (92.6%, 47.5% and 32.1% respectively). Bleeding was an issue in only one fourth of planned cases. Abdominal hysterectomy was more often total (56.2%) while the remaining was supracervical (43.8%). Infection (45.7%) was the most common post-operative complication but others include disseminated intravascular coagulopathy (23.5%), bladder/ureter injury (13%) and a combination of bladder/ureter and bowel injury (7.4%). The median units of blood transfused, duration of ICU, and total hospital stay were 4.5 units, 1 day and 5 days respectively. Conclusion: Bleeding problem was the main indication for emergent CH. The most common postoperative complication associated with CH was infection and about one in ten patient had bladder/ureter or bowel injury during surgery.
181
Open Communication Session 5dHysterectomy (2:54 PM d 2:59 PM)
Intraoperative Blood Loss during Hysterectomy in Women with Benign Uterine Diseases: Comparison of Two Laparoscopic Approaches Wang Y,1,2 Bissonnette F,1,2 Bleau G.1,2 1Obstetrics and Gynecology, SaintLuc Hospital, CHUM, Montreal, Quebec, Canada; 2Universite´ de Montre´al Study Objective: The primary objective was to compare intraoperative blood loss in women who underwent LAVH or TLH for benign uterine diseases. Secondary objectives pertained to operative time, length of hospital stay and intraoperative complications.
Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159
the pelvis and lower abdomen are considered to be the ‘‘secondary Mu¨llerian system’’ due to their embryological resemblance to the Mu¨llerian ducts. They have the ability to convert into uterine tissue under hormonal influences. The ‘‘uterus like mass’’ may be the end-stage of transition from ovarian stromal cells or peritoneal endometriosis into smooth muscle cells due to local metaplasia or a remnant of a congenital Mu¨llerian fusion defect. We present two distinct cases of a uterus-like mass.
173
Video Session 7dEndometriosis II (12:02 PM d 12:08 PM)
Dissection of Endometriosis from Cul-de-Sac and Pelvic Sidewall Using Ultrasonic Energy Santomauro AG,1 Ferzandi TR.2 1Obstetrics and Gynecology, Bridgeport Hospital, Bridgeport, Connecticut; 2Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, Massachusetts This video shows the dissection of severe endometriosis of the cul-de-sac and pelvic sidewall in a patient with long-standing pelvic pain. The use of Autosonix by Covidien is demonstrated here, which uses ultrasonic energy. The advantage of this is that vascular adhesions are lysed at a low setting, while avascular or filmy adhesions can be lysed at high power producing a more rapid dissection. This energy can also be used close to intricate structures because of minimal lateral thermal spread when compared to monopolar current.
174
Video Session 7dEndometriosis II (12:09 PM d 12:17 PM)
Laparoscopic Treatment of Ureteral Endometriosis Kaufman Y,1,2 Alturki H,1 Lam A.1 1Centre for Advanced Reproductive Endosurgery, Australia; 2The Lady Davis Carmel Medical Center Affiliated to the Medical School of the Technion Institute of Technology, Haifa, Israel Approximately 2% of women with endometriosis have involvement of the urinary tract. In 15% of these cases the ureter is involved. Ureteral disease is usually unilateral, more commonly on the left side and in the distal third of the ureter. Extrinsic disease occurs in 80% of cases and involves the outer layers of the ureter up to the submucosa. Intrinsic disease involves the submucosa and the uroepithelium. Preoperative diagnosis of urinary tract endometriosis may often be a challenge. Symptoms are often vague and non-specific and the severity of symptoms correlates poorly with the degree of ureteral obstruction. Silent obstruction can cause loss of renal function and therefore a preoperative high index of suspicion for ureteral involvement should be maintained with all patients diagnosed with endometriosis. We present 2 cases of urinary tract endometriosis.
175
Video Session 7dEndometriosis II (12:18 PM d 12:25 PM)
Minimally Invasive Ureteric Reimplantation in Severe Endometriosis Galletto D, Cavalli N, Tanaka MT, Mendes JB Jr, Tanaka AS, Cavalli LO, Pacagnan EF. Obstetrics and Gynecology, Genesis Hospital, Cascavel, Parana, Brazil To demonstrate the feasibility of ureteric reimplantation after excision of severe endometriosis in the ureter using an entirely minimally invasive technique. Material and Method: A 37-year-old woman with intense pelvic pain had previous hysterectomy and several surgeries for endometriosis. Imaging exams showed obstruction of right ureter and a 5 cm mass in the projection of iliac arteries, ureter and bladder. Results:Operation time was 7 hours, blood loss 220 ml, 1 week hospital stay. The authors demonstrate operation over the bladder, ureter and vagina. Reimplantation of the ureter was performed by the Gregoir technique. Conclusion: The minimally invasive approach is technically feasible and may afford great benefits to
patients who would otherwise undergo open surgery with greater discomfort and prolonged hospitalization.
176
Video Session 7dEndometriosis II (12:26 PM d 12:32 PM)
Neutral Argon Plasma in Laparoscopic Management of Endometriosis Nezhat CH, Morozov V. Atlanta Center for Special Minimally Invasive Surgery & Reproductive Medicine, Atlanta, Georgia In this video, we demonstrate the use of a Neutral Argon Plasma system utilitzed on High Temperature/High Flow/Forced mode to laparoscopically vaporize and excise pelvic endometriosis. Specimens were sent to pathology for the identification of residual disease after use of Neutral Argon Plasma. No residual endometriosis was identified at the base of the vaporized and excised lesions. Thermal spread was limited to less than 1 mm depth. No complications were observed. A Neutral Argon Plasma device can be used safely and efficiently to laparoscopically treat endometriosis, especially superficial implants. Minimal thermal spread and the absence of flow of electrical current through the body makes its use especially appealing.
177
Open Communication Session 5dHysterectomy (2:30 PM d 2:35 PM)
Endocervical Coring at Laparoscopic Supracervical Hysterectomy Removes a Majority of Endocervical Glands Makai GEH, Rosenblatt PL, Kamat BR, DiSciullo AJ. Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, Massachusetts Study Objective: Endocervical coring during hysterectomy, a previously described technique, removes a central cylinder of tissue from the cervix. While this maneuver may have other benefits, removing this tissue may reduce cyclic vaginal bleeding and subsequent development of cervical neoplasia. In this pilot study we aimed to evaluate the amount and type of tissue removed during endocervical coring at laparoscopic supracervical hysterectomy with transcervical morcellation (LSH/TCM). Removal of all or a majority of active endocervical tissue would provide pathologic evidence in support of the safety and efficacy of supracervical hysterectomy. Design: After obtaining IRB approval, eighteen patients who had undergone LSH/TCM between January and April 2008 were retrospectively enrolled in the study. Endocervical core specimens had been collected using either the WISAP serrated-edge (hand-driven) morcellator, Gynecare (electronic) morcellator, CURT or CISH instruments. Choice and size of device depended on availability and provider preference. Patients with malignancy or history of abnormal cervical cytology were excluded from the study. Specimens were prepared in a manner similar to cervical cone biopsy and evaluated by a single pathologist for consistency. Data regarding squamous, endocervical, and endometrial tissue was collected and recorded. Measurements and Main Results: Main outcome measures were removal of the entire transformation zone (in 3/18 cases), radial margins clear of endocervical glands (in 14/18 cases) and radial margins free of endometrial glands (in 18/18 cases). Statistical evaluation to compare tissue removed by each device was impossible due to small sample size. Conclusion: A majority of endocervical and endometrial glands is removed at the time of endocervical coring with these devices. However, the transformation zone is not completely removed. Larger numbers of cases with each device are needed to determine a preferential method. Removing this endocervical tissue may reduce cyclic bleeding and risk of cervical neoplasia. Further studies are needed to test these hypotheses. 178
Open Communication Session 5dHysterectomy (2:36 PM d 2:41 PM)
Safety and Efficiency of Bipolar Electrocoagulation for Total Laparoscopic Hysterectomy Song J, Hsu CD. Obstetrics and Gynecology, Nassau University Medical Center/Affiliated with State Univeristy of New York, Stonybrook University School of Medicine, East Meadow, New York
Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159 Study Objective: The purpose of this study was to evaluate whether bipolar electro-coagulation of the uterine arteries and infundibulo-pelvic ligaments can be used in an procedure to secure main blood vessels of uterus when total hysterectomy and bilateral oophorectomy is carried out by laparoscopy. Design: A case control study was carried out in patients who underwent total laparoscopic hysterectomy and bilateral oophorectomy for six-month period. Setting: All patients were from Nassau University Medical Center and New York Hospital Queens. Patients were managed and followed up in inpatient and outpatient care. Patients: Thirty patients (group 1) were selected randomly for surgical management due to uterine myoma, adenomyosis, pelvic pain, extensive endometriosis. Control group (group 2) includes thirty patients who had same surgery by using ligature. Demographics were analysed between two groups showing no difference statistically. Intervention: Uterine artery was coagulated by bipolar electrocoagulator and separated from the uterine side wall by scissors. Similar procedure was performed for ovarian artery. Endoloop tie or clip was not applied to the arterial pedicle after confirming hemostasis under water examination. Measurements and Main Results: The duration of operation, amount of bleeding, decrease in homoglobin, intra and post operative complications were analyzed and compared with control group. The average duration of operation was 119.2 min and 121.8 min in Groups 1 and 2, respectively (pO0.05). The average amount of bleeding was 169.8 ml and 172.4 ml in Groups 1 and 2, respectively (pO0.05). Hemoglobin decreased in average by 0.85 g/100 ml and 0.91 g/100 ml in Groups 1 and 2, respectively (pO 0.05). No intra and post operative complication was noted in both groups. Conclusion: These results demonstrate that bipolar electrocoagulation of uterine and ovarian arterial pedicles is safe and efficient method for advanced laparoscopic surgery like total laparoscopic hysterctomy and bilateral oophorectomy.
179
Open Communication Session 5dHysterectomy (2:42 PM d 2:47 PM)
Laparoscopic Hysterectomy on an Out-Patient Basis: One Year’s Experience in an Urban HMO Setting Kivnick S, Yera RE. Obstetrics and Gynecology, Kaiser-Permanente, West Los Angeles, Los Angeles, California Study Objective: To describe our experience with outpatient laparoscopic hysterectomy for a range of indications. Design: Retrospective case reveiw of all hysterectomies attempted laparoscopically in 2007 at Kaiser Permanente, West Los Angeles. Setting: Kaiser Permanente is a large HMO in California and other states. K-P, West LA is a community hospital in an urban setting, caring for 170,000 members. All operations in this series were performed by the 19 staff physicians in the obstetrics and gynecology department. Patients: All women on with hysterectomies attempted laparoscopically in 2007. Intervention: Laparoscopic supracervical hysterectomy or total laparoscopic hysterectomy (with or without bilateral salpingoophorectomy). Measurements and Main Results: Of the 326 hysterectomies in 2007, 271 (83%) were attempted laparoscopically. 268 (99%) were completed laparoscopically: 202 (75%) LSH and 66 (25%) TLH. 3 cases were converted to TAH. 260 cases (92%) were completed as outpatients. 8 patients were discharged the next day for social reasons. 3 of the outpatients were re-admitted for complications (2 for ileus; 1 cuff cellulitis). Mean age: 47.2 7.6 years. Mean BMI 29.7 6.1 kg/m2. Mean operative time: 114.8 47.3 minutes. Median uterine weight: 373 grams (range 15e2495 g). Mean estimated blood loss: 50 ml (range 10e500 ml). Surgical indications: fibroids 190 (69.6%); abnormal uterine bleeding 31 (11.4%); pain 14 (5.1%); endometrial cancer 11 (3.7%); ovarian cancer risk 7(2.6%); cervical dysplasia 5 (1.8%); endometrial hyperplasia 4 (1.5%); cervical cancer 1 (.4%); other 9 (3.3%). There were no differences in demographic or surgical characteristics between the outpatient and inpatient groups.
S47
Conclusion: Laparoscopic hysterectomy can be performed on an outpatient basis in a community hospital with low rates of complications and re-admissions. A small percentage of patients will insist on overnight hospitalization. The outpatient approach is suitable even for patients with very large, myomatous uteri and selected patients with endometrial cancer.
180
Open Communication Session 5dHysterectomy (2:48 PM d 2:53 PM)
Incidence, Risk Factors, Indications and Complication Rates of Cesarean Hysterectomy Cordoba M,1 Diamond MP,2 Bahado-Singh RO,3 Awonuga AO,2 Dbouk T,1 Kumar S,1 Imudia AN.1 1Obstetrics and Gynecology, Wayne State University/Detroit Medical Center, Detroit, Michigan; 2Division of Reproductive Endocrinology and Infertility, Wayne State University/ Detroit Medical Center, Detroit, Michigan; 3Division of Maternal Fetal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan Study Objective: To establish the incidence, risk factors, indications, and complication rates associated with cesarean hysterectomy (CH) in our institution in the last seventeen years. Design: This is a retrospective cohort study of 158 women who had cesarean hysterectomy in three different hospitals of Detroit Medical Center between January 1991 and December 2007. Following institutional research board approval, data were obtained from patients’ medical records and analyzed using SPSS 11.5 program in order to determine our institution CH experience. Setting: Tertiary Institutions in Metropolitan Detroit. Patients: Obstetrics patients attending 3 hospitals of Detroit Medical Hospital. Measurements and Main Results: During the study period, 45,599 cesarean deliveries were performed, 158 (0.35%) of them were CHs; of these 90.7% were performed emergently while 9.3% were planned because of pre-existing neoplasm in one of the reproductive organs. Overall, more African Americans had CH than Caucasians (73.5% vs. 26.5%). The two most common risk factors associated with CH were previous cesarean section (73.5%) and total placenta previa (34.6%). Bleeding problems during or after cesarean delivery, placenta accreta/ percreta, and uterine atony were the leading indications of CH (92.6%, 47.5% and 32.1% respectively). Bleeding was an issue in only one fourth of planned cases. Abdominal hysterectomy was more often total (56.2%) while the remaining was supracervical (43.8%). Infection (45.7%) was the most common post-operative complication but others include disseminated intravascular coagulopathy (23.5%), bladder/ureter injury (13%) and a combination of bladder/ureter and bowel injury (7.4%). The median units of blood transfused, duration of ICU, and total hospital stay were 4.5 units, 1 day and 5 days respectively. Conclusion: Bleeding problem was the main indication for emergent CH. The most common postoperative complication associated with CH was infection and about one in ten patient had bladder/ureter or bowel injury during surgery.
181
Open Communication Session 5dHysterectomy (2:54 PM d 2:59 PM)
Intraoperative Blood Loss during Hysterectomy in Women with Benign Uterine Diseases: Comparison of Two Laparoscopic Approaches Wang Y,1,2 Bissonnette F,1,2 Bleau G.1,2 1Obstetrics and Gynecology, SaintLuc Hospital, CHUM, Montreal, Quebec, Canada; 2Universite´ de Montre´al Study Objective: The primary objective was to compare intraoperative blood loss in women who underwent LAVH or TLH for benign uterine diseases. Secondary objectives pertained to operative time, length of hospital stay and intraoperative complications.