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Symptomatic submucous myoma in postmenopausal women
August ] 999, Vol. 6, No. 3 Supplement The Journal of the American Association of Gynecologic Laparoscopists
Measurements' and Main Results. The procedure was performed as first described but with slight modifications (e.g., vaginal manipulator, ETS stapler). Indications for CISH were similar to those for open or vaginal hysterectomy. In 314 patients (average age 44 yrs, range 22-92 yrs), average operating time was 1 hour and 12 minutes, average blood loss 115 ml, average hospital stay less than 24 hours, and average return to work less than 2 weeks. Complications were six cases of cervical bleeding, three early (days 3, 5, and 7) with one requiring return to the operating room, and three late; one case of internal bleeding requiring return to the operating room; one of ileus treated conservatively with a nasogastric tube; and one pelvic hematoma on day 5 treated conservatively. Two procedures were converted to laparotomy, one in a morbidly obese woman and the other in a patient with a large uterus:pelvis ratio. With CISH it is possible to leave the pelvic floor intact; the procedure is cost effective, requires a short hospital stay and short recuperation, and has high patient's satisfaction. However, it is an advanced laparoscopic procedure, technically challenging, with a high learning curve. Conclusion. CISH is the procedure of choice for hysterectomy in our institution.
occur during extraction of Endobags through the abdominal wall. Gas flow of -15 L/minute due to irregular insuffiator function can lead to suction of gas and body fluids into the insuffiator and bacterial contamination. In 3 of 73 cases blood and irrigation fluids were found in the insuffiation hose. Conclusion. Intraabdominal pressure can massively exceed nominal pressure, not due to insuffiation technique but to interaction among patients, technique, and physicians. Iatrogenic pressure peaks should be limited by careful abdominal manipulation. Gas filters should always be used to prevent contamination. Although no serious complication occurred, this study demonstrates potential insufflation problems.
138. Hematometra after Endometrial Resection ND Motashaw, S Dave. Breach Candy Hospital, Mumbai, India.
Objective. To describe hematometra, a rare complications of endometrial resection. Measurements' and Main Results'. This complication occurred in two women. One patient, who had had previous colorectal resection associated with several laparotomies, complained of severe abdominal pain. The hematometra developed 3 years and 4 months after endometrial resection and was evacuated under US guidance. The second woman had undergone abdominoplasty and endometrial resection 4 months earlier and developed severe abdominal pain. Ultrasound showed a hematometra and a haematosalpinx. She underwent LAVH with bilateral salpingectomy. Conclusion. Hematometra may occur after endometrial resection.
137. Real Intraabdominal Pressure During Laparoscopy: Intraoperative Data-Acquisition Model for Quality Control Study 1JEMorrison, Jr, 2VR Jacobs, 2C Mundhenke, 2K Golombeck, 2W Jonat. Fayette Medical Center, Fayette, Alabama; 2Frauenklinik, Christian-Albrechts University, Kiel, Germany.
Objective. To determine reliability of insuffiation technique during 73 standard laparoscopies. Measurements and Main Results. A computer-based data-acquisition model was designed for intraoperative on-line pressure (mm Hg) and gas flow (L/min) measurements at nominal pressure of 12 mm Hg. Insuffiators from Storz (2 models), Wolf, BEI Medical, and Snowden and Pencer were evaluated. Insufflation pressure (<75 mm Hg) and intraabdominal pressure (<50 mm Hg) are often not identical and for a short time can greatly exceed nominal pressure (12 mm Hg). Pressure peaks are not caused by insuffiation technique but insufficient relaxation (30-50 mm Hg), leaning on the abdomen (30-40 mm Hg), instrument manipulation (25 mm Hg), and cannula insertion (18-25 mm Hg). Negative pressure of-50 mm Hg can
139. Symptomatic Submucous Myoma in Postmenopausal Women ND Motashaw, S Dave. Breach Candy Hospital, Mumbai, India.
Objective. To report our experience with postmenopausal women with AUB caused by submucous myomata. Measurements and Main Results. The 143 patients underwent hysteroscopy after imaging procedures. Surgery was done on a day care basis. Aresectoscope with glycine (1.5% aminoacetic acid) as the distending medium was used. Antibiotics were administered. There were no intraoperative or postoperative complications. Myomata were found in 19 (13.2%) patients.
$39
Abstracts
Histopathologic examination confirmed the diagnosis. On follow-up, bleeding had ceased in all 19 women. No further therapy was necessary. Conclusion. Hysteroscopic myomectomy can be performed safely and effectively in postmenopausal women.
140. Hysteroscopic Diagnosis and Treatment of Endometrial Polyps JL Mufioz, JS Jimenez, G Vaquero, M Ramirez, C Perez, R Noguero, I Solis, I Martin, C Delgado, C Hernandez, P Miranda, JM Hernandez, P de la Fuente. Hysteroscopy Unit, Hospital 12 Octubre, Madrid, Spain.
Objective. To assess the efficacy of a protocol to diagnose and treat endometrial polyps. Measurements and Main Results. In 2625 hysteroscopies, we found 551 endometrial polyps (20.9%). Of these, 61.4% were in asymptomatic menopausal women. During diagnostic hysteroscopy in women of childbearing age, we found polyps in only 14%. In 35.7% they were 1 to 2 cm and in 21.4% they were larger than 2 cm. Hysteroscopic removal of polyps with the resectoscope was performed in 39.3%. In all polyps smaller than 1 cm we performed biopsy and/or hysteroscopy at 3 months, with resolution of symptoms. No operative complications occurred. Histologic study showed endometrial polyps in 83.2%, endometrial hyperplasia in 6.8%, and endometrial adenocarcinoma in one patient. At follow-up, 96.2 % of women were asymptomatic and hysteroscopy was normal. Conclusion. Hysteroscopy is an effective method of diagnosing endometrial polyps. We recommend hysteroscopic removal of all endometrial polyps, because the procedure is simple, enables complete removal, and provides an accurate diagnosis in a case of malignancy.
Measurements andMain Results'. We conducted a retrospective analysis of 1890 hysteroscopies performed in postmenopausal women. The main symptom (58%) in 1111 patients was AUB. In these patients, 20.4% had endometrial atrophy, 13.9% had endometrial hyperplasia, and 34.3% had an organic lesion (endometrial polyps 21%, uterine myomas 13.3%). Endometrial adenocarcinoma was present in 7.5%. Most commonly, more than one pathology was found, mainly atrophic areas mixed with areas with other pathologies. Treatment in 20.4% of patients was expectant. In 48.2% we performed hysteroscopic resection of pathology and endometrial ablation. The rest of the women underwent hysterectomy. Conclusion. Hysteroscopy is a precise method of diagnosing, treating, and following postmenopausal women with AUB. 142. Ovarian Remnant Syndrome after
Laparoscopic Oophorectomy 1,3CH Nezhat, 1 SFR Nezhat, 1,3CRNezhat, 3SA Mirmalek, 4DS Seidman. 1Stanford University School of Medicine, Stanford, California; 2Mount Sinai Medical Center, New York, New York; 3Center for Special Pelvic Surgery and Northside Hospital, Atlanta, Georgia; 4Sheba Medical Center, Israel.
Objective. To review preoperative histories, clinical characteristics, and surgical techniques in patients with ovation remnant syndrome after laparoscopic oophorectomy. Measurements and Main Results'. Fifteen women (average age 40 yrs, range 25-48 yrs) with ovarian remnant syndrome after multipuncture laparoscopic oophorectomy were evaluated for surgical history. The infundibutopelvic ligament was secured with bipolar desiccation in eight patients, pretied surgical loops in four, linear stapler in two, and two 0 polyglactin sutures in one. In all but one patient, prior oophorectomy was performed for pelvic endometriosis. The other had severe postoperative adhesions. Cystic ovarian remnants were identified by pelvic US in nine women and by CT scan in one. In one patient CT scan and pelvic US identified an abdominal mass. Benign ovarian cysts or tissue was present in all women. Pain was completely resolved in 11 women and partially in 4.
141. The Value of Hysteroscopy for Abnormal Uterine Bleeding in Menopausal Women JL Mufioz, JS Jimenez, C Perez, M Ramirez, G Vaquero, I Martin, C Hernandez, I Solis, R Noguero, P Miranda, JM Hernandez, P de la Fuente. Hysteroscopy Unit, Hospital 12 Octubre, Madrid, Spain.
Objective. To evaluate hysteroscopy for AUB in postmenopausal women.
$40
Measurements' and Main Results. The procedure was performed as first described but with slight modifications (e.g., vaginal manipulator, ETS stapler). Indications for CISH were similar to those for open or vaginal hysterectomy. In 314 patients (average age 44 yrs, range 22-92 yrs), average operating time was 1 hour and 12 minutes, average blood loss 115 ml, average hospital stay less than 24 hours, and average return to work less than 2 weeks. Complications were six cases of cervical bleeding, three early (days 3, 5, and 7) with one requiring return to the operating room, and three late; one case of internal bleeding requiring return to the operating room; one of ileus treated conservatively with a nasogastric tube; and one pelvic hematoma on day 5 treated conservatively. Two procedures were converted to laparotomy, one in a morbidly obese woman and the other in a patient with a large uterus:pelvis ratio. With CISH it is possible to leave the pelvic floor intact; the procedure is cost effective, requires a short hospital stay and short recuperation, and has high patient's satisfaction. However, it is an advanced laparoscopic procedure, technically challenging, with a high learning curve. Conclusion. CISH is the procedure of choice for hysterectomy in our institution.
occur during extraction of Endobags through the abdominal wall. Gas flow of -15 L/minute due to irregular insuffiator function can lead to suction of gas and body fluids into the insuffiator and bacterial contamination. In 3 of 73 cases blood and irrigation fluids were found in the insuffiation hose. Conclusion. Intraabdominal pressure can massively exceed nominal pressure, not due to insuffiation technique but to interaction among patients, technique, and physicians. Iatrogenic pressure peaks should be limited by careful abdominal manipulation. Gas filters should always be used to prevent contamination. Although no serious complication occurred, this study demonstrates potential insufflation problems.
138. Hematometra after Endometrial Resection ND Motashaw, S Dave. Breach Candy Hospital, Mumbai, India.
Objective. To describe hematometra, a rare complications of endometrial resection. Measurements' and Main Results'. This complication occurred in two women. One patient, who had had previous colorectal resection associated with several laparotomies, complained of severe abdominal pain. The hematometra developed 3 years and 4 months after endometrial resection and was evacuated under US guidance. The second woman had undergone abdominoplasty and endometrial resection 4 months earlier and developed severe abdominal pain. Ultrasound showed a hematometra and a haematosalpinx. She underwent LAVH with bilateral salpingectomy. Conclusion. Hematometra may occur after endometrial resection.
137. Real Intraabdominal Pressure During Laparoscopy: Intraoperative Data-Acquisition Model for Quality Control Study 1JEMorrison, Jr, 2VR Jacobs, 2C Mundhenke, 2K Golombeck, 2W Jonat. Fayette Medical Center, Fayette, Alabama; 2Frauenklinik, Christian-Albrechts University, Kiel, Germany.
Objective. To determine reliability of insuffiation technique during 73 standard laparoscopies. Measurements and Main Results. A computer-based data-acquisition model was designed for intraoperative on-line pressure (mm Hg) and gas flow (L/min) measurements at nominal pressure of 12 mm Hg. Insuffiators from Storz (2 models), Wolf, BEI Medical, and Snowden and Pencer were evaluated. Insufflation pressure (<75 mm Hg) and intraabdominal pressure (<50 mm Hg) are often not identical and for a short time can greatly exceed nominal pressure (12 mm Hg). Pressure peaks are not caused by insuffiation technique but insufficient relaxation (30-50 mm Hg), leaning on the abdomen (30-40 mm Hg), instrument manipulation (25 mm Hg), and cannula insertion (18-25 mm Hg). Negative pressure of-50 mm Hg can
139. Symptomatic Submucous Myoma in Postmenopausal Women ND Motashaw, S Dave. Breach Candy Hospital, Mumbai, India.
Objective. To report our experience with postmenopausal women with AUB caused by submucous myomata. Measurements and Main Results. The 143 patients underwent hysteroscopy after imaging procedures. Surgery was done on a day care basis. Aresectoscope with glycine (1.5% aminoacetic acid) as the distending medium was used. Antibiotics were administered. There were no intraoperative or postoperative complications. Myomata were found in 19 (13.2%) patients.
$39
Abstracts
Histopathologic examination confirmed the diagnosis. On follow-up, bleeding had ceased in all 19 women. No further therapy was necessary. Conclusion. Hysteroscopic myomectomy can be performed safely and effectively in postmenopausal women.
140. Hysteroscopic Diagnosis and Treatment of Endometrial Polyps JL Mufioz, JS Jimenez, G Vaquero, M Ramirez, C Perez, R Noguero, I Solis, I Martin, C Delgado, C Hernandez, P Miranda, JM Hernandez, P de la Fuente. Hysteroscopy Unit, Hospital 12 Octubre, Madrid, Spain.
Objective. To assess the efficacy of a protocol to diagnose and treat endometrial polyps. Measurements and Main Results. In 2625 hysteroscopies, we found 551 endometrial polyps (20.9%). Of these, 61.4% were in asymptomatic menopausal women. During diagnostic hysteroscopy in women of childbearing age, we found polyps in only 14%. In 35.7% they were 1 to 2 cm and in 21.4% they were larger than 2 cm. Hysteroscopic removal of polyps with the resectoscope was performed in 39.3%. In all polyps smaller than 1 cm we performed biopsy and/or hysteroscopy at 3 months, with resolution of symptoms. No operative complications occurred. Histologic study showed endometrial polyps in 83.2%, endometrial hyperplasia in 6.8%, and endometrial adenocarcinoma in one patient. At follow-up, 96.2 % of women were asymptomatic and hysteroscopy was normal. Conclusion. Hysteroscopy is an effective method of diagnosing endometrial polyps. We recommend hysteroscopic removal of all endometrial polyps, because the procedure is simple, enables complete removal, and provides an accurate diagnosis in a case of malignancy.
Measurements andMain Results'. We conducted a retrospective analysis of 1890 hysteroscopies performed in postmenopausal women. The main symptom (58%) in 1111 patients was AUB. In these patients, 20.4% had endometrial atrophy, 13.9% had endometrial hyperplasia, and 34.3% had an organic lesion (endometrial polyps 21%, uterine myomas 13.3%). Endometrial adenocarcinoma was present in 7.5%. Most commonly, more than one pathology was found, mainly atrophic areas mixed with areas with other pathologies. Treatment in 20.4% of patients was expectant. In 48.2% we performed hysteroscopic resection of pathology and endometrial ablation. The rest of the women underwent hysterectomy. Conclusion. Hysteroscopy is a precise method of diagnosing, treating, and following postmenopausal women with AUB. 142. Ovarian Remnant Syndrome after
Laparoscopic Oophorectomy 1,3CH Nezhat, 1 SFR Nezhat, 1,3CRNezhat, 3SA Mirmalek, 4DS Seidman. 1Stanford University School of Medicine, Stanford, California; 2Mount Sinai Medical Center, New York, New York; 3Center for Special Pelvic Surgery and Northside Hospital, Atlanta, Georgia; 4Sheba Medical Center, Israel.
Objective. To review preoperative histories, clinical characteristics, and surgical techniques in patients with ovation remnant syndrome after laparoscopic oophorectomy. Measurements and Main Results'. Fifteen women (average age 40 yrs, range 25-48 yrs) with ovarian remnant syndrome after multipuncture laparoscopic oophorectomy were evaluated for surgical history. The infundibutopelvic ligament was secured with bipolar desiccation in eight patients, pretied surgical loops in four, linear stapler in two, and two 0 polyglactin sutures in one. In all but one patient, prior oophorectomy was performed for pelvic endometriosis. The other had severe postoperative adhesions. Cystic ovarian remnants were identified by pelvic US in nine women and by CT scan in one. In one patient CT scan and pelvic US identified an abdominal mass. Benign ovarian cysts or tissue was present in all women. Pain was completely resolved in 11 women and partially in 4.
141. The Value of Hysteroscopy for Abnormal Uterine Bleeding in Menopausal Women JL Mufioz, JS Jimenez, C Perez, M Ramirez, G Vaquero, I Martin, C Hernandez, I Solis, R Noguero, P Miranda, JM Hernandez, P de la Fuente. Hysteroscopy Unit, Hospital 12 Octubre, Madrid, Spain.
Objective. To evaluate hysteroscopy for AUB in postmenopausal women.
$40